David Gratzer

Are Doctors Part of The Obesity Problem?

2013-05-09T12:41:27-04:00

Are doctors part of the obesity solution -- or part of the problem?

Obesity is widely discussed, and increasingly doctors are weighing in. Here in Canada's largest province, the Ontario Medical Association recently called for food labeling and a tax on junk food to "help prevent thousands of premature deaths associated with obesity."

It's the sort of provocative prescription that yields attention -- and it did. Google "OMA" and "obesity," and there are over a quarter of a million hits. But evidence for food labeling is, at best, mixed, and experiments with so-called "fat taxes" have been less than successful (Denmark dropped its tax after just a year).

But should the OMA be more focused on Ontario doctors?

Doctors, after all, are the ones we tend to turn to for health advice and counseling. If Canada has a weight issue, should our physicians be doing more?

The answer seems to be yes. The problem is that docs aren't doing much.

That's not to say that doctors couldn't be part of the solution. In fact there is good evidence that if docs talk to patients about their weight issues, there are good results. Last June, for example, the Canadian Medical Association Journal published a paper showing that patients were more likely to lose weight if advised by their doctor. That result echoes the results of other studies.

But if doctors can have influence, surprisingly few seem to see themselves in that light.

The same CMAJ paper cited a survey finding that 45 per cent of American docs said that they didn't feel qualified to treat obesity. More incredibly, 72 per cent of U.S. primary care physicians surveyed said that no one in their practice was trained to deal with weight-related issues.

The more things change, the more they stay the same: in a classic paper published over a decade ago, obese Americans were contacted and asked if their health care professionals had advised them to lose weight. A majority reported no. I don't think the results would be any different on this side of the 49th parallel.

If we doctors are doing a poor job of discussing obesity with patients, it turns out that patients themselves don't really seek opinion from their physicians.

In a 2009 Ipsos Survey, 23 questions were asked about weight management practices. While almost three-quarters of the overweight and obese Canadian adults surveyed had tried to lose weight (58 per cent in the previous 12 months), only 21 per cent reported seeking help from their physician in the previous year.

Let's then quickly summarize: doctors could have a major role in helping people lose weight but, all too often, neither physicians nor patients are bringing up obesity in the doctor's office.

If anything, I'm not surprised. Maybe it relates back to our training, which is heavy on disease treatment and light on prevention. Back in medical school, I remember class after class discussing the pathology of diabetes and the results of this illness; frankly, I can't remember ever sitting through a lecture in which we talked about preventing diabetes through better eating habits and addressing obesity.

And in the years since med school, having logged hundreds of hours listening to lectures and reading journals and discussing challenging cases with colleagues, relatively little time has been spent on weight management.

It's easy to blame others, so I'll focus on myself. As it turns out, I live and practice in Ontario (and I'm a member of the OMA). Am I doing enough to address obesity? For years, I didn't even have a scale in my office.

What did I do to change things? First, I invested in a scale and a measuring tape. Second, I started asking more questions of patients. Some of those conversations were awkward. But, to my own surprise, people have been pretty keen for advice.

I'm a specialist, not a primary care doctor; many of the drugs I use can increase a patient's weight. Now prescriptions are often given with tips on avoiding weight gain. I emphasize the importance of drug compliance, but also exercise and a proper diet.

When discussing obesity, we tend to look for big, sweeping solutions. The causes of obesity are complex; alas, so are the needed solutions. Today, the Montreal Economic Institute releases my paper on what governments should and shouldn't do, what the private sector should do, and what physicians should do.

For the record, in my own practice, I incorporated my ideas about what physicians should do. It didn't involve legislation; it did involve a scale -- and common sense.

Why Canada's Definition of Austerity Is All Wrong

2013-02-27T08:00:59-05:00

The word "austerity" just won't go away. Early this year, the Canadian Centre for Policy Alternatives held a seminar on a "post-austerity vision for Ontario." The Council of Canadians devotes a whole page of its website to "Canada's austerity agenda." On January 12, progressive activist Deirdre Pike wrote about the horrors of Canadian austerity in the Hamilton Spectator. At a February conference, Canadian Union of Public Employees President Paul Moist did an interview about his union's "pushback against austerity." In Sunday's Toronto Star, the usually sober Alex Himelfarb, the former clerk of the Privy Council, suggests that, in Canada, "austerity has been implemented in slow motion, in increments..."

I'm not the first observer to point out that this rhetoric bastardizes the English language. One online dictionary defines austerity as "difficult economic conditions created by government measures to reduce public expenditure." Pike's article defined austerity as "enforced or extreme economy." Either definition is a problem for anyone who's shouting about "austerity" here in Canada, since most Canadian governments aren't actually reducing public expenditure.

On the contrary: government program spending is still growing from sea to sea. Virtually every government in Canada is spending more in current dollars from one year to the next. Many are spending more in inflation-adjusted dollars, too. If they aren't, they're generally coming pretty close.

Take the target of the CCPA's wrath: Ontario. In its first downturn-era budget in 2009-2010, the Ontario government planned to spend $99.6 billion on programs. As of the fall economic update in October 2012, program spending was expected to be $115.8 billion by year-end. Some austerity.

Even after the anticlimactic Drummond report, neither Premier McGuinty nor his successor have ever committed to cutting total spending. In her most recent comment on the issue, Wynne said she planned to limit overall spending growth to "1% below GDP growth" until Ontario's debt-to-GDP ratio is back to pre-recession levels.

Things aren't so different in the rest of the country. When the PQ government tabled Quebec's latest budget in November, it planned to spend 1.8% more, a rate of increase marginally below their projected inflation rate for 2013. That's after more than a decade of spending increases at a much faster rate. British Columbia's 2013 budget plan will increase spending by an average of 1.5% over each of the next three fiscal years. In Saskatchewan (where the budget is balanced), the 2012-2013 spending plan is up by almost 5% over the previous year's budget.

In federal politics, any use of the word "austerity" to describe the current situation is pure hysteria. Let's consider the federal government's "austerity" that Himelfarb so bemoans. Ottawa's 2008-09 budget projected annual program spending of over $206 billion; by 2011-2012, the federal government had already added another $37 billion to the pile. The most recent numbers in the fall update project that from the end of this fiscal year to 2015-16, program spending should grow annually by an average of over 2%. Even with the risk of lower revenues, the most recent signal from the Finance Minister was that he saw no need to "slash and burn."

It's true that there's a legitimate debate about actual austerity in other places around the world. Greece is struggling to pay unsustainable debts and remain in the Eurozone at the same time. To meet these conflicting goals, the Greek government has made significant spending cuts in real terms.

Greek hospitals and pharmacies are short of key medications. Pensions were cut. Greek unemployment rates are at record highs. Whatever you might think about Greece's policy choices, it's at least fair to use the word austerity to describe the outcome.

In Canada and the United States, the misuse of the word "austerity" has become so common that even Matthew Yglesias - a liberal writer for Slate.com - found time to mock it on Twitter. On January 2, he wrote that "liberals have started using the word 'austerity' as a free-floating signifier for 'budget provisions I disagree with.'" That's clearly the case in Canada as well.

And it's not helpful. We can't have an adult debate about policy choices if we're unwilling to acknowledge the vast range of alternatives between running off billions of dollars on a printing press on the one hand, and Dickens-style poorhouse austerity on the other.

