Public-Private Partnerships Redux
Sunday August 28th 2005, 1:17 pm
Filed under: Canadian Politics

There is a lot of misinformation and rhetoric from both sides of the P3 public-private partnership debate (i.e. pro- and anti-privatization). The problem is that neither side acknowledges that there are pros and cons to both scenarios (public vs. private financing). Few people are willing to lay out all the facts and let people make up their own minds.

Personally, I don’t think the rationale for involving the private sector is because it will cost less overall. I think the rationale is that Ontario needs to spread its infrastructure costs over a longer period of time, rather than all at once, all up front. I’ve searched long and hard for NDP plans for infrastructure renewal but from what I understand, our only plan is to simply borrow more money.

Yes, public borrowing costs less in the long-run, but the problem we face at present is one of cashflow, not of long-term cost. Sure, we can borrow the money now, but it likely means sacrificing spending in other arenas or running up U.S.-style deficits. Deficit spending now-and-then is OK – we all do that for key life events (mortgage, student loans, etc) – but a perpetual “borrow-and-spend” model is unsustainable. Think about it: in the past 12 years alone, Ontario’s debt has grown from $50 billion to $150 billion – the interest on that debt growing from $4.2 billion to $9.6 billion/year – almost as much as Ontario spends on Education ($10.5 billion) and accounting for $1 out of every $8 spent – and that’s without any significant infrastructure renewal. If we continue to borrow at this rate (or, more accurately, borrow at an accelerated rate), we will soon spend more in interest than on critical social programs. It creates a vicious cycle – because the more we borrow, the less “productive” capital we have to spend after interest charges are subtracted. This in turn leads to cutbacks in services – not good.

I think it is disingenuous to suggest that avoiding large deficits is merely a “political choice” (and thus has no bearing on financial realities), as has been suggested. Any government that adheres to the principles of ‘good governance’ should recognize that it is unjust to pass the burden of unsustainable debt to our kids just so that we can build hospitals for aging baby boomers in the present. Honestly, I don’t know what the solutions are, but experience suggests that massive deficits result in further cuts to social spending, which is the last thing we want.



Is it Time for Canada to Withdraw from NAFTA?
Friday August 26th 2005, 12:43 pm
Filed under: American Politics, Canadian Politics

Comments in today’s Ottawa Citizen by the new U.S. Ambassador to Canada surely increase the chance of an all-out trade war between Canada and the United States. Ambassador David Wilkins – who had been to Canada just once in 30 years prior to his appointment two months ago – typifies the Bush administration’s approach to foreign policy: bullying. Canadians, of course, are angry that the U.S. has decided to ignore a binding NAFTA ruling that calls on them to stop tariffs on Canadian softwood lumber and return the $5 billion of now-illegally seized funds to Canadian producers. The U.S. position is clear – they refuse to recognize rulings that are issued by non-U.S. bodies, despite the U.S. signing the NAFTA dispute resolution mechanisms as part of the trade agreement. According to the Citizen article, “It’s the position of the U.S. government, [Wilkins] said, that the 2004 ruling of the U.S. International Trade Commission, an independent federal agency, remains the binding decision in the case.” So, if a U.S. agency, responding to protectionist lobbying by the U.S. lumber groups – surely a conflict of interest if ever there is one — decides that Canada is subsidizing its lumber, then it must be so! Apparently, non-partisan WTO and NAFTA rulings to the contrary don’t sway an administration that has made a living out of hypocrisy and ignoring facts (let alone endorsing unilateral action, while having the nerve to tell the American people they aren’t). According to the Wilkins, the response of Canadian politicians are merely “emotional tirades”.

But Wilkins goes further – he suggested that the U.S. will punish Canada even more if it doesn’t bend to U.S. demands. “I don’t think we need to go down another avenue, but we could,” Mr. Wilkins warned. “We could start talking about import barriers by Canada on certain goods, like dairy and egg products and things of that nature, and broadcast regulations that are exempt from NAFTA.” Suggesting they will force the Canadian government to remove Canadian-content broadcast rules is perhaps the easiest way of rallying Canadians against U.S. bullying tactics. Let’s be clear: the U.S. goal is to force the Canadian government to sell its forests to private interests, instead of charging logging companies for their use. This would open Canada’s forests to American ownership and weaken Canada share of the U.S. softwood market.

