Archive for December, 2012

Canada’s Broken Healthcare System

December 31, 2012

The tale of two cities

Geoffrey Simpson documents the failures of Canada’s often-praised health care system. The following is a personal illustration of its inefficiencies. It has nothing to do with the medical expertise of the various professionals who deliver the services, but results from the organization of the system itself, which politicians and officials fail to recognise. Delivery of health care in Bangkok, Thailand is more efficient than that in Ottawa. It is cheaper for the government, private insurers and for the individual who pays for this by a combination of taxes, premiums to private insurers and cash, to say nothing of the benefits accruing to the patient….myself in this case.

Delivery of medical services involves reporting of symptoms, diagnosis and treatment. The shorter the time period for the delivery of treatment, the sooner the remedy is likely to occur, the lower the overall costs, and not least the less discomfort to the patient.  Delivery in Bangkok is faster and cheaper than in Ottawa for the following reasons.

The symptoms involved two sore shoulders. In Bangkok, an appointment with a  hospital-based shoulder sports medicine doctor at 8.30am Tuesday morning lead to a MRI scan at 2pm on the same day, with the results reported two days later. The initial diagnosis suggested that a cortisone injection or an operation might be required if the rotator cuff muscle was damaged. An operation is generally recommended, but because of my age, it was unlikely to be successful. Cortisone would relieve the pain but would make a future operation not possible. A decision would be made once the MRI results were interpreted.

In Ottawa, a decision was reached by a circuitous and inefficient route. The symptoms were reported to a GP six months earlier who ordered physio treatment for the shoulders. This had limited effect and was followed by a doctor ordering an x-ray, followed by a meeting with the doctor followed by further physio, followed by a doctor ordering an ultrasound, followed by further physio. The ultrasound showed a full tear in the right rotator cuff muscle. It was suggested that a MRI would provide the most definitive information but was (for some reason, probably cost) not recommended.

The Ontario process lead to several visits to the doctor paid for by the government, treatment applied before a full diagnosis was made. X-ray and ultrasound were paid for by the government. The X-ray was done immediately, while there was a three week wait time for the ultrasound. The physio was paid for by a combination of private insurance and cash.

In contrast, the Bangkok process involved one visit to a sports medicine doctor and the MRI being done the same day so that treatment could begin at once based on correct diagnostic information. Payment for this was a combination of cash, Ontario and private insurance. A doctor’s report and a CD of the MRI scans was received three days after the initial appointment. Treatment could then begin at once based on complete information.

It is hard to praise the Canadian system which prolongs the stages of diagnosis to six months from 48 hours elsewhere, and involves intermediate treatment based on incomplete information. The patient, myself in this case, feels the difference.

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State Owned Enterprises and Investment Canada

December 31, 2012

Two recent arguments about the screening of foreign investment by Investment Canada are lack of transparency, and the need for special procedures to review acquisitions by foreign state owned enterprise SOEs.

1. While there may be the need for minor amendments to the review process, the general criticism fails to understand how the screening
process works, and how the proposed changes can weaken the policy. By making the screening procedures more rigid, it will become easier to work around them, and by trying to treat SOEs differently, it will be necessary to establish guidelines creating more complexity which helps firms bypass the general effectiveness of the screening process.

Of the hundreds of individual Investment Canada decisions made to date, none have been debated in Parliament. Rather the Act giving the power to review investments was debated and passed in 1985, and successive governments have reported annually on the decisions made. Todate, details of the commitments by a foreign investor are not disclosed publicly. Those proposing change appear not to have read the extensive material published on the IC website. One case reports on a commitment which the government later challenged.

Whatever commitments an investor makes cannot always be fulfilled if underlying conditions change. If an investor committed to maintain or increase investment in Canada and there was a 2008-type recession, the firm might not be able to live up to this commitment.  Canada would have the option of asking the foreign firm to leave, thereby increasing unemployment or renegotiate the commitment. This is what happens in an active economy with the government usually accepting the consequences of the changed conditions.

The suggestion that the IC rules for foreign investment should be redrafted to create greater certainty reveals a misunderstanding of how economic adjustments occur. In the medical arena, a starving patient can commit to a doctor today to eat a healthy diet including sugar, but if later she becomes diabetic the diet will make her sicker and perhaps kill her. Some degree of future flexibility has to be incorporated into any set of circumstances which change over time. Thus drafting new policies re investment commitments may do more harm than good. The more rigid the commitments required, the easier it is to find a way around them.

2. The CNOOC case involves a state owned enterprise. Should there be special rules for them? Not all SOEs are the same. There is probably little concern about investments in Canada by the Norwegian government’s sovereign wealth fund, and foreigners have little concern about investments made by the Alberta Heritage Fund. But people become uncomfortable when a SOE from a communist country invests in Canada and other free market economies.