In present-day Canada, there isn't a single government that can fairly be accused of falling under either of those extremes. Finance ministers are trying to contain debts and deficits with what can barely be called restraint - and only barely. Remember that reality whenever you next hear another 'progressive' lobby group carelessly throw around the dreaded "A" word.

Canada's Health Care's Not Much Better Than America's

2013-02-05T08:14:15-05:00

In 1999, I wrote my first book, Code Blue: Reviving Canada's Health Care System. In it, I noted Canada's obsession with all things American when it comes to debating health-care issues -- as if the only alternative to Canadian medicare was the American system. My point? Many countries offer sophisticated medical care and universal coverage and yet have very different health-care models. And, more importantly, several of these countries achieve better health outcomes.

In recent years, this problem has reappeared, but in reverse. Americans often talk about comparisons to Canadian health care as if our single-payer model is their only alternative.

Slate's Matthew Yglesias is the latest to offer up the Canadian system as a worthwhile comparison to the American model. To be fair, he actually writes that: "Now, there are, no doubt, downsides to [the Canadian] approach," an honest caveat that many American fans of Canada's system can't bring themselves to acknowledge. The hook for his piece was accurate, too. He wants readers to realize that if you compare public health care spending in the U.S. to public health spending in Canada, our Southern neighbours actually spend more per capita than we do. (That's over and above the billions that the United States spends on private care and private insurance.)

Speaking to his American audience, Yglesias's punchline is that when it comes to health reform, it's "insane to completely ignore the culturally similar neighboring country that spends less while covering more people." And if you put it that way, fine. Completely ignoring the Canadian comparison is foolish. But Yglesias' remarks repeat an implied mistake that others have made. When he talks about how Canada "covers more people" for less money, "covers more people" is a meaningless baseline without factoring for the scope, the speed and the quality of the care that coverage buys.

To get past the Canadian v. U.S. fixation, consider the following international health-care rankings.

In 2010, the Commonwealth Fund ranked Canada 6th out of 7 countries in overall health care quality. The United States is 7th.

In 2012, the Conference Board of Canada ranks Canada 10th out of 17 "peer states" on overall health care performance, using metrics that weigh heavily toward mortality rates. The U.S. is ranked 17th.

In the one area where the U.S. scores consistently best -- publicly-funded access to drugs -- Canada scores very poorly in annual comparisons to other OECD countries, and one 2009 comparison ranks Canada between 22nd place and 29th place relative to OECD nations on various public drug access, public drug plan and reimbursement indicators.

Another Commonwealth Fund review in late 2012 ranks both Canada and the U.S. poorly on a range of primary care measures. Canada is far back on the use of electronic medical records (just behind the U.S.); we finish 10th out of 10 on urgent access to primary care physicians, and 9th out of 10 (behind the U.S.) on after-hours access to a primary care physician.

And so on. There are other studies, of course, and they draw a similar conclusion.

I work in the Canadian system, and I'm often proud of what we can achieve for our patients. I've also worked with American health policy experts, and envy America's world-class research and the unchallenged leadership of institutions like the Cleveland Clinic, the Mayo Clinic and Johns Hopkins. Yet I've been a critic of both systems because I believe both countries can do so much better.

The first step to better health care? Breaking free from a pair of intellectual traps.

Trap 1: In both countries, the public debate remains fixated on "how many are covered at what cost." We should also be talking about what people are covered for, how and how well they're covered and overall wellness. We skip over these points because both of our (very different) health-care systems were designed around a 1940s and 1950s hospital-centric approach (a point I discuss in more detail in my second book, The Cure).

Trap 2: Too often we speak about "the best in the world" in a tone that suggests that Canadian health care (or American health care) is perfect, even though there are major problems both north and south of the 49th parallel.

To be fair, international health care rankings never offer a consensus on which country truly has "the best" system. But there is one area where these rankings are consistent: they usually place Canada and the U.S. mid to low pack.

We can learn more from a global health care perspective, and the tradeoffs each system makes. We pride ourselves on universality -- but so do the Dutch and the Swiss, and they don't have the sort of problems endemic to medicare (that is, long surgical wait times, diagnostic waits and limited coverage of drugs for rare disease patients).

There is no perfect health care system, of course. But there is world beyond North America. It's a point that writers like Yglesias should acknowledge and -- in an age of budgetary restraint -- governments across the continent should consider.

The Case Against Taxing Soda

2012-11-15T00:35:16-05:00

Can we tax ourselves to better health? Many think the answer is yes. New York Mayor Michael Bloomberg champions a tax on soda; two California towns recently put the idea up for referenda; the Ontario Medical Association favours taxing sugary and fatty foods. (And, hey, the news from Europe: French lawmakers consider a Nutella tax.)

On this, we can all agree: North Americans are becoming very unhealthy. Obesity rates on both sides of the 49th parallel have soared, with one in four Canadians now qualifying as obese (American stats are even worse).

For much of the last century, medicine was all about fighting diseases like polio and smallpox. In this century, lifestyle choices and chronic illnesses have become major medical problems -- and cost drivers. Rising obesity rates mean an epidemic of diabetes, cardiac disease, and slew of other avoidable problems, and their associated costs. "Fat," as the Financial Times quipped, "is a financial issue."

It's not surprising that so many champion ideas to trim our waists. The biggest target? Soda. Many North American experts now claim that soda is the new tobacco -- indeed, Google those terms and you get more than 7 million hits. For them, Coke is the new Camel. Yale's Kelly Brownell claims that "[soda companies] are using many of the same tactics that tobacco companies used." Heavy rhetoric? Dr. Thomas Farley recently made a similar point and he's New York City's health commissioner.

And thus, people on both sides of the 49th parallel favour a war on soda. Writes Western economics professor Mike Moffatt: "soft drinks provide little to no nutrition, so it is easier to implement a specific tax on them than on all junk food. A tax on pop would more closely resemble the sin taxes on alcohol and tobacco." But as I point out in a paper released today by the Montreal Economic Institute, a soda tax would be bad idea.

Let me take a step back and note the basic problem in fighting obesity like we fought tobacco.

1. The times are different.

When the Surgeon General issued his landmark report in 1964, millions of North Americans made no connection between tobacco and cancer. We live in the age of Google -- people know far more about their health. I've never met a patient who thought copious amounts of soda led to more healthful living.

2. The product is different.

Tobacco is never good for you. There is no right amount of tobacco; it does nothing but increase the risk of cancer and other diseases. Soda -- like eating cake or a slice of pizza at lunch -- can be part of a balanced, healthy diet.

And, thus,

3. The needed solution is different.

Taxes on tobacco helped push millions of people to butt out; faced with a heavy financial penalty, they had no alternative drug. Diet is vastly more complex -- and it's not clear that a tax on soda would even be that helpful. People, after all, may avoid soda, but consume something in its place (this is the concept of caloric substitution).

Fanciful argument? Actually, researchers at Cornell University did a real-world experiment with taxation and soda: half the households in an upstate New York town faced a 10 per cent tax on soda consumption and the other half didn't. Interestingly the tax discouraged consumption only for the first month and then people went back to their old ways. And, alas, the law of unintended consequences: beer consumption increased for those facing higher soda taxes. The paper was published with the title: "From Coke to Coors."

Others have reached similar conclusions. One study in the Journal of Health Economics found that substitution effects are so complex that poorly targeted food and beverage taxes "could actually increase weight."

Here is an irony of modern times: medicine has never been better but we are increasingly less healthy. We need to take obesity seriously. But in our effort to better our health, we can't be seduced into simple solutions. A tax on sugary beverages sounds compelling. It's also too simplistic to make a difference.