Peter Donolo’s solution to the softwood problem is to abandon the rule of law (the legalities of trade) in favor of Canadian meddling into the insidious U.S. lobbying – to build up allies in Congress and with U.S. consumers, since the U.S. only listens to Americans. (Note: you may have to access Donolo’s article by searching ‘Peter Donolo’ at http://news.google.com instead of directly from the Globe and Mail). I’ve got to agree with Greg’s comments over at Sinister Thoughts about it being a slippery slope.

Even the people who helped negotiate NAFTA say the U.S. is not living up to its obligations. They recommend retaliation.

Canadian Prime Minster Paul Martin calls the U.S. position untenable. In fact, it is so untenable that it threatens the entire North American Free Trade Agreement. Industry Minister David Emerson is sticking to his guns, asking Canadians if they are going to allow “the bully to basically mop the floor with us?” Former Foreign Minister Lloyd Axworthy in a Toronto Star op-ed piece characterized the U.S. administrations dealings like this: “The reality is that we are dealing with an American political system currently steeped in the ideology of “empire.” It recognizes few rules, adheres only to those treaties that are expedient to basic interests, and believes that the only political currency that counts is the exercise of raw power.” He recommends withdrawing from NAFTA and relying on the WTO. This on the heels of his pithy open letter to U.S. Secretary of State Condi Rice a couple months ago.

Following the whole Devil’s Lake controversy, it is clear the U.S. is not interested in living up to its international obligations. I laughed at Brett Lamb’s reference to Darth Vader’s famous line: “I’ve Altered the Deal, Pray I Don’t Alter It Anymore” (can’t you just see Dick Cheney saying that to the Canadians?). What seemed so unlikely a year ago, is now being seriously debated among Canadians: Should we withdraw from NAFTA? Given the kind of bad faith the Bush administration has displayed, it may be time to forego the ineffectiveness of the bi-lateral trade agreement.



P3 Hospitals in Ontario: A Closer Look
Thursday August 25th 2005, 5:56 pm
Filed under: - Healthcare, Canadian Politics

Another week, another disturbing flip-flop by Ontario Premier Dalton McGuinty – this time on the issue of P3 hospitals (public private partnerships). McGuinty specifically campaigned on reversing the Tory move towards P3s for hospital construction (stopping the “Americanization of our hospitals” he said), but like so many campaign promises, McGuinty is unrepentant in his willingness to break them. (In fairness, he is in a bind given that the previous Tory government claimed the deficit would be only half of the $5.6 billion it turned out to be).

So what’s all the fuss about P3 hospitals? Well, it boils down to the same old debate — privatization vs. more government spending. P3 advocates say it is the only way to meet the infrastructure demands for the Province — that it provides cheap (in the short term), fast and efficient construction of hospitals. Anti-privatization forces reject it on ideological grounds — i.e. private companies should have no involvement in healthcare — period.

Given my inclination to be skeptical of those extolling magical benefits of privatization — and equally skeptical of those driven by rhetoric not facts — I set out to learn more about the P3 arrangements being proposed by the Ontario government. One of the first things I learned was that there is wide variety of arrangements that fall under the broad P3 category, each with vast differences as to the level of private involvement and thus each with vastly different consequences for retaining public sector control of services. There are many arrangements out there – but there seem to be three basic categories of P3s:

1) Privately Built and Operated: this is the most privatized form of P3 and one that critics fear the most. Under these arrangements the private sector finances, builds and operates the hospital — doctors, nurses and technicians would be employed by the private entity. It is easy to see how this could lead quite quickly to private healthcare, since the hospital would likely be able to charge fees for certain procedures. Allowing these kind of facilities is, in effect, allowing full privately delivered healthcare. As such, this is not a good option for Ontario and critics are right to oppose this kind of privatization.

