A Doctor and a Realtor Drive to the Beer Store in an EV...
Post 42 | Strange Priorities
This post was prompted by a Globe & Mail article reporting that another 7000 residents in my childhood hometown of Sault Ste. Marie recently became doctorless – on the same day the Ontario government made a costly decision regarding beer retailing. Married with a recent Maclean’s article on private healthcare, it set some thoughts in motion around the concept of priorities - with Ontario in the spotlight.
Let’s kick off with some numbers.
$75 Billion | Ontario’s annual healthcare expenditure, representing 35% of total provincial budget
15,000 | Primary care physicians in Ontario serving a population of 15.6 million (a ratio of 1 doctor per 1040 residents)
15% (2.3 Million) | Estimated number of Ontario residents without a primary care doctor, projected to reach 25% (4.4 million) by 2026
19,000 | Estimated number of foreign trained physicians (13,000) and nurses (6000) living in Ontario who are not certified to practice
3.5 Million | Estimated Ontario housing shortage
200,000 | Estimated skilled trades job openings in Ontario over the next decade
82,000 | Number of licensed realtors in Ontario (a ratio of 1 agent for every 2 homes sold)
$225 Million | Ontario’s recently announced penalty payment to the Beer Store corporation for an 18 month early exit from an exclusivity agreement - to enable expansion of beer sales to 8500 additional retailers
5.3% | Estimated rate of alcohol deaths globally, not accounting for its contribution to dozens of health related ailments.
$9.4 Billion | Ontario’s total share of subsidies for three electrical vehicle (EV) plants to be built in the province
$1.4 Million | Ontario’s cost for each EV plant job, assuming the stated number of 6500 ever materializes
What a funky combination of data to throw at you -- but let’s see how it threads together.
To start, let’s acknowledge that money spent (though the favoured term these days is invested, despite how badly it gets wasted) is no guarantee of desirable outcomes. Throwing more funding at a program often just stokes the fire of inefficiency and waste. Our massive and escalating healthcare spend in Ontario, for example, has gifted us worsening physician shortages and lengthened wait times – with a backlog of 200,000 surgeries a year ago. So we know money is not the only prescription as we often lack efficiency and effectiveness.
To that end, last year’s Bill 60 was a positive structural move to expand the private care option in Ontario. The reflexive cry that we must protect universal public healthcare at all costs misses on many fronts and seems driven by a combination of nostalgia and union self-interest. In part, it ignores that diagnostics, hernias, colonoscopies & endoscopies, blood testing, dentistry, optometry, prescription drugs, mental health, MRIs and more have been conducted by private organizations for years. It shuts a blind eye to Quebec’s special status allowing direct pay for care to a degree that would shock those who believe we still have a single-tier system. And it misses the fact that Ontario, Alberta and BC have a long history of priority access or private clinics. Yet a majority of Canadians cling to the idea of single-tier health as a priority, while it crumbles around us through lack of effectiveness and affordability.
Despite attempted reforms in Ontario Health over the past years, little is demonstrably trickling down to our daily reality. We spend more, wait longer and get less. And because healthcare remains an impenetrable black box for the average person to understand, we are simply left to ask - why isn’t it working?
Specific to the doctor shortage, there are plenty of recommendations floating about -- increase nurse practitioners’ allowable duties and OHIP billing participation, increase multi-practitioner health team structures, reduce required doctor referrals to specialists, fast track accreditation for foreign trained professionals, increase medical school and residency capacity, reduce admin and insurance paperwork to redirect as much as 20% more physician time to patients, and much more.
Most of this is out of my bailiwick so I won’t opine on the best solutions, though they all seem entirely pragmatic. Where I land with certainty, however, is that solutions should not include more coordinated federal Health Canada programs like universal pharmacare or dentalcare. These move in precisely the wrong direction.
So how does a doctor shortage relate to realtors, beer and EVs?
Well it’s a bit roundabout, but stick with me. Viewed collectively it offers a peek into the clash between what we state to be our priorities, and our often conflicting actions.
By way of initial example - we hear daily of housing shortages, yet offer little more than lip service regarding the skilled tradespeople needed to build those houses. We have spent thirty years promoting the knowledge worker industry - tacitly demoting most other careers to lesser status and giving the trades also-ran billing. Our post-secondary institutions are bursting with relatively useless liberal arts programs funded with billions in taxpayer dollars, while we suffer chronic shortfalls in tradespeople entering careers that would drive productivity and increase standard of living.
Our federal government has abandoned our proud hewers of wood and drawers of water heritage - a term encapsulating how we built our economy on the natural resources bounty of Canada. They now do everything possible to distance us from that reality, even while we continue to sit on the most abundant resource pool in the world with its pent up economic and job development, based on global demand. One of Justin Trudeau’s early mawkish speeches at the World Economic Forum (WEF) encapsulated this perfectly when he declared, “My predecessor wanted you to know Canada for its resources. I want you to know Canadians for our resourcefulness” - whatever the hell that means.
Meanwhile, one of those resourceful knowledge worker jobs has become that of Realtor - a group that has ballooned in Ontario to 5.5 times more agents than doctors. Last year saw 82,000 realtors sell 160,000 homes while our doctor-Ontarian ratio sat at 1:1040. But like government jobs, real estate servicing is a non-asset producing industry that juices our GDP while contributing nothing to our productivity. Eliminate 85% of all agents and we’ll be fine. Reduce doctors by another 1% - not so good. Yet one keeps growing while the other is floundering.
Then we have Ontario throwing nearly $10 billion dollars at three foreign corporations to build electric vehicle components, while unable to mine many of the required metals that lay under our feet. Having written about electric vehicles and net zero in prior posts I will recap only - that we are betting the farm on a likely transitory technology, for vehicles that are showing anemic uptake, pushed more by a morality frenzy around net zero than clear outcomes, and where Canada’s ICE-to-EV net zero impact is maximally 0.15%. We could be using that money to organically develop in-demand jobs - doctors and trades for instance - for tens of thousands of dollars a pop, rather than millions each.
And finally, we painfully watch our province throw away a quarter of a billion dollars to expand beer access. And while previously noting that increased funds are no guarantee of good outcomes, imagine another $225 million toward healthcare or trades careers rather than this expensive political photo op. For starters, how about $4.5 million of that annually toward men’s PSA prostate cancer blood testing to help some of the 1600 Ontario men who will otherwise die annually from this manageable disease? And how about funding more apprentice programs to help existing trades businesses expand while simultaneously developing people into these careers - and building all those houses we need? The options are unlimited.
So let’s recap, shall we…
We have too many people selling too few homes, with too few people to build them, too little focus on the value of the careers to do so, and fewer people who can afford them - while spending massive dollars on sketchy industrial bets, to force us to drive in vehicles we don’t really want, to nearer beer stores that will help us drink more conveniently, which will worsen our health - while millions can’t access a doctor for that very health, partly because we’re wasting money on EVs and beer.
Strange priorities, indeed.
Stay tuned and stay pragmatic.
Excellently written. The situation we find ourselves increasingly in is both sad and pathetic. Where are our saviours going to come from??
Love it! Painfully accurate connecting such seemingly disparate things that are in fact so well connected … and written with wit. Bravo! 👏 👏👏