Why Bloomberg's War on Soda Will Fail

2012-09-13T11:25:24-04:00

It's a big goodbye to the big soda in the Big Apple. New York City Mayor Michael Bloomberg's proposed ban on large-sized sweetened beverages was approved today by a Board of Health vote.

Many have criticized the proposal as being impractical (and, hey, count me among them). But there's a deeper problem: it's philosophical underpinnings.

For years, public health advocates have openly -- and selectively -- tried to demonize soda companies in language that compares them to cigarette companies. Yale's Kelly Brownell claims that "[soda companies] are using many of the same tactics that tobacco companies used." Heavy rhetoric? Dr. Thomas Farley recently made a similar point -- he's New York City's health commissioner, by the way. Google "soda" and "new tobacco," for the record, and you get over 7 million hits. Even investment writers are starting to buy (or sell) the corporate blame game, as seen in a recent post on The Motley Fool. The rhetorical cycle has gotten so out of hand that one author recently claimed that drinking soda is worse than smoking, joining a growing list of advocates who claim that sweetened sodas are toxic.

If the fight's the same, it follows logically, then the policy prescriptions should be the same, too. So public health officials are consciously comparing their strategy of rules, regulations, and taxes on soda to those used against tobacco addiction; New York City's vote today is one result. Papers and essays linking anti-tobacco strategies to obesity are all too common, yet few provide evidence that these strategies will work against a different target. It is, as the military would say, a classic case of fighting the last war.

Let's be clear: there is an obesity epidemic and we need to reverse rising rates of obesity for the sake of our health and our health care system. But it's a mistake to believe we should take the same approach with obesity as we did with tobacco.

Here are five reasons why:

OBESITY IS A CONDITION. TOBACCO IS A PRODUCT. You can drink soda, eat cake or enjoy the occasional burger and still maintain a healthy, balanced diet. Millions do. However, there's no healthy amount of tobacco.

ADDICTION. Nicotine is inherently physiologically addictive. Few foods or beverages come close. While some studies attempt to suggest otherwise, the evidence simply isn't there to support the idea of fast food addiction. Most people who are "addicted to food" are addicted to a habit, not to a product. Coke tastes good but it's not a cig.

POLICY COMPLEXITY. Tobacco use is easy to regulate, since it's hard to hide a burning cigarette. Tobacco is easy to tax, since cigarettes were always made in standard sizes by a small cartel of companies. In fact, cigarettes are so taxable that the first federal cigarette tax was levied in 1864, a full century before the Surgeon-General conclusively linked cigarettes with increased cancer.

Food is not so simple. Do you tax calories, or added sugar, or fat? Do you tax soda? Or do you tax all sweetened beverages, including healthy sweetened juices like cranberry juice? If you want to restrict large sizes for sweetened beverages ala Bloomberg, what do you do about milkshakes or lattes?

SECONDARY SMOKE. Laws pushed smoking out of most public facilities and (literally) into the cold. There was widespread public support for these measures, even among smokers, since evidence showed clear risks of cancer and respiratory illness from exposure to second-hand smoke. There is no direct risk from being in close proximity to your neighbor's fries or his Pepsi.

THERE ARE NO DIET CIGARETTES. There can be reasonable debate about the health and market impacts of diet sodas. However, the important point is that a no-calorie beverage is a no-calorie beverage -- nothing like the infamous 'low tar' cigarette claims of tobacco companies to deflect health criticisms. And the argument (made, for instance, in The Motley Fool) that soda makers bear direct responsibility for peddling sugar to their consumers? Nonsense. Big Tobacco turned nicotine addiction into a business model while beverage companies could care less if consumers buy drinks with zero calories or drinks with 1,000 calories. Soda companies are pushing soda, not sugar.

If we want to reverse the obesity epidemic -- as we must -- then the policies we choose must be more nuanced and more positive. Copying the heavy-handed war on tobacco, as Mayor Bloomberg is doing with his war on soda, will fail.

But don't expect the Tobacco 2.0 attitude to change any time soon. After all, the lure of instant gratification is as common in public health circles as it is in your favorite pizza place.

Is it Dutch Disease or a Central Canadian Cold?

2012-09-10T11:01:37-04:00

"Wrong." On Friday, Canada's most prominent economist weighed in. And with the Bank's research to back him up, Bank of Canada Governor Mark Carney told us that advocates of the so-called Dutch Disease theory have it wrong. The high price of oil isn't killing the Canadian economy, nor is the high price of the Canadian dollar.

Carney's view, though, is unlikely to settle the issue. In fact, with a Pequiste government in Quebec, with Central Canada's manufacturing still hurting, expect to hear more -- not less -- about one region exploiting another.

A bit of data is a good thing in a heated debate. Consider Statistics Canada latest (seasonally adjusted) monthly manufacturing sales numbers covering June 2012 sales. And when you do, ask yourself a simple question: does the data support Dutch Disease -- or are we seeing a case of a Central Canadian Cold?

If the high value of the loonie really makes it impossible to sell Canadian goods, then it should be tough to sell them in every sector and in every part of the country, whether they were sold from a refinery in Sarnia or a factory in Saskatoon. But what if manufacturing in different regions is growing at very different speeds? If that's the case, it's logical to conclude that other forces are driving those outcomes, not the high Canadian dollar.

The pre-recession peak for Canadian manufacturing was in the late summer of 2007. To make an apples-to-apples comparison, compare June 2012 sales to June 2007 sales, adjusted for inflation. (Statistics Canada source data drawn from CANSIM Table 304-0015 and CANSIM TABLE 383-0011.)

Notice that there's a clear split. When it comes to the sale of factory-produced goods, half of Canada's provinces are still selling millions or even billions of dollars less per month:

• Prince Edward Island - 78% of 2007 manufactured goods sales level
• British Columbia - 82%
• Quebec - 87%
• Manitoba - 88%
• Ontario- 88%

The other five provinces are doing better. Some are doing substantially better:

• Alberta - 102% of 2007 manufactured goods sales level
• Nova Scotia - 105%
• Newfoundland and Labrador - 105%
• New Brunswick - 111%
• Saskatchewan - 130%

While half of Canada's provinces are struggling to regain lost ground, the other half has more than recovered from their manufacturing dip. In fact, Saskatchewan is doing so well that it is poised to overtake my home province of Manitoba in monthly factory sales, even though Saskatchewan has fewer people and a limited history as a centre for manufacturing.

Just as it's simplistic to blame Ontario's factory woes on Alberta's oil, it'd be equally simplistic to pin the positive outcome in five provinces on any single factor. But Statistics Canada data suggests a few obvious explanations.

Alberta and Saskatchewan both saw significant increases in manufacturing labour productivity in the last decade. Over the same period, Ontario's manufacturing sector productivity basically flat-lined. In manufacturing, not coincidentally, Saskatchewan has lower labor costs per-unit than several of its provincial competitors.

Skeptics will say that three of the provinces (Alberta, Saskatchewan, Newfoundland and Labrador) are on the winner's list because of oil and other resources, so they must be thriving because of those commodities.

The truth is much more interesting. Potash and oil are important factors, but much of the manufacturing recovery in all three oily provinces has been in duller sectors like food processing, building products and metal fabrication. Many firms that are doing well are producing goods that have appeal to a range of domestic and international markets.