2) Privately Built and Leased to the Public Sector: this is a fairly standard practice in the private sector – essentially like an office building, that has a tenant signed up from the beginning (so they can dictate to the developer how they want their spaces to work). Under this arrangement, the private entity simply provides the facilities, but employees are brought in by the public sector (or, like many university hospitals, a non-profit board). The public sector or board makes annual payments to the private entity. In most cases, the private entity owns the land and hospital, but it is also possible for the pubic sector to do a ‘land lease’. In this case, the public sector retains ownership of the land, but leases it to the private entity for a lengthy period (99-years is common) who develops it, and, in turn, leases the finish product to the public sector or hospital board. This is a common arrangement with various kinds of real estate in London (UK) or New York. In these cases, after the 99-year lease is up, the property, together with its improvements (i.e. the hospital) reverts to the original owner (i.e. the public sector). Typically, it is the private entity’s responsibility to ensure the building is adequately mantained and arrangements can be made to cancel the lease if they do not perform.

3) Privately Built, Leased to the Public Sector, but with the Public Sector Building Equity in the Property: While details are sketchy, it appears this is the kind of private-sector involvement that Ontario envisions. This is effectively like #2, where the public sector finances and leases the hospital, but whereby the lease also includes an equity payment. In effect, it’s like mortgage – they are paying part of the principle cost slowly over time. This results in the hospital reverting to the public sector much more quickly than in #2, say, in 20 years instead of 100. The advantage is obvious: instead of paying the entire cost of a couple hospitals up-front, you can building scores of hospitals up-front and pay for them slowly over time. It should be noted that all medical services will continue to be provided by the public sector or hospital boards as per usual (I believe Ontario is playing with the ideal of allowing the public sector to look after maintenance of the building — janitorial staff, etc — this is consistent with the way typical real estate deals like this work — but it need not be the case — the contract could easily be written to allow the tenant — the public sector — to look after such services, thus ensuring those jobs stay unionized).

In all cases, the private sector finances and builds the hospital. They differ, however, in that in case #2, the hospital reverts back to the public sector after a lengthy period. In case #3, the hospital reverts back to the public sector in a shorter period. Critic say that, since private companies are only interested in profit, they will cut corners and the building will be sub-standard. In my experience as an architect, institutions (universities, museums, etc) hire construction managers to constantly monitor construction to ensure the contractor is meeting the specifications outlined by the client. There is no reason to believe the public sector, as the client, would not follow suit. The key — and this would be true with or without private sector involvement – is to have very detailed plans and specifications for the project (otherwise, the constractor will say it is an extra), and to minimize changes along the way.

Critics also warn that fully privatized hospitals means private jobs, often resulting in lower wages or fewer benefits or worse working conditions (longer hours, fewer holidays, etc). This is a justified critique, but it only applies to case #1.

Critics also say that, since the public sector can borrow money at lower interest rates (since they typically have much better credit ratings, or can issue tax-exempt bonds), the cost of any private sector involvement will be higher. This is probably true, but the question at hand is whether the marginally higher interest charge is offset by the advantage of paying for a large amount of infrastructure over time. The analogy is a mortgage — if you put more down up-front, your interest charges will be lower, but you either not be able to afford as nice a place or your other finances will be heavilty burdened.

Critics also suggest that, in the long run, the government will end up paying more than if it had just built the hospital itself. I think this is also a valid argument, but it doesn’t accurately reflect the situation. It’s like the different between owning vs. leasing a car. Leasing a car results in significantly lower monthly payments, allowing you to buy a car that you couldn’t normally afford, or simply lowering your auto costs so you can spend the extra money on other things (or save it!). In Ontario’s case, the choice is whether to build the 66 hospitals it needs now and pay for them over the next 20 years, or whether to build 4 now paying for them up-front.

So, as with most things, when you do some digging, you learn new things. What I learned was that some kinds of privatization are very bad, particularly for key public services such as healthcare. However, in other cases — and in fact, if I understand correctly, in the arrangements the Ontario government is pursuing — the private sector involvement has nothing to do with the delivery of healthcare. It is purely a real estate deal, to allow the province to build the hospitals it needs now and pay for it over a longer period of time. This allows it to spread its infrastructure investment out over the long haul (of course, one could criticize all the previous Ontario governments for so badly neglecting the need for so many years — why, for example, didn’t we gradually build new hospitals over time?).