Similar to the treatment of foreign visitors where those from some countries require visas, it would be possible to have different rules for foreign investment by SOEs than for private investors. But then the rules would have to be further refined so that SOE investors from countries like Norway are treated differently from those from China, creating all sorts of profitable opportunities for lawyers, consultants and economists to advise potential  investors on how to structure their operations so as to gain approval for their investment.

Having separate conditions for SOEs may seem a good idea, but unless they are general and permit those screening to exercise their judgment they are likely to fail. If in the  extreme case all SOEs were banned from having a controlling interest of say 50 per cent plus equity ownership in a Canadian firm, this would seldom work. Control can be exercised with a much lower percentage, perhaps 10 per cent if the remaining 90 per cent are widely owned.

Alternatively, a banned foreign SOE might be able to control a Canadian resource deposit by having zero investment but a long term contract to buy all the resource output of the Canadian firm for the next ten years.  It would not be the same as having management control, but a main purpose of such a transaction might be achieved.

Canada through the looking glass – 4

December 3, 2012

Does multiculturalism harm the environment?

The question contains two words, both overused and often qualified so that their meaning is lost. Below I examine the nature of and dialogue surrounding multiculturalism, a term used, at times, to promote an illiberal environment. The previous posting on employment, immigration and temporary foreign workers, is joined at the hip with multiculturalism, which deals with measures to introduce and integrate newcomers into Canadian society. Unfortunately, multiculturalism has at times been appropriated by those advocating narrow special, rather than broader national interests.

For example, multicultural policy can be used by those promoting religious, gender, linguistic, and ethnic interests. With so many interests identified, it is not possible to evaluate whether the policy works or how it could be made to work. A few years ago there was pressure to hire more female faculty in Canadian universities. In several disciplines it has been remarkably successful, but it soon gave rise to pressure by others to hire people with different ethnic, linguistic and religious backgrounds leaving diminished the importance of academic excellence as a hiring criterion. Gender may have got to the table first, but it quickly became impossible (and undesirable) to cater to all these interests, especially at the expense of excellence.

In many professional fields it would be unfortunate to favour each of these interests at the expense of excellence. In fact, on its own, excellence in many fields became combined with majority shares of female enrollment, graduation and practice. But this could not be achieved if other interests had to be satisfied.

Where do multicultural policies originate?

Before entering this controversial quagmire, some facts about the Canadian situation may be helpful. Official multicultural policy originated in 1971 as a Liberal government initiative. A Conservative government passed the first Act in 1988 and it is now administered by the Department of Canadian Heritage. It is described as follows on the departmental website:

“The Canadian Multiculturalism Act affirms the policy of the government to ensure that every Canadian receives equal treatment by the government which respects and celebrates diversity. The Act also:

  • recognizes Canada’s multicultural heritage and that this heritage must be protected
  • recognizes Aboriginal rights
  • recognizes English and French remain the only official languages but that other languages may be used
  • recognizes equality rights regardless of colour, religion, etc.
  • recognizes minorities’ rights to enjoy their cultures.”

A recent report for Citizenship and Immigration by Professor Will Kymlicka, The Current State of Multiculturalism in Canada and Research Themes on Canadian Multiculturalism 2008‑2010, sets out the current issues at http://www.cic.gc.ca/english/resources/publications/multi-state/index.asp

Kymlicka is a strong advocate of Canada’s multicultural policies. Others differ. The report provides a survey of opposing views. Before proceeding, some facts about the origins and diversity of the Canadian population may be helpful.

Canadian immigrants

All Canadians are either immigrants or the descendants of immigrants, including native Canadians. Robert Leikin suggests immigrants should be called postmigrants. Each time a new wave of immigrants flows in, the postmigrants complain that the newcomers are changing their society, usually for the worse.

In the US, the 2012 presidential election saw media commentators of Irish and Jewish extraction bemoaning the racial composition of present day USA. But it was less than 100 years ago that similar complaints were made about Irish and Jewish immigrants by those who had immigrated earlier.

In a recent book review, I noted,

“ In a sense the mix of migration and economics has always been so, as documented in Jeffrey Kaye’s excellent new book Moving Millions, How Coyote Capitalism Fuels Global Immigration (Wiley 2010). He recounts how the long-time residents of Hazelton, Pennsylvania are reacting today to the arrival of Hispanics in exactly the same way that in earlier times residents of neighbouring coal mining communities responded to the arrival of Slavic, English, Scottish, Welsh, Irish, Italian, and Lithuanian miners from around 1875 to 1910. Their descendants have responded to the Hispanic invasion with the passage in 2006 of “one of the nation’s strictest anti-illegal immigration laws.” I am sure similar remarks were made by Canadian postmigrants at different times.