The laggards tend to be concentrated in sectors that are captive to U.S. markets. As Carney noted in his speech, Canada's commodities boom helped boost some manufacturing as well. You can be sure that, say, an Edmonton factory that makes building materials wouldn't be planning an expansion if there wasn't new demand for housing in Fort McMurray.

Even a cursory glance at the evidence suggests that younger, more flexible, less unionized manufacturing clusters outside of Central Canada are better equipped to compete. There's also clear cause to support Ottawa's push to secure trade deal access to new export markets in Europe and Asia. The provinces with the most business-friendly approach to their commodity sectors are also seeing solid spinoff benefits in manufacturing, even in the face of a higher dollar and a weak global economy.

Despite Carney's words, expect to hear about the Dutch Disease for years to come -- in union press releases and in Pequiste speeches. But given the data, rather than blame others, perhaps it's time for all of us in Central Canada to stop bashing the economies of the New West. Maybe it's time to start learning from them instead.

Politicians Face Trending Scandal: FatGate

2012-08-24T11:36:38-04:00

Only a few years ago, if you'd attacked a politician for his weight, or complained about where she ate her dinner, it would be seen as poor form. Reporters could write about a politician's views on taxes and trade, but the burgers and buns on his dinner plate were off limits.

How times have changed.

Consider that even in ever-polite Canada, twice in the last few months, stories have pointed out that, well, size matters.

First, in Toronto, Mayor Rob Ford was mocked by local newspapers after a passerby filmed him entering a fast food restaurant. Then, in the Quebec election campaign, Parti Quebecois leader Pauline Marois insisted that a future health minister should "set a good example" when it came to his or her lifestyle. She said it in the same riding where a prominent -- and obese -- local candidate running for another party has been seen as a potential health minister.

As the obesity issue becomes more and more political, personal food choices are now fair game. Looking across the 49th parallel, we see a similar trend. Last winter, the Washington Post openly asked if First Lady Michelle Obama was a hypocrite. Her crime: she'd ordered burgers at a restaurant at the same time she was publicly campaigning against childhood obesity. (Remember: Mrs. Obama is a healthy weight.) In May, a group of vegan doctors wrote to President Obama, insisting the First Family should only ever be seen eating healthy foods in public.

This turn of events isn't helpful, but it was predictable. It's the inevitable consequence of bad public health thinking and shortsighted public health politics.

In recent years, members of the health care community have expressed alarm about the long-term costs and health consequences of the obesity epidemic. (Count me among them.) But the fight against obesity has also mobilized a growing number of public health zealots, who've taken a punitive, selective and judgmental approach to anti-obesity policy.

There's the usual search for villains -- usually "corporations." There's the usual search for victims, as if cheeseburgers were devoured only by helpless people. In the fight for attention, public health advocates have been making ever-more edgy claims: eating eggs is be as bad as smoking, soda is worse than smoking, and fast food is as addictive as heroin.

And that kind of rhetoric has consequences. If you talk as though every milkshake sold is a sin, it can't be a surprise that everyone drinking a milkshake gets painted as a sinner.

Take the example of the Yale Rudd Center for Food Policy & Obesity. One of the Center's areas of policy focus is discrimination against the overweight and the obese. Yet ironically, the Rudd Center's hot rhetoric feeds the image of the obesity epidemic as a corporate morality tale comparable to the struggle against smoking. If soda is so dangerous that it must be taxed and its size limited, then surely it doesn't matter if the First Lady eats well and exercises regularly; what matters is whether she had a sip of the "poison."

What to do? Tune out the hysteria. If you do, you'll find that most doctors agree on a more reasonable perspective. Obesity is not something that can be blamed on one ingredient or one meal. Yes, it's unwise to drink too much sweetened soda, or to eat fast food regularly. But if you balance calories-in with calories-out and balance your food choices over time, it's not necessary to consider every meal a fight between good and evil.

But that reasonable message is getting lost in the din of "solutions." The balanced diet is too nuanced a concept in a world where public health advocates demand The One Great Law and the One Great Tax that will save everyone from the evils of Big Food and Big Soda.

Some in the public health community believe that they can use laws and taxes to socially engineer the North American diet -- and, for that matter, the German diet, the Chinese diet and the Mexican diet. But in the end, individuals will have the last say in what they buy, cook, serve, eat and drink. If we want them to choose wisely, we have to be careful about how we judge those choices.

Even if the people in question happen to be in politics.

Back to School for Striking Quebec Students -- But Not Back to Democracy

2012-08-20T08:27:07-04:00

And so, it ends with a whimper, not a bang.

On Friday, college students at CEGEP du Vieux Montréal and at CEGEP Saint-Laurent voted to end the "strike"; in the days before, students at other CEGEPs across Quebec voted to return to class. Though many university student associations have yet to vote, the strike against proposed tuition hikes seems to have run its course. Some students are already back in the classroom.

The student protests shut down Quebec higher education, gained international attention and shook that province's politics. By all accounts, the democratic protests were highly successful at gaining attention.

There's only one catch: the protests were anything but democratic. Indeed, it would have been illegal for any labour union in the country to conduct itself the way the student union leadership did.

Quebec student leaders themselves have acknowledged the success of the Red Square movement with their tactics -- and, hey, they aren't talking about grassroots support. Rather, Francophone student associations opted to use direct democracy to make decisions (in contrast, Anglophone schools rely on representative councils and campus-wide referenda instead).

If you're thinking direct democracy sounds like the efficient Swiss tradition of annual citizen referenda, think again. In truth, we're talking about something closer to the operation of a dockworker's union of old. At most Quebec student unions, assemblies are empowered to make major decisions; these meetings typically have tiny quorum thresholds and ban proxy voting.

While most students opposed the tuition hikes, it's also true that most students didn't want to jeopardize their own educational future in protest. That's where the far-left's exploitation of direct democracy played such an important role. The myth is that assembly-based student government is healthy because it's democratically inclusive. In fact, radical student leaders found the meetings effective precisely because they were so exclusive.

Many -- like the author of a recent Viewpoints article -- see these assemblies as critical to a long-run campaign to promote their own political agenda, regardless of actual student demands or circumstances. "The current strike in Quebec has been a long time coming," Elise Thorburn writes. "We can realistically say that activists there have been organizing for this strike not only since 2010, but since 1968."

How exclusive were the strike votes? When Radio-Canada investigated, reporters found that activists in Quebec set the agenda, dates, times and meeting venues to exclude students with real lives, real classes and real jobs. Students replying online to the story complained that strike assemblies often conflicted with exams or classes. Others complained that assemblies took several hours to get to a vote, making it impossible for students with other obligations to stay.

Shutting down a school for months is obviously a significant decision. Yet turnouts at the original strike-vote assemblies generally ranged between 5% and 35%. At Concordia, fewer than 1,800 students were present to vote in a confused debate, making a potentially life-changing decision for more than 36,000 other classmates. And, by the way, the strike vote was done in a way that would be illegal for any Canadian labour union -- by a show of hands rather than a secret ballot.

That's not to fully dismiss the concerns of students. I was a student union president myself in the mid-1990s at the University of Manitoba. With that experience behind me, I thought Anglophone Canada's harsh editorial reaction to student protests was a little over the top. After all, it's routine -- and fair -- for people to complain about the government raising fees with little or no warning. Premier Jean Charest's proposed tuition hikes are modest and reasonable, but it's equally reasonable for students to protest mid-program fee hikes -- especially given the uncertainty of future employment.