If the delivery of health services remains public and the public sector is simply leasing the building (and eventually acquiring ownership of it after 20 years), then there is no reason to fear. If you add up the cost of the payments over the long haul, it might cost the government more money than paying up-front for the hospitals, but any reasonable person can understand that you can’t make up for years of neglect all at once. So the choice is building the hospitals we need now using the leasing strategy or building what we can afford to by paying the whole cost up-front as we go. And given the neglect over the past couple decades, it seems more important that we reinvest now rather than wait. Once the facility shortfall has been met (i.e. the 66 hospitals are built), if politicians are willing to make the planned investments going forward – to not neglect them for 40 years — we can return to building public facilities in the usual way.



August 22, 2005 Election Update: Liberals Near Majority
Wednesday August 24th 2005, 7:14 am
Filed under: - 2006 Canada Election, Canadian Politics

A new Ipsos-Reid Poll (Aug 22) shows the Liberals nearly majority government territory. It is all bad news for the Conservatives and the not great news for the NDP or Bloc Quebecois either. As per usual, I have entered this data into my election model to forecast the corresponding seat counts — see my 2005-06 Election Forecast page for full details. You can also compare this to my last update. The nationwide summary is as follows (you can see a riding-by-riding breakdown at the above webpage):

2005 PREDICTED RESULTS – 8/22/05
LIB
CPC
NDP
GRN
BQ
OTH
TOTAL SEATS
150
71
27
0
60
0
% OF SEATS
48.7%
23.1%
8.8%
0%
19.5%
0%



Not Hillary: Democrats Should Look for Conviction, Character and Executive Experience
Monday August 22nd 2005, 4:40 pm
Filed under: - Democrats, American Politics

Hillary Clinton The Democrats cannot be serious about running Hillary Clinton for President in 2008, can they? According to an article in Maclean’s, Democrats endorse Clinton’s candidacy (more than the next three combined — John Kerry, John Edwards and Joseph Biden) but the key question is whether Clinton can appeal more broadly. I just cannot see it. Here’s why:

Mark Warner As policy positions between Republicans and Democrats become increasingly the same, voters will choose the candidate who best demonstrates conviction and integrity (let’s call it, for lack of a better term, ‘character’). This is effectively what happened in 2004. With little difference between Bush and Kerry on key issues, voters chose who they felt was the more honest person. And make no mistake: Democrats are converging with the Republicans on key policy positions. It began with Bill Clinton’s centrist views (he seemed to have the balance about right) and accelerated with Gore and Kerry. Hillary Clinton would continue the trend. And most importantly, Hillary’s chameleon from liberal to “Republican light” will be easy to attack on the key virtues of conviction and integrity. It will be easy for Republicans to demonstrate Hillary’s ‘flip-flopping’ even more so than John Kerry’s.

Evan Bayh Instead of running a candidate who is pretending to be a “Republican light”, Democrats should run a person of character – someone who has consistently stood up and proudly declared themselves in favor of moderate but progressive reform, someone who can clearly articulate their positions, is fiscally responsible and someone who will give Americans a real choice on issues of policy (i.e. policies that differ from Republicans). And, importantly, the Democratic candidate should have experience in the executive branch. Think about it – every single President since JFK (some 45 years by the time 2008 rolls around) was either Vice-President or a Governor. Somehow I don’t think Hillary being an ex-President’s wife will be viewed in the same light as someone who was actually elected on a ballot.

Bill Richardson So who fits the bill? A person like Virginia Governor Mark Warner comes to mind – someone who led his state out of financial crisis, added thousands of jobs and recognized to have vastly improved his state’s education system. Popular New Mexico Governor Bill Richardson is another possibility. As is former Indiana Governor and current Senator Evan Bayh. The difference with these three people is that they are moderates, unlike Clinton who is trying to look like a moderate even though her past statements and voting record say otherwise. Real policy alternatives together with conviction and integrity – these are the qualities for which Democrats should be looking.



Cindy Sheehan and Michaelle Jean: When the Media Values Style Over Substance
Sunday August 21st 2005, 9:53 pm
Filed under: American Politics, Canadian Politics

Two stories currently making the rounds serve to illustrate how style wins out over substance in the mainstream media. In Canada, there is the non-story of Michaelle Jean being appointed the Governor-General and many questioning whether she and her husband are really Quebec separatists. In the U.S., there is the non-story of Cindy Sheehan, whose son was killed in Iraq and who is now camping outside of George W. Bush’s ranch seeking a second audience to vent her anger.

