Northern Economist 2.0

Wednesday 17 January 2024

Reforming Thunder Bay City Council: The Journey Begins

 

It appears that Thunder Bay City Council has finally decided to get serious about looking at its size and composition with the move to appoint a six-member citizen committee that will lead a review process over the next year that might actually result in changes in time for the 2026 municipal election.  The committee will have a far-reaching mandate to explore the size of council, their status as full or part-time membership as well as the structure of the current at-large and ward hybrid model that has governed Thunder Bay municipal politics since the 1980s.  When Thunder Bay was created it 1970, it began with a mayor and 12 councillors elected evenly across four wards which was revised to seven wards in 1976 and then took its current form of seven ward and five at large councillors in 1985.

 

This is coming about nearly three years after a previous council began to explore the issue and which ultimately generated this post which concluded: “it would be better if more of an effort was made to commission an independent arm’s length panel to review the situation and present options to council.”  Well, a committee has finally been appointed by City Council and is made up of six members.  The committee is chaired by former councillor Rebecca Johnson and vice-chaired by another former councillor Cody Fraser as well as citizens Riley Burton, Wayne Bahlieda, Heather McLeod and Carlos Santander-Maturana. 

 

The committee will conduct a two-phase consultation with the public.  The first phase includes a survey to ascertain how the public engages and interacts with City Council and examining if they have a desire to see changes to the composition of council. Phase two will include discussion and consultation with the public on potential options that could result in changes to council composition and/or the ward boundaries.  The committee will then take all of this information and “provide a report to City council with recommended changes to the composition of council or the ward system next year”.

 

The wording on the City of Thunder Bay website seems to imply that there will be changes and the chair of the committee in a TBTNewswatch story seemed to say that she believed that this time there were going to be changes made.  Indeed, phase two already says it is about options for change even before phase one has ascertained a desire for change  This is somewhat disconcerting because it suggests that someone or somebody somewhere has already decided that changes will be made, and the only real question is what those changes might be.  When put alongside a less than transparent process for committee member selection that were apparently “carefully chosen” and a survey that requires registration, one begins to wonder if the result is already a foregone conclusion.  Of course, one should be charitable on an issue that has reared its head up numerous times over the years and has only finally resulted in a serious attempt to examine it.  Given the length of time it has taken to get to this point, I suppose one should simply be grateful a committee has been struck even if the process seems akin to foxes guarding the hen house.

 

It is fair to ask what possibly an economist could contribute to a debate on municipal governance?  However, barring the reality that economists are municipal citizens too, it remains that economists are fully capable of examining the costs and benefits of institutional arrangements and their evolution as well as public finance aspects.  It is not an incursion into new territory to be staked out but rather an extension of what many institutional economists and economic historians already do.   In the case of the size, structure, composition and representativeness of the current institutional arrangement, there needs to be a framework for the decision making as well as an examination of what issues need to be addressed with the change.

 

A change in the current arrangements of municipal council represents an institutional change or innovation and such changes should be made if the perceived net benefits of the new arrangement exceed the net benefits of the previous one plus the costs of transitioning to a new arrangement – both social and economic costs.  It requires in the end an analysis of the current system and its benefits and costs not just economically but in terms of effectiveness in democratic representation and decision making as well as community spirit and engagement. 

 

What is not functioning under the current arrangement?  What could be improved?  What are the advantages of the current system of seven ward and five at-large representatives plus a mayor and what are its drawbacks?  In other words, what exactly are we trying to fix or improve.  What is driving the need to make changes to city council?  For example, simply being unable to get a consensus on building a new turf facility is not a reason to change the decision-making mechanism. Similarly, rancorous meetings are also not a reason to reform city council if the debate results in things getting done or poor decisions avoided.

 

Much of the debate in the past has focused on issues like ward councillors being too focused on their wards and not seeing the “bigger picture” when it comes to city issues.  Other times, there have been concerns that at-large councillors by not being tied to a ward and its needs were somehow shirking their duties by picking and choosing what they wanted to focus on.  Indeed, Thunder Bay politics at the municipal level has occasionally seemed like council consisted of a mayor, five mayors in waiting and seven dwarf councillors left to do a lot of the heavy lifting on local issues.  On the other hand, one could also argue that having five at large councillors allowed for citizens to go beyond their immediate ward councillor when lobbying if they felt they had not had their issue addressed.