But the student leadership seems to have gone three steps beyond a reasonable protest, essentially hijacking Quebec's post-secondary education system and tens of thousands of students with it. Now, with the strike winding down, the Parti Quebecois hopes to capitalize. Strike leader Leo Bureau-Blouin is both a PQ candidate and a regular presence at campaign events. Last week, PQ Leader Pauline Marois explained that Bureau-Blouin would probably keep up his studies part-time if he was elected. That's good for him -- but, thanks to his politics, students across Quebec didn't have the option in recent months of working and studying.

When announcing his candidacy, Bureau-Blouin made a point of saying that he hoped to represent all the voters in his riding. Nice. This would be nice, too: students having a greater influence in the actions of their student associations. The next Quebec government needs to democratize the student associations. After all, if Quebec student associations want the right to strike like regular labour unions, shouldn't they be held to the same basic democratic standards?

If We're Rich Right Now, It's Because We've Been Damn Lucky

2012-07-19T02:04:03-04:00

There's an old joke about a therapist and a young woman. The therapist shows her one ink blot after another and asks her what she sees. Each time, she responds "sex." After several ink blots, the therapist comments that the woman seems to be obsessed by sex. "Me?" she responds indignantly. "You're the one showing all the dirty pictures."

Greek bailouts, faulty Spanish banks, and poor U.S. jobs numbers. The world is on fire, yet Canada has entered a period of relative bliss. And it's easy to compare Canadian successes to American problems.

Unemployment? Your cousin in Florida may be looking for work, but you're not, since the unemployment rate is lower in Canada by a full percentage point (7.2 per cent vs. 8.2 per cent). Housing prices? Your property in Edmonton is worth a pretty penny -- housing prices never crashed north of the 49th parallel -- but your Aunt regrets her Vegas condo purchase.

And, of course, this bombshell analysis released earlier in July: according to Environics Analytics Wealthscapes data, the average Canadian household is more than $40,000 richer than the average American household. The average household net worth in Canada was $363,202 in 2011; in the U.S., it was $319,970.

Many, particularly those with an eye on the United States, have asked: why the Canadian boomlet? Last year, writer Fred Barnes wrote at length on the topic for the cerebral quarterly National Affairs. Policy analyst Jason Clemens put the pen to paper for The Wall Street Journal. This week, novelist and columnist Steve Marche draws lessons from Canada's success for Bloomberg.com, in a cleverly titled piece, "Hardheaded Socialism Makes Canada Richer Than the U.S."

That last essay has gathered attention in recent days. It's been reprinted in this country, of course, but also as far away as the Korea Herald. It's sparked various responses, including a front-page piece by Financial Post editor Terence Corcoran in yesterday's National Post (and also a blog on HuffPost by U.S.- Canada expert, Christopher Sands).

And while Barnes, Clemens, and Marche have all been thoughtful, it's difficult not to think of the therapist and the young woman -- you can see in a complicated pattern pretty much what you want to see.

Let's start with Marche. To his fawning eyes, everything looks great in Canada, from the Charter of Rights to the currency. Marche is intelligent and clever with words, but even if Egyptians should copy our Charter (as he recommends) and Icelanders could piggy-back on our loonie (as he suggests they might), it's difficult to see how this really has led to Canadian success.

He gets more wonkish later in the piece, and largely credits Canadian success to hard decisions made in the 1990s. He describes these decisions as "hardheaded (even ruthless), fiscally conservative form of socialism."

Its originator was Paul Martin, who was finance minister for most of the '90s, and served a stint as prime minister from 2003 to 2006. Alone among finance ministers in the Group of Eight nations, he "resisted the siren call of deregulation," in his words, and insisted that the banks tighten their loan-loss and reserve requirements. He also made a courageous decision not to allow Canadian banks to merge, even though their chief executives claimed they would never be globally competitive unless they did. The stability of Canadian banks and the concomitant stability in the housing market provide the clearest explanation for why Canadians are richer than Americans today.

Let's set aside the very question as to where Canadians really are richer than Americans. (Terry Corcoran argues pretty persuasively over at the National Post that the analysis isn't worth the paper is written on.) Instead, let's focus on Marche's "hardheaded socialism" claim.

A few points.

First, Canada isn't that socialist -- and America isn't that free-market. Compare government spending as a percentage of GDP. The Canada-U.S. difference is modest. Government spending in Canada was 43.2 per cent in 2011; the United States it was 41.9 per cent. As Clive Crook quips over at the Atlantic: "I guess that makes the difference between hardheaded socialism and capitalism red in tooth and claw about 2 percentage points of GDP."

Second, both countries have made various interventions into the housing market. Canadian "socialism" means that it's harder to get a mortgage here -- true. But in the "free market" United States, government agencies like Fannie Mae and Freddie Mac made loans readily available (too readily available) while the U.S. tax code allows mortgage deductions. That's not to be simplistic and suggest that the housing crisis was sparked solely by public-sector measures. But there are a variety of factors at play in the United States, including government policies -- what Marche would surely dub "socialist."

Banking regulations also differ, and the picture is vastly more complicated than Marche suggests (that is, an industry tightly controlled by government, having been supposedly tamed by the visionary Martin).

Author Reiham Salam writes well on this, over at National Review.

It is worth noting, however, that Canada never had a Glass-Steagall-style wall of separation between commercial and investment banking, and its highly-concentrated financial services industry has thus long been dominated by so-called "universal banks." Canada was able to "resist the siren call of deregulation" in part because Bay Street was in some respects less tightly regulated than Wall Street.

Third, natural resources are mentioned in passing in the Marche piece -- literally just two sentences. And this is where Clemens and Barnes can be faulted, too. All three have focused on the influence of government policy on Canada's prosperity. It's a bit like writing a history of the Second World War and not seriously considering the European theatre.

Good policy is important in a country's success -- sure. But good luck can often be more important. And Canada is a nation that has won the lottery, except there is no prize boat or house, but rather an exceptional amount of natural resources, all of which are trading at historically high prices.

Yes, Martin made big decisions two decades ago; it's also true that the Harper government resisted the siren call of massive stimulus spending in this decade. But Canada is an economy built on natural resources, and natural resources are booming. If oil traded at $9 a barrel, not $90, Marche would still be writing about Shakespeare.

The day after Bloomberg.com ran Marche's analysis on Canada, the Bank of Canada issued its quarterly report. For the record, the governors predict a down-tick in economic growth. The short report doesn't mention hardheaded socialism, by the way, but rather a cooling in oil prices.

This leads to an important question: if Canada is lucky, where do we go from here? For as history shows, oil booms are followed by oil busts. Canadians know this lesson too well. We enjoyed prosperity in the 1970s only to see harder times in the 1980s and 1990s.

And here there are lessons to draw -- not for Americans, but for Canadians. We need to use our moment wisely. In the 1970s, we oversaw massive government projects that we couldn't afford. It literally took decades to put our fiscal house in order.

Times are good today, they may not be so good in a few years. It's easy, like the woman in the joke, to see what we want (our genius in all aspects of our governance), no matter how complex the pattern. But times will change, and quickly.

Canadians need to be less self-congratulatory; we need to be strategic and prudent. We must use this opportunity to address bad policies (our health care system's excessive focus on health, not health care, for instance) and prepare for the future.

Such an approach isn't hardheaded socialism or free-market enthusiasm; it's realism.

Does Michigan Need a $550M Gift From the Canadian Taxpayer?