It boggles the mind to think how little coverage the Downing Street Memos received compared to these personal stories. The memos document how the U.S. administration intentionally cooked up evidence to justify the Iraq war. Call me crazy (and with respect to Cindy’s loss and those in Canada sensitive to Quebec favoritism) but I would have thought the Memos would be more important. But with child-like attention spans, major media outlets apparently decided that everyday people didn’t want to hear about the Memos, but would instead enjoy a poignant story of a grieving mother and Quebec reporter being pulled by the Left and Right for partisan purposes.

So we are subjected to the daily mudslinging of American liberals and conservatives, each trying to use Sheehan as an example of something larger. Liberals want to use her to illustrate how disconnected George W. Bush is from the people. Conservatives want to show that Sheehan’s actions demonstrate the desperation of the American Left. Now, a father whose son died in Iraq has set up opposite Sheehan’s camp in Crawford to show his support for Bush. So we have competing camps: “Camp Casey” vs. “Camp Qualls”. All of this makes for good TV, but serves no purpose. For liberals, it is protest by proxy – rather than actually taking to the streets to protest the War, liberals instead blindly support Sheehan without questioning her motives (and question them we must, given that she previously admitted that Bush did give her comfort when he met with her the first time). Conservatives, for their part, continue to question the patriotism of those that question the War, claiming it emboldens the enemy. Both sides have ramped up the rhetoric, with Conservatives accusing Sheehan of anti-Semitism (because she suggested that the War was more about Israeli security than American security). Other conservatives like Bill O’Reilly (oh, I forgot, he’s really a moderate…oh no, he’s really just a ‘traditionalist’, whatever that means) discredit Sheehan by linking her to Michael Moore (and by proxy the radical Left).

Likewise, Canadian liberals and conservatives want to use Jean as an example of something larger. Liberals want to prop her up as an example of Canadian multiculturalism – a Haitian immigrant and the first black Governor-General. Conservatives want to use Jean as (yet another) example of Western alienation – another case of eastern elites currying favor to Quebeckers at the expense of the West. Again, it makes for good TV, but serves no purpose other than to further divide people. Jean, for her part, issued a statement affirming her commitment to Canada. (As someone who lived in Quebec for five years, I know that it is possible to be pro-Quebec and pro-Canada). Not good enough for Conservatives. Not that it matters anyway, since most Canadians don’t think about the Governor-General at all, since it is just a symbolic position.

Both stories are anecdotal light drama, not substantive investigative reporting. Yet, media outlets live for this kind of personalization of political tensions. And we just eat it up.



Paseo Colorado: Privatized Public Space in Pasadena
Wednesday August 17th 2005, 8:32 am
Filed under: Architecture, Los Angeles, Urban Design

We made the trek out to Pasadena this past weekend. It’s a nice place and quite un-L.A. – 19th century urban fabric, walk-able, lots of shops & restaurants and highly urban. As you walk down the main drag, Colorado Blvd, just past two fairly un-urban highrises (set back from the street, on plinths with no ground-level retail), you come across Paseo Colorado, a 3-block, 15-acre, mega-development that, on first-glance, appears to imitate the urban character of the rest of Colorado Blvd.

In some respects, it is reasonably successful, with shops along Colorado Blvd and incorporating a 19th century building into the complex. One big positive is the incorporation of 400 units of housing into the western end of the complex. Another positive is the re-creation of the axial relationship with Pasadena’s Civic Center, just north of the site. Unfortunately, the central space that re-creates that axis is pretty dreadful (this axis – the “Garfield Promenade” – was originally slated to be just 58 feet, but the City required the developer to make it 78 feet to reflect the original Garfield Street).

Given the hype surrounding it, I had high expectations for Paseo Colorado. Unforunately, on balance, I was disappointed. Unlike The Grove, which has some pretensions of being a real public place, Paseo Colorado – which is billed as an “open-air urban village” – feels much more like a standard mall, with anchor stores on the ends, two levels of shops complete with bridges from one side to the other. The only difference is that it is outdoors – not so much new as it is retro, emulating some of the first malls ever built (except it is two levels). Its outdoor spaces are not well-designed and the whole complex uses more-or-less the same materials. It is not well scaled to human proportions, thus it feels bigger and more commercial than necessary. There is no enough variation in the materials, which also have a cheap feel to them. So, nobody will be fooled into thinking it is anything but one large mall complex.

