The good news in Ontario's 2019 budget is that the province is slowing spending on medical care, which is the first step to freeing up funds to invest in programs like education, child care, and housing that can keep Ontarians from getting sick in the first place.
The bad news is Ontario isn't taking the second step to actually invest in those programs.
Here's a breakdown of the 2019 Ontario budget on six key topics:
Health doesn’t start with medical care. It starts where we are born, grow, live, work and age. These living conditions have a stronger influence on our health than medical care, which kicks in primarily to treat illness, rather than promote wellness.
As a result, many population health scholars worry when medical spending risks crowding out government investment in other social policies like education, childcare, housing, poverty-reduction, etc.
The risk is particularly worrisome when physician remuneration is a driving factor behind rising medical care budgets, as is the case in Canada. Canadian Institute for Health Information data show that the portion of total government spending allocated to physician remuneration is up 12% over the last decade – about $1.5 billion in Ontario alone. Simultaneously, the Canadian Medical Association resisted federal efforts to close tax loopholes from which doctors benefit, which most other Canadians do not.
While it may appear ironic, Premier Ford’s first budget actually lays groundwork for healthier spending by slowing the rate at which medical care will grow in the next years. While the previous government raised medical spending by 5% annually in its last years in office, faster than the economy grew, the Ford government plans to increase medical spending around 2%, less than the economy is predicted to grow. As a result, Premier Ford’s budget leaves more fiscal capacity to invest in policies that promote well-being and prevent illness.
This is worth toasting over a drink at 9am, which the budget now makes possible in Ontario bars.
Alas, the Premier squanders this fiscal capacity. Rather than invest more in social policies that promote health, his plan proposes to cut $2.4 billion from annual expenditures on children’s and social services by the end of his mandate, along with another $1.3 billion from grade school, and $1 billion from postsecondary (after adjusting for inflation). College, trades and university students have particular reason to be frustrated in Ontario, where postsecondary investments per person under age 45 are now barely half the comparable investment in BC.
Despite these cuts, the Ford government won’t balance its books during its first term in office. Annual interest payments on government debt will rise by $1.4 billion, after inflation. In effect, the Ford government is swapping larger interest payments for social spending cuts. That’s not a recipe for health promotion.
Deficits persist throughout Premier Ford’s first mandate because his plan doesn’t collect the revenue necessary to cover spending, kicking the fiscal can down the road to younger Canadians and future generations.
His now (in)famous decision to eliminate Ontario’s carbon-cap-and-trade system is particularly ironic. Not only does it impede the path to balanced budgets by $2 billion a year, it exacerbates the environmental debts inflicted on younger Canadians. It ignores that the World Health Organization now identifies extreme weather associated with climate change with the greatest risks to human health in the 21st century.
The Premier may point to his new child care tax credit for good headlines. But it is weak child care policy. Research shows a high quality, affordable child care system in Ontario will require another $3 billion in annual investment. The Ford tax credit invests $390 million. All his talk of families getting up to $6,000 a year per child obscures the fine print in his budget that anticipates a typical family will get $1,250 – not even a month of child care fees in many cities.
For a budget that promises to make life more affordable, the Premier’s plan contains little to reconnect home prices to local earnings. Sure, the Premier rightly points out that supply shortages contribute to higher prices, and promises to cut “red tape” that may impede development. But there is little mention of how to help local mayors overcome the NIMBY’ism that obstructs density.
Plus the housing budget is cut by $366 million, and overlooks opportunities to reduce harmful demand, like investors who keep homes empty or operate entire units as short-term rentals. The Premier also reinstituted the possibility for limitless rent-increases in new rental supply. This means he abandoned the search for reasonable middle ground between rental business profitability so more units get built, while protecting renters from unsustainable rent hikes.
If his budget really were “for the people,” the Ford government slogan, it would include a comprehensive strategy to restore housing affordability, forever. When we get one, I’ll be the first to celebrate at one of the tailgate parties this budget makes easier to host!