2012-07-05T17:26:25-04:00

In mid-June, the federal government committed every Canadian man, woman and child to pay $15.79 to create jobs and build infrastructure in Michigan -- yes, Michigan -- whose per capita income is nearly the same as Canada's.

Weeks later, nobody here seems to have noticed. The foreign aid will cover that state's costs for a multi-billion dollar bridge project linking Michigan and Ontario. Of course, the upside is economic benefit on this side of the Detroit River and better infrastructure for North America's busiest trade corridor. But that doesn't change the fact that the deal seems to be too clever by half.

The background: $130 billion worth of trade and commerce goes across the Detroit River each year via a ferry, a tunnel, and the Ambassador Bridge, connecting Windsor and Detroit. The toll bridge is privately owned by the Detroit International Bridge Company and its Canadian subsidiary. After 9/11, governments pushed for a second bridge, adding capacity during emergencies and speeding up traffic (and thus trade).

So began a long feud between governments and the company. In response, the toll-bridge owners spent a small fortune lobbying Michigan legislators to protect the Ambassador Bridge from government-financed competition. They've delayed every bi-national effort to build a new crossing. So when the Bridge Company suggested it could build a second span at its own expense, Ottawa revoked the company's permits to do so.

The result: a costly political stalemate.

Thus, the June announcement. Ottawa hopes to break the stalemate by funding a new bridge with Michigan. The spin is that the Canadian government is loaning Michigan the money. Except that it's not really a loan, and it's not really practical.

The Americans are candid. The Detroit Free Press called the deal a "tasty gift on a platter." Michigan Governor Rick Snyder said the project "will not cost Michigan taxpayers any money." Michigan's handout on the deal says the state "will bear no responsibility for repayment of the Canadian funding." Not so long ago, Canadian officials were more candid, too. In early 2011, then-Transportation Minister Chuck Strahl contacted a Michigan-based business newspaper to explain the offer. "Let me be very clear -- the additional $550 million is not a loan," Strahl said.

Ottawa's spin that we're loaning Michigan the $550 million to be repaid by future tolls charged on the Canadian side. But tolls aren't expected to cover Michigan's share until somewhere between 2054 and 2064. That's if construction costs stay on-budget, and if toll revenues appear as projected. Both are big ifs. Freight traffic across the Ambassador Bridge has been in decline for several years. Last year, truck traffic was 25 per cent less than its 2006 peak.

The most remarkable part: the 44-page deal, the triumphant press conference in Windsor and the $550 million "gift on a platter" might not even break the stalemate.

Governor Snyder tried to outflank his opponents by cutting the legislature right out of the June 15 deal. It's a bold strategy -- and an unpopular one. A January poll found Michigan voters would oppose such a gubernatorial effort by a 2:1 margin (60 per cent to 30 per cent). If that opposition holds, it's a big problem. And it's not the only problem: the latest deal depends on the state delivering on controversial land assembly work on the Michigan shore. Even if Canadian taxpayers pay for that work, expropriation is still subject to state law; the Bridge Company thus has at least one legal route to delay the plan.

That's why the real story here is a story of Canadian wishful thinking, not Canadian success. Speaking vaguely of "battles ahead," the Prime Minister talked tough. "We are prepared to do whatever it takes" to get the proposed bridge built, he said.

Apparently, "whatever it takes" includes foreign aid to Michigan, but it doesn't include other alternatives that might have produced a cheaper, more conclusive outcome. If the Ambassador Bridge's owners are truly anti-competitive, then Canada should have tried playing legal hardball with its Canadian subsidiary, or even tested a bridge boycott (with trade rerouted through Sarnia) to push for a more reasonable outcome. Negotiation was also an option. Canada could have demanded 'fair conditions' -- like a toll agreement or a Canadian partner -- under which we'd accept the Bridge Company's plan for a second span, since this could have led to a second-best option at a far lower price.

Instead, the Conservatives did the sort of thing that conservatives aren't supposed to do. They threw cash and a splashy press conference at the problem, and then cheered as if either step represented some sort of victory.

It's enough to make you wonder: if Ottawa finally signs a free trade agreement with South Korea, will we be loaning out $550 million to help seal the deal?

Obamacare Is in Anything But Stable Condition

2012-06-29T00:43:00-04:00

Obamacare -- the signature legislation of President Obama's White House -- is constitutional.

Of course, Thursday's U.S. Supreme Court ruling is more complicated, and some aspects of his health care reform have been reigned in. But, for the most part, the Supreme Court's decision is favourable to the White House. Very favourable.

Thursday's decision is significant for the administration in what it didn't do, as opposed to what it did. The Supreme Court didn't strike down the law; it didn't embarrass the White House; it didn't undo years of work by Democrats.

It was a close call. For nearly four years, Republicans have worked overtime trying to find a way to discredit President Obama's health care reform efforts. They refused to co-operate with Democrats in the drafting of the legislation; they have held countless townhalls and meetings with dramatic (and overheated) rhetoric; they have used their Congressional power to hold hearing after hearing to question the administration and flush out awkward details.

For weeks now, court watchers speculated that the White House had ended up doing a better and faster job of destroying Obamacare than its Republican opponents ever dreamed possible. It was the administration, after all, that had expedited the case against its own legislation and then forwarded an awkward argument in front of the Justices.

So likely did it seem that key portions of the legislation would be struck down, that CNN initially reported incorrectly that it was ruled unconstitutional. "The Justices have just gutted, Wolf, the centerpiece provision of the health care law," CNN reporter John King declared. He added that it was "a direct blow to President Obama."

Thursday, though, there was no direct blow. The requirement that people be forced to buy health insurance -- the so-called mandate -- stood the court challenge (albeit not as a requirement, but as a tax).

This isn't simply a political win for the White House, establishing that the law is constitutional. It literally saves the legislation.

Without the mandate, the law couldn't possibly work.

Democrats have spent years mulling over how to expand coverage to the millions of uninsured Americans. Many favour the sort of government-run system found in countries like Canada and Britain.

Burned by public revolt against President Clinton's efforts to expand coverage in the 1990s, Democrats championed something of a compromise. "No" to government-run health, but "yes" to a more regulated system of private insurance. Forget Canada, Democratic policy makers decided, but push the American system closer to Switzerland's or Belgium's.

To make a complex web of regulations work, such a system requires nearly everyone to participate. That way, a 20-year-old man who has never seen a doctor will help pay for the costs of the 60 year-old woman with a cardiac history.

Canadians don't often think about the economics of private health insurance, so let me give a non-insurance analogy. Say you own an all-you-can-eat buffet. To make up for the people who pile their plates sky-high with food, your restaurant needs customers who eat sparingly. Obamacare forces everyone to the health-insurance buffet -- the people who need care, but also, the healthy ones who don't feast on meals of health care, so to speak.

Had the Supreme Court struck down the mandate, Obamacare would have had all the regulations and costs, but lacked the young, healthy people to make it work. You can understand why the White House was quiet with anxiety all week. This was a close call.

But with the court challenge behind them, all is not well for the White House. Yes, the Supreme Court did no serious damage to the signature legislation. But the implementation of Obamacare seems anything but straight forward. Costs have soared despite the fact that most reforms don't kick in until 2014; several states have effectively rebelled; one basic reform (the long-term care insurance) was already scrapped.

After nearly four years of hard work by President Obama, in other words, the debate over American health care seems no closer to resolution.