Despite claiming to replicate the traditional fabric of the surrounding area, it still brings people off the street into a large mall-like central spine, and the impact for on-street retail is obvious – I saw few people along Colorado Blvd, despite the presence of shops. Urban design is sometimes a subtle thing – and the urban design-challenged typically heap praise upon the project. By most economic accounts, it is successful, being 96% leased, fetching $400/s.f. rents and generating a modest amount of additional tax revenue for the city. But I can’t help but think that its financial success owes more to its location next to ‘Old Pasadena’ than to its banal design.



Healthcare Reform Must Move Beyond the Privatization vs. Public Spending Debate
Tuesday August 16th 2005, 8:49 am
Filed under: - Healthcare, Canadian Politics

The Supreme Court ruling earlier this summer, Alberta’s ‘third way’ healthcare proposals, new polls on Canadians’ changing attitudes towards healthcare and recent declarations by the Canadian Medical Association have all put healthcare reform back into the political spotlight.

Most reasonable people in Canada recognize that while its foundation is solid, changes to Medicare are necessary to improve care and ensure its sustainability. Universal health (along with universal education) is a pillar of Canadian society and identity, but we cannot be afraid to fine-tune the system to meet the changing needs of our society. Unfortunately, most want a quick fix. Right-wingers think the answer is expanding private care (under the banner of “choice”). Left-wingers think the answer is more government spending (under the banner of “equality”). Such “solutions” are merely accounting moves – shifting the burden from either individuals or the government rather than acknowledging systemic problems of the system. Canada spends 9.9% of its GDP on healthcare – comparable to most developed countries (for 2003, Australia = 9.5%, France = 9.5%, and the OECD average is 8.6%; the U.S. is the highest at 15.3%). Instead of simply moving money around, reforms must focus on increasing the utility of the money already spent while, of course, increasing the quality of care. So what reforms would increase utility and care? Here are some that I have found to be the most plausible:

1) Electronic Medical Records: This would allow doctors and nurses to instantly see a patient’s medical history, allergies, prescriptions (past and present), likely cutting the time taken to take a medical history, eliminate duplicate tests and avoid harmful drug interactions.

2) Recognize Foreign Credentials: More doctors, nurses and technicians in under-served regions would cut down wait times, which often exacerbate health problems. We might also see fewer Canadian-trained doctors leaving for the U.S., since more doctors means less workloads for each (many doctors leave not because of they are attracted by higher salaries but because they are over-worked).

3) Wait Times Database: an electronic database of wait times at hospitals and institutions nation-wide would enable patients and doctors to see if nearby (or even in other provinces) could accommodate their surgery more quickly than those in their immediate vicinity. This would ensure immediate care for those most in need and would even out wait lists across the country (thus bringing down maximum wait times). Moreover, as recommended by the Canadian Medical Association, we need to establish reasonable wait times (though it needs to be expanded beyond the five areas they studied). If space cannot be found within the public system across the country, Medicare should pay for that patient’s care at a private institution. Given the other measures recommended here, I would hope this would be a rare circumstance.

4) Medical Technology Fund: Instead of simply paying capital costs for new MRI and CT machines, a portion of health spending could be diverted to a technology fund that would be invested and grow over time. This would establish a sustainable pool of funds from which the government could tap periodically to purchase (or rent) the latest medical technology.

5) Drug Purchasing and Patent Reform: using the collective buying power of the federal government to buy drugs results in lower overall average costs. While easier said than done (due to the WTO and TRIPS, the Trade Related Aspects of Intellectual Property Rights agreement), we need to lower the 20-year protection of patents. That’s a very long time to have a monopoly of research.

