Social Policy in Ontario

The ‘care economy’ is growing the government, whether conservatives like it or not

Posted on March 30, 2022 in Governance Debates

Source: TheStar.com — Authors: John Michael McGrath

TVO.org – Opinion
Mar 29, 2022.   By John Michael McGrath

Recent moves from both the federal and provincial governments show that the future will involve a whole lot of spending

It’s been a busy two days in provincial announcements, though things will get busier as we get closer and closer to the likely election day of June 2. On Monday, Ontario and Canada announced a six-year, $13.2 billion agreement to subsidize child care in this, the last province to sign onto the federal plan. Then, on Tuesday, the province announced its “Plan to Stay Open,” a series of measures designed to make the province at least a little more resilient in the face of either a new COVID-19 wave or future health-care challenges

The measures in the Plan to Stay Open™ are a bit of a grab bag; some are simply continuations of pandemic-era policies like wastewater surveillance, while others are new and come with decent-sized price stickers. For example, the province wants to grow the health-sector labour force, so to do that, it’s offering grants to nurses (to the tune of $142 million) to work in underserved communities. It’s also making permanent the wage top-ups for personal-support workers and direct-support workers, as well as expanding Ontario’s capacity to train new doctors in medical schools.

And we’re going to need new doctors, nurses, and PSWs because the province is also proposing to build 3,000 more hospital beds over the next 10 years. To borrow a phrase health-care advocates have been using recently, beds without staff are just furniture.

These are all important — if a little obvious and belated — responses to COVID-19, but long after this pandemic is behind us, Ontario will still need those hospital beds, nurses, and doctors.  Remember that just bringing Ontario up to the Canadian average of hospital beds per capita would mean a 50 per cent expansion of our existing system, and absolutely nothing being announced or seriously discussed right now would go that far. And the province’s population is aging, and that’s going to mean even more demand for hospital and long-term-care services. This is not really a problem we can find a clever solution to: the Ontarians who are going to need hospitals in the 2040s and 2050s already exist, but the beds don’t — or at least not enough of them.

What the child-care agreement and Ontario’s health-care spending outlook have in common is that they’re both part of what broadly gets called the “care economy”: we’re talking about how to meet people’s basic physical and developmental needs as they’re born and as they age. And it’s one of the most basic themes that elected governments will need to address for the decades ahead. What distinguishes the care economy from other macro-challenges that are either here or coming our way (like, say, climate change) is that because we’re talking about, quite literally, the care and attending of living breathing humans, we’re talking about work that is very labour-intensive and can’t be offshored to places where the labour standards are lower.

This is a problem for government because automation and off-shoring have been the go-to strategies to keep labour costs down in wealthy economies for half a century or more now. But the care economy is intrinsically hard to automate, and the political pressure tends to work in the opposite direction: the popular promises in Ontario elections include lowering the ratio of students to teachers, or raising the standard of care in long-term-care homes by hiring more nurses. There are very good and understandable reasons for that — the pandemic death toll has been measurably worse in Ontario because we treated long-term care as warehousing for the elderly — but these promises come with dollar figures attached to them.

This is a pretty bleak outlook for any conservatives who want to restrain the growth of government spending: The government isn’t just getting bigger. It’s getting bigger specifically in the areas where costs are most likely to grow over the long-term. Notably, Doug Ford can’t really be said to be one of those tight-fisted Tories anymore: if his party’s semi-official campaign slogan (the “party of yes”) means anything, it’s that cost alone is not going to stop the PCs from doing things. Which doesn’t make them progressives: they’ll continue to apply fiscal discipline to public education because, in short, they don’t like teacher unions. And, at the margins, they’ll probably spend less when they hold power than would the Liberal or NDP alternatives.

But we shouldn’t lose sight of the broader picture here: even the right-leaning premiers across this country (including Ford, the last to cross this finish line) have accepted a pretty substantial expansion of public spending on child care that they could have refused on principle but did not. National child care, having been implemented, stands a fair chance of being permanent now. And COVID-19 has spurred even penny-pinching provinces like Ontario to commit to substantial health-care capacity expansions.

Canada’s public sector is going to grow in coming decades, whether that money comes from federal coffers or provincial ones. Elections will change the margins but not the ultimate shape of things to come. The demands of the care economy won’t really allow for anything else.

https://www.tvo.org/article/the-care-economy-is-growing-the-government-whether-conservatives-like-it-or-not

Tags: budget, child care, economy, featured, Health, ideology, pharmaceutical, standard of living

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