Canadians have a tendency to look at American health care with a jaundiced eye. We see heavy costs and uneven quality. I suspect most Canadians have been sympathetic with the President's goals of universal coverage -- something we take for granted north of the 49th parallel. All this talk of court challenges, mandates, and constitutionality seems a bit exotic.

But the debate in the United States isn't so foreign. Like practically ever other Western nation, the U.S. is attempting to deal with the high-tech, high-expense medical revolution that has transformed health care. In Washington today, post Supreme Court ruling, they are thinking long and hard about health-care reform. But today, post Supreme Court ruling, government officials in Winnipeg (and Regina, and Toronto, and every other provincial capital) are thinking long and hard about health-care reform, too.

With the Supreme Court ruling, the debate continues in America. And everywhere else across the Western world.

A Supersized Dud

2012-06-01T10:38:39-04:00

New York City Mayor Michael Bloomberg made big news on Wednesday with his proposed ban on large serving sweetened drinks. The New York Daily News labels the mayor "a big soda scrooge" while the New York Post sees a future with "no more supersized Cokes."

But will the proposal achieve anything more than big buzz? As with other such efforts from the mayor's office, it has so many loopholes that the answer is likely no.

Yes, big servings of Coke will be on the endangered list -- unless, of course, you go to a fast food joint, and order a fountain drink where you will still be able to get free refills. Big soda scrooge? Clever one-liner, but he can't be accused of being a big milkshake scrooge -- since you'll be able to chocolate up under the proposal. The mayor is tough on soda, but sweetened fruit juices or alcoholic beverages? Not so much. They too would be exempt.

Welcome to the latest campaign in Mayor Bloomberg's war on fat -- and his latest misstep in an effort to regulate America to a healthier diet.

Consider earlier, similarly splashy initiatives. Remember the regulation requiring calorie counts on restaurant menus? Here, too, the war on fat proves selective. Walk into the McDonald's at Times Square, and you can get a full calorie count on a quarter pounder. What about the delis in the area that serve up a pound of corned beef, lightly decorated with bread? No, since the regulation applies only to chain restaurants. The problem, though, isn't just the implementation -- it's the basic concept. Most major studies of the new menus find them to be ineffective at reducing overconsumption. A recent Columbia University study suggests many aren't even able to read the menus properly.

It's a persistent theme through the multi-year war on fat -- good on PR, bad on policy. When public health managers complained about low fruit and vegetable consumption, City Hall created a new bureaucracy to operate produce carts. An analysis of the city's own data shows the program has had no significant impact on civic dietary habits, except among residents who are already in the habit of eating fresh produce. Other proposals -- like regulating food stamps and tax on soda -- never saw the light of day, failing to win the needed support in Albany and Washington.

In New York's war on fat, what matters is the perception of action. Tangible results? Not so much.

In the United States, health costs are spiraling up as a result of the obesity epidemic. But that fact alone is not enough to justify any regulation or effort, especially when it comes to food -- backlash can destroy progress just as surely as indifference.

The real problem with obesity remains one of motivation, not law. This isn't like smoking, where every puff you inhale is poison, in any quantity. When it comes to obesity, many people simply don't see their daily dietary choices as important health decisions.

In 2005, New York's then-Commissioner of Health and Mental Hygiene said that only 39 percent of obese New York adults surveyed correctly described themselves as "very overweight." After years of alarming headlines and ad campaigns on the obesity issue, similar polls have shown limited change.

Bloomberg's buffet of hit-and-miss laws will do nothing to change this. To give a sense of how hard it would be to change behavior through legal penalties, a recent British study found that so-called fat taxes would have to be as high as 20 percent before they change behavior.

How to deal with the obesity problem? Certainly, government policy could be smarter. We need to emphasize physical education in our schools; children are spending too much time playing sports on their PS3s, and not enough time playing sports in the real world. Agricultural subsidies and regulations give an unfair market advantage to unhealthy foods. Health insurance policies should emphasize wellness, and not just sick care; yet Washington regulations (even after ObamaCare) make it difficult.

But, ultimately, Americans need to go back to the basics: families must eat out less, and eat together more. Government policies can't achieve this, just a return to common sense.

And that's the reason that Bloomberg's war on fat has been a failure. Sure, it will keep a third-term mayor in the news. But better health outcomes for New Yorkers? Not so much. It's time for a change in strategy, Mr. Mayor.

Drummond's Prescription for Health Care Won't Cure the Spending Bug

2012-02-28T17:08:36-05:00

Political debate in Ontario is now dominated by a simple question: Did Drummond recommend it or didn't he?

On February 15, rock-star economist Don Drummond turned in several hundred pages worth of recommendations to the government, providing advice on how to balance Ontario's budget.

Premier Dalton McGuinty has already rejected two of Drummond's biggest cost-saving ideas: cutting energy rebates and eliminating early kindergarten. Opposition critics at Queen's Park are still trying to get a yes or no answer on the hundreds of remaining recommendations.

Last week, I argued in the Financial Post that the report's biggest mistake was its failure to focus on economic growth. But even measured by the standard of its main purpose -- deficit reduction -- the report falls badly short. With that in mind, this is the first of a series of posts I'll make here examining Drummond's recommendations.

I'll start with Drummond's weakness on health reform. If Ontario hopes to contain future budgets with spending cuts, health spending is a critical target. Drummond himself notes Ontario's health budget has risen by 6.9 per cent on average in recent years; private sector projections suggest cost rises in the 6.5 per cent range. Looking forward, Drummond's "status quo" scenario projects annual increases of 4.9 per cent through to 2017.

Meanwhile, Drummond's target rate of cost growth is 2.5 per cent or below.

The report's ideas to achieve that goal are riddled with contradictions.

He would concentrate administration under local health networks to cut the number of health organizations, yet he wants new organizations to manage chronic care. He calls for clearer lines of accountability, yet he seeks to give another agency completely new regulatory authority to impose system-wide changes from the outside.

Drummond wants Ontario to "[c]reate policies to move people away from inpatient acute care settings by shifting access to the health care system away from emergency rooms and towards community care." He insists that "[t]his alone should reduce the number of people who end up being admitted to hospital beds..." It's an amusing claim. Health managers have struggled to "create policies" to do just that for decades, without success. The most common tool used worldwide to reduce emergency room pressure -- user fees for non-emergency treatments -- is, of course, rejected outright.

Drummond is also well-versed in the health system's trendiest solution: He wants to shift more work to lower tiers of medical staff, including pharmacists and physician assistants. More primary care, more "care quarterbacks," and more changes to physician compensation.

Toronto Star columnist Thomas Walkom thrives on attacking this sort of report. Yet even he had trouble finding any red meat, calling Drummond's health plans "vague," a "litany of familiar nostrums" and "quixotic."

In fact, Drummond's health prescription is so generic, Health Minister Deb Matthews believes she's already implementing most of it. And she's probably right. Yet nobody was projecting the end of health inflation when the Minister announced these initiatives, so it's unclear how stamping Drummond's name on the same model will bring cost growth down from five to seven per cent to 2.5 per cent.

Virtually every public health system in the industrial west has seen cost rises stubbornly stay within a range of three per cent to 10 per cent -- even in countries where brutal rationing is used to contain costs. The downturn hasn't changed that. U.S. analysts recently claimed victory after recessionary pressures brought Medicare and Medicaid inflation to record lows in 2009-2010. "Record lows" means that spending grew 3.8 per cent and 3.9 per cent, respectively.