6) Sustainable Funding: like most countries, Canada is facing an unsustainable situation with a declining workforce and an aging population. This means that more people are tapping a system that is funded by fewer and fewer people. Health funding in Canada could be set up to mirror the Canadian Pension Plan – which a dedicated (but progressive) payroll tax into which current workers pay (as opposed to come out of general revenues), a portion of which would be invested and grow over time. This would give the system a ‘cushion’ for the upcoming wave of baby-boomers who are due to retire.

7) More Spaces in Canadian Medical Schools: Canada needs more doctors, nurses and specialists – we have only about 2 doctors per 1000 people, while the OECD average is about 3. Many people have suggested that we need in the neighborhood of 3000 new doctors each year in order to replace those leaving practice. Currently there are only 2200 spaces in Canadian med schools (and about 2000 remain in Canada). The ‘gap’ between 3000 and 2000 is roughly the same as the gap between the OECD average of 3 and 2 doctors per 1000. Adding 800 new spaces at med schools across the country would close this gap. There is no shortage of bright young people who currently can’t get into med school because of a lack of positions.

8) Non-Profit Community Care: most Medicare supporters use the terms private and for-profit interchangeably. This is not entirely true. It is entirely possible to deliver care privately through the non-profit sector. This need not be the horror that is suggested. We should embrace the growth of local non-profit community-centered clinics that adhere to the principles of the Canada Health Act and can provide specific services at no cost.

None of the above recommendations are particularly revolutionary. They aim to increase the effectiveness of the current system without cutting services and without increasing spending (it is easy to make dollars go further if you cut covered services, and it is equally easy to increase services by simply spending more). I believe Medicare is fundamentally sound, but needs several systemic adjustments in order to ensure its sustainability for the future and to increase its responsiveness in the present. If we could move beyond the politicized “more spending” vs. “more privatization” debate that has produced deadlock, we might actually be able to improve upon the existing system.



A Tragedy of the Commons: A Case for User-Pay Freeways in Los Angeles
Monday August 15th 2005, 6:58 am
Filed under: Los Angeles, Urban Planning

Garrett Hardin’s 1968 essay “The Tragedy of the Commons” has been used by people on the right and the left to simultaneously explain why we must privatize public goods (the right) or why we must ensure their sustainability (the left). The theory is that if a public good is free and available for all to use (like an English ‘commons’ as in Hardin’s analogy), individuals will act in their own self interest, use it without regard to others, thus resulting in a tragic end (in his case, the commons land is over-farmed, becomes unusable and the villagers perish). But Hardin did not fully appreciate the ability of commoners to adapt to changing circumstances. Faced with the prospect of overuse, English commoners ‘stinted’ the land – put in place temporary measures to protect the common good (for example, limiting the number of cows each farmer could graze). The good folks of medieval England could appreciate the collective benefit of such a public good, but at the same time acted to protect that resource when it was threatened.

If only the good people of Los Angeles could be so wise. You see, I think that the ‘free’ use of L.A.’s extensive freeways is a classic ‘tragedy of the commons’. L.A. is a fantastic place, but for a great many people, traffic congestion and environmental degradation has reached critical levels. Being a polycentric city with people driving to-and-fro between scores of activity centers, L.A. and its environs are difficult to serve with mass transit. For many people, driving is the only time-effective way of moving around the city. But there’s one big problem: using the freeways is viewed as a ‘free’ good (like the English commons). Obviously, in a democratic society, people should be able to do what they want, including drive the car around town. However, I do think that we need to start paying the full cost of the impacts of driving, either on the health, environment or the physical infrastructure (and no, the pittance of tax dollars that goes towards transportation doesn’t even begin to pay those costs).

English commoners understood that temporary measures were necessary to avert a disaster. Surely Angelinos have the same ‘common’ sense (so to speak). One such temporary measure would be to install camera-based tolling of the freeway system, using, for example, the technology of Toronto’s Highway 407. It’s fabulous – there are no tollbooths, no stopping or slowing down. It’s simple: as you enter the freeway, a camera photographs your license plate and it is place and time-coded. The same thing happens upon exiting. You are then sent a bill based on the distance traveled. Rates are variable depending on the time of day you use the freeway — peak times (morning and afternoon commutes) cost more.