Some claim that only native peoples can justifiably complain about the harmful effects of new arrivals, and the effects were indeed harmful. But using Leikin’s argument and DNA evidence of earlier arrivals, aboriginals were themselves, at one time, new arrivals. With DNA and other data, it is now possible to trace the origins and movement of mankind from 160, 000 years ago to the present. It is depicted on a map with explanations at http://www.bradshawfoundation.com/journey/

Using current geographical names, humankind originated around Ethiopia and Somalia about 160,000 years ago and gradually spread throughout Africa into Europe and Asia, and finally into North and South America around 25,000 years ago. In historical terms North America is newly populated, in the last 16% of the time since humankind has evolved.

During the 160,000 years, there were ice ages which pushed humans to the south. One started 22,000 years ago and ended 10,000 to 8,000 years ago, at which time agriculture started to flourish and the Sahara was grassed over.  Today we seem to be in another warming period.

Canada’s first immigrants arrived across the Bering land bridge from Asia. The only living beings they met were probably animals, who, if they could, would have objected to having their feeding grounds disturbed. We are more familiar with the arrival of migrants in Canada from Europe from 1500 AD, especially from France, Spain and Britain. As each group came, complaints were made by those who came earlier that their way of life was being disturbed. This continues to the present as, for example, the descendants of the French and British in Canada complain about the influx of Asians, Latin Americans, West Indians, Africans and other non-traditional immigrants in the view of those who previously migrated. The French and British also complain about each other.

Thus, immigration to Canada is very recent, other than the few who came 25,000 years ago. The most recent 500 years has seen an uptick in activity, and especially during the last 150 years. Per annum immigration reached peaks of 125,000 in the 1880s, 400,000 in 1912, falling to between 150,000 and 250,000 over the last 15 years. Relative to population these flows were highest in the first decade of the 1900s, reaching over 5% per annum, and since the 1970s have been less than one per cent. Country sources have varied over the years. Data for all of this are found on the CIC website at http://www.cic.gc.ca/english/resources/statistics/facts2011/permanent/index.asp

What constitutes multiculturalism policy?

Multiculturalism evolved to aid in the integration of new arrivals with earlier postmigrants. One component is the official policy of bilingualism and biculturalism, reinforced by a Royal Commission Report in 1969. Its mandate included aid to the integration of new immigrants with Canada’s French and English postmigrants, who made up a big chunk of the existing population. Since then it has been misused by some groups which have illiberal interests. Thus, in my view, the policy to-date has had less than sterling success.

A valid objective is to pursue policies which promote integration within a country. If you want to call this multiculturalism, that is fine. But if the label embraces measures which promote special interests at the expense of others, or worse, promotes policies with harmful effects on others under the guise of multiculturalism, then either revision or removal is needed.

Timothy Garton Ash provides a clear statement of the issues in a review article of five books in the New York Review of Books or Nov. 22nd, 2012       .

“Multiculturalism” has become a term of wholly uncertain meaning. Does it refer to a social reality? A set of policies? A normative theory? An ideology? Last year, I served on a Council of Europe working group with members from eight other European countries. We found that the word meant something different, and usually confused, in every country.

Some, though not all, of the policies described as “multiculturalism” over the last thirty years have had deeply illiberal consequences. They have allowed the development of “parallel societies” or “subsidized isolation.” Self-appointed community leaders have used public funds to reinforce cultural norms that would be unacceptable in the wider society, especially in relation to women. This has come close to official endorsement of cultural and moral relativism. A perverse effect has been to disempower the voices of the more liberal, secular, and critical minority within such ethnically or culturally defined minorities.

If, therefore, you want to elaborate a version of multiculturalism that is genuinely compatible with liberalism, as some distinguished political theorists do, you have to spend pages hedging the term about with clarifications and qualifications. By the time you have finished doing that, the justification for a separate new “ism” has evaporated. Why not simply talk about the form of modern liberalism suited—meaning also, developed and adapted—to the conditions of a contemporary, multicultural society? http://www.nybooks.com/articles/archives/2012/nov/22/freedom-diversity-liberal-pentagram/

One of the striking examples of successful integration occurs in American cities like New York, Chicago and LosAngeles. None, that I am aware of, had pro-active policies labeled multicultural, but liberal democratic policies were part of the environment which aided the integration of people with different religious, racial and ethnic backgrounds.

Of course there were hiccups along the way, and some remain, such as the sheriff of Maricopa County, Arizona, Joe Arpaio, himself a postmigrant of Italian born immigrants, who makes life difficult for newly arrived Arizona residents from the south. This is a state where the tourist economy would collapse if recent migrants, legal and illegal were expelled, making it difficult for Republicans to know which side they should be on. In Toronto, I understand that the construction industry would suffer, at least in good times, if illegal Italian migrants were not available.

Canada is a country which administers official French and English bilingualism with limited results – most French-Canadians speak English, but a pathetically small number of English-Canadians (myself included) outside of Quebec speak much French. Policies of bilingualism and multilingualism are of limited success. The same is true for other aspects of multicultural policies.

Particular issues related to multiculturalism in Canada, and there are many, will be discussed in a future posting.