Since health care consumes over 40 per cent of Ontario's budget, even a modest shortfall could burn up much of what Drummond hopes to save elsewhere. Ontario's health budget is $47 billion this fiscal year. Suppose we contain cost growth in 2012-2013 to just three per cent, instead of the target 2.5 per cent. That half-point margin of failure means $235 million must be made up somewhere else to hit Drummond's targets. And the $235 million will have to be saved every year thereafter, unless reductions in the following year are pushed even lower to compensate.

My own view -- the closing to each of these posts -- is that Ontario must take some risks to promote an aggressive economic recovery. Selective savings won't raise enough to balance the budget alone -- especially if the savings ideas are as vague, generic, and contradictory as those in Drummond's health review.

So let me repeat my basic point: When Premier Dalton McGuinty went looking for advice, he hired Drummond. What he got was an economist who told him to charge more for parking and amalgamate public health boards. What he needed more was an economist to explain how to get Ontario working again.

She's a Good Sheila

2012-01-18T00:33:17-05:00

It ended with a whimper, not a bang.

This past weekend, Sheila Copps fell just 26 votes shy of winning the Liberal Party presidency, against businessman Michael Crawley.

Sheila Copps has since suggested that she has run her last race and will focus on charity, in particular efforts to help Haiti.

So ends a long political career.

Copps first ran for office in 1977. She served in Toronto before going to Ottawa in 1984. When the Chrétien Liberals won in 1993, she joined the Cabinet, holding various roles, including Deputy Prime Minister. She lost a bitter nomination battle in 2004 to Prime Minister Paul Martin's organizers and candidate.

I met up with her in Toronto this past November. I'm not a Liberal, nor was I involved in the race. Still, Copps spoke to me at some length. What was clear was her passion.

Copps argued that the party needed a hand. Though out of office, she felt that she could help the Liberals in the party's greatest time of need.

"The presidency is two years," she said, and then added with a grin: "I think I can work my butt off for two years." In the four weeks before our conversation, she estimated that she had slept in her own bed just three times -- so it was, with a campaign that stretched from sea to sea.

It's easy, after leaving politics, to settle into a more comfortable life -- to leave behind the church basements and rubber chicken dinners, opting for the five-star hotels and the lavish restaurants. Many of her former colleagues in Cabinet have done just that.

There is no problem, of course, with a good retirement after a long political career. If anyone deserved it, Copps did. It's a testament to her commitment to her party and her country that she did re-enter public life, choosing a hard campaign for an unpaid office, out of a sense of duty.

Copps is known for her humour. When John Crosbie told her to "just quiet down, baby" during Question Period in 1985, she responded that she was "nobody's baby."

She crossed swords on more occasions with Crosbie but, in the end, she appreciated that a good political fight wasn't necessarily personal. Crosbie was invited to write the introduction to her autobiography. He did, and began: "I write this Introduction to her new book as a tribute to a feisty, sometimes ferocious, feminist protagonist, never shy or retiring but redoubtable political personality."

For the record, in the end, she had a good line, too. "I lost a provincial election once by 14 votes amongst 35,000. So this is a landslide," she told The Globe.

In person, Copps is witty and clever, too.

But she should be remembered for more than that. In particular, her commitment to public service.

Canadians often grumble about their politicians. We are quick to blame Ottawa, and sometimes rightly so. But in the commitment of people like Sheila Copps, we should also remember that we are also very lucky. Political life is hard; the dedication of people like Copps is important.

Many thanks Sheila.

Premiers' Health Care Meeting Will Be Loud But Fruitless

2012-01-16T01:50:35-05:00

Today, the premiers are meeting in Victoria. Top of the agenda: health care.

It's a meeting that will be long on rhetoric but short on purpose. Historically, such meetings allow premiers to bemoan the lack of stable, long-term funding from Ottawa. And Victoria was meant to be a part of the complicated federal-provincial courtship culminating in a new historic deal.

Except that, late last year, the federal government committed itself to stable, long-term funding -- extending the generous increases in federal funding for a full five more years, before tying future increases to economic growth.

Even though the provinces are limited in their ability to complain, expect two things in the coming days.

First, most provinces will complain anyway.

They will suggest that -- having received under the Tories a deal basically as generous as under the Liberals -- they are being mistreated.

In December, Manitoba NDP Finance Minister Stan Struthers declared that the federal proposal was "un-Canadian." His boss will be equally harsh, as will many of his colleagues (Alberta will be the exception).

Yes, the complaints are baseless. Six per cent annual increases at a time of recession and uncertainty are generous. But, yes, we'll hear them complain anyway.

Second, various health-care "experts" will claim that the Tories are destroying Canadian health care.

Who speaks on behalf of the doomsday school of thought on medicare? The chief spokesman is Roy Romanow. As you will recall, a decade ago, the former premier of Saskatchewan was appointed commissioner by Prime Minister Jean Chrétien to consider health care.

In recent weeks, he's been much in the news with his doomsday prophesy: The federal offer is, he claims, the end of medicare as we know it. Romanow argues that, by not setting national standards and leaving medicare to the provinces, the federal government is effectively abandoning the program to the metaphorical wolves.

Doomsday prophesies rarely come true, and this one seems about as compelling as the Mayan claim that the world will end in 2012. There will be much play in the media but on January 1 of next year, the sun will rise and Canadians will still have medicare.

The reality is that the last batch of national standards didn't work out. As Prime Minister, Paul Martin signed the health accord. The money flowed, but the provinces largely didn't keep their end of the deal -- not on the Liberal watch, not under the Tories. Reductions in wait times? Many provinces aren't even collecting all the relevant data, which they promised to do, never mind hitting the benchmarks.

It would be possible, of course, for the federal government to push the provinces. They could demand better results for the money.

But there are profound limitations to such demands. Start with practicality -- as was seen in the last federal-provincial accord, it's difficult to collect data and even more difficult to see their utility. As noted by the Wait Time Alliance, a reduction in wait times in five priority areas probably has resulted it wait times increasing in other areas.

National standards? The argument put forward by some (including Romanow) is that by setting clear goals, the provinces will be forced to innovate.

But the problem with the current system isn't a lack of ambition. The Premiers (and their predecessors) have tried for years to make this system work better.

In the 1990s, of course, the argument was that the system was underfunded. But it's hard to make that argument today. Health spending in Ontario, as an example, has rocketed up by 7.6% for the last decade, as economist Don Drummond recently observed. Add in countless reforms and consultations, and the reality is this: the system continues to be marred by deep problems. Millions are without a family doctor; waiting lists plague all aspects of the system.

A federal commitment to reduce wait times for, say, MRIs will do what all such top-down directives achieve -- some modest temporary improvement. But the core problems would remain.

Indeed, if anything, it's Ottawa's rigidity that got us into this fix in the first place. The Canada Health Act forbids much experimentation with private solutions, the sort of basic reforms seen in other countries. It's that type of innovation that would help the system -- but the law forbids it.

Consider, for instance, a 2010 report by the New York-based Commonwealth Fund. Of the seven systems studied, Canadian health care ranked second in overall cost and second last in overall performance. And, no, the study is hardly a whitewashing of the American system. For the record, the U.S. health care ranked dead last.

Ottawa isn't part of the solution. It's part of the problem. But, then, so are the Premiers, who are content not to challenge the status quo, but spend, spend, spend.

Which is why Victoria will be like so many past meetings of the Premiers. Rich in rhetoric but poor in significance.