 

And the hybrid system itself with two types of councillors is rather unique – why is it that Thunder Bay cannot have either a system of all ward councillors or all at large councillors?  What was the original purpose of going to a hybrid model and have those reasons shifted?  Then, there is the issue of the total number of councillors given the population size as on a per capita basis Thunder Bay probably has more councillors than many other cities in Ontario.  Burlington, for example, with a population nearly double that of Thunder Bay, has six ward councillors plus a mayor.  Kingston, on the other hand, which is one and a half times Thunder Bay’s population, has a mayor representing “the city as a whole” and twelve district councillors.

 

Perhaps fewer councillors but all full-time rather than the current part-time might make for better decision making.  However, that would likely mean a higher stipend and part of the argument for reducing the size of council is a belief that somehow there are going to be cost savings.  If you are indeed looking at cost savings in municipal government, reducing the number and salaries of councillors is merely symbolic as the real savings lie elsewhere. On the other hand, one can argue that being a councillor is about community service and the money should not matter.

 

Would having all councillors as ward councillors make the council too parochial as each seeks only to look after neighborhood concerns?  Or will having all at-large councillors undermine the position of mayor as all councillors can claim to have a city-wide mandate from the electorate?  Indeed, if all the councillors are at large, why elect a separate mayor at all?  Make the mayor the at-large councillor with the most votes.  Or, if we move to an all-at-large approach, will only high-profile individuals and financially better off individuals being able to run for council given that ward races can favour ward residents with close neighborhood ties while city wide campaigns are more expensive to mount? 

 

And all of this of course is intertwined with the issue about whether we need to or should redesign our ward system given the current imbalances in population across wards as populations in the city have shifted.  Should we go to eight or ten numbered as opposed to named wards with approximately equivalent populations, as well as a mayor?  Should the councillors be all at-large or all ward based or some new type of hybrid?  What should the borders of the new wards be?  Will changing the number of wards and councillors as well as redesigning borders lead to better democratic accountability?  More citizen involvement? And on top of all of this – do we want a first past the post system electing our councillors?  Ranked or weighted ballots – especially for at-large candidates?

 

 


 

As mentioned before, all of this is really not new territory for an economist.  Institutions and their quality are fundamental to successfully functioning economies.  Has Thunder Bay been hurt economically by its current municipal institutions? Indeed, one could in a moment of introspection go further and ask if amalgamation was responsible for the economic slowdown after 1970 given a monopoly one-city government replaced what were a set of competitive municipalities.  There can be a lot at stake here as change for the sake of change without understanding the reasons for change as well as the long-term ramifications can leave us worse off.  Borrowing from the words of our outgoing City Manager, if you “don’t know what you don’t know”, then how can you know that what you are doing is the best decision possible?  The committee indeed has its work cut out for it and one hopes that they are independently minded enough to be able to know what questions to ask, when to ask them and more importantly, when to suggest to do something and when to do nothing.

Sunday 17 November 2019

The Four Ages of Ontario Government Health Spending


Understanding the pressures and challenges facing Ontario’s health care system and in particular - provincial government health spending – requires an overview of the numbers.  The Canadian Institute for Health Information (CIHI) via its National Health Expenditure Database provides a wealth of information on health spending in Canada.  The 2019 edition of the National Health Expenditure release allows us to piece together a broad picture of where health spending in Ontario has been over the last few decades. 

Figure 1 on total health spending in Ontario provides a view of total and provincial government health spending over the period 1975 to 2019 (with 2018 and 2019 being estimates).  They show steadily rising spending.  Total health spending on health in Ontario was $4.4 billion in 1975 and has grown to an estimated $100.5 billion.  Meanwhile, over the same period provincial government health spending has grown from $3.1 billion to $63.4 billion.  The massive growth in health spending over time is part of the conventional wisdom that health spending is unsustainable.




However, these numbers are nominal totals and do not take into consideration population, inflation or economic growth which are all necessary to provide context for these numbers.  Between 1975 and 2019, provincial government health spending in Ontario grew 20-fold while GDP grew 13-fold, population grew 1.7-fold and prices 5-fold.  

Wednesday 13 November 2019

Ontario’s Health System is Undergoing Structural Change Again


Ontario is embarking on yet another