In Toronto, the 407 is privately-run; whether L.A.’s toll system is privately or publicly run is not the main debate here. I would be willing to remove all State funding for L.A. freeways and give people the equivalent back in the form of a tax cut. And I would do that because I think that we can generate more revenue with a user-pay system. You use it, you pay for it. And – importantly – the tolls could be split into equal funds that re-invest in highway maintenance (to fix the dreadful state of the roads), mass transit, and mitigation for health and environmental impacts caused by driving. Of course, as with all things in a polarized society, nobody would accept such a reasonable suggestion. Right-wingers will deplore the additional ‘tax’ on driving and left-wingers will deplore the effects this will have on low-income folks who are forced to live in lower-cost areas on the city’s fringe. No politician will have the courage to look beyond their short-term re-election campaign. But, in order to avert a ‘tragedy of the commons’, it is sometimes necessary to make sacrifices in the short-term in order to preserve our quality of life for the long term. English commoners understood this. It is time for us to use the common sense that our commoner ancestors instilled in us.



Playing the Blame Game Won’t Stop Gangs or Gun Violence in Toronto
Sunday August 14th 2005, 11:37 am
Filed under: Canadian Politics, Toronto

Surely one of the most dim-witted editorials on the recent spat of gun violence in Toronto has to be Rondi Adamson’s in today’s Toronto Star. While marginally better, Adamson’s nemesis, Linda McQuaig, gives more-or-less the opposite argument. While I appreciate the Star giving a voice to ‘both sides’ of various issues (as though only two exist), the Adamson/McQuaig pen battle illustrates how ideologues favor clarity over reality; unfortunately, these editorials dumb down the debate. To right-wingers (like Adamson), the simple ‘solution’ is more police. To left-wingers (like McQuaig), the simple ‘solution’ is more social programming. And this debate isn’t just in the mainstream press, either. Take, for example, Warren Kinsella’s recent attacks on Toronto Mayor David Miller because he believes Miller is “soft on crime” (he would prefer his friend and Ontario conservative leader John Tory, who lost the mayor race to Miller). While other bloggers like Brett Lamb have come to Miller’s defense.

I must say, I have been unimpressed with most of these arguments. Adamson says that “criminals just don’t obey the law” and that “’American guns’ are no more threatening than any other variety”, thus begging the entire question on guns and gun control. McQuaig concludes by simply blaming rising gun crimes on conservative tax cuts. Kinsella claims that Miller sees crime as “an invention of the Fraser Institute… a fictional right-wing construct… a spin line.” And Lamb, for his part, explains gun crime violence as a “sign that the neoconservative policies and attitudes of past governments”, namely the Tory decision to amalgamate Toronto.

Such commentaries simply play the blame game — an attempt to clarify who is at fault without acknowledging the causes of gangs and gun violence are so varied that no one thing is to blame and no one person or program can solve it. And, it should be obvious to anyone that like any problems, you need to treat both the cause and the symptoms. Surely, poverty is a factor. And surely the lack of stable and positive role models on kids contributes to their choice to join gangs. So, clearly, social programs can help. Access to handguns is an obvious factor, so making it as difficult as we can to get a hold of one surely is a wise course of action (either by making them extremely costly at the source, tighter security at the U.S. border, by requiring background checks at least via the legal route, etc). Rising crime stigmatizes neighborhoods, which only empowers gangs further (since those neighborhoods become marked as their turf). So, clearly a greater police presence is necessary to ensure that public space is not claimed by any one group, but a right for all citizens. And yes, the Mayor must lead – go to the trouble spots, talk to people, see what they need from the city to combat the problem (i.e. it isn’t just a photo-op). Even city planners can help by directing, to the extent possible, re-investment and development towards susceptible areas to counteract the stigmas.

So, in multiple ways, government (at various levels and in various ways) can help. But the problem of gangs and violence also needs to be something that the affected communities themselves want to solve. It is difficult enough to just get by in troubled neighborhoods, but community leaders must organize to ensure gangs aren’t passively accepted (either because they sympathize with their anger at those that have better opportunities or because they like the quick money that results from crime). Responsibility and culpability must be shared by parents, community leaders, the police, the mayor, border agents, failing social programs, etc. And everyone must do there part to ensure the gangs and gun violence stops. Solve the problem because the only people who lose in the ‘blame game’ are those unfortunate enough to be in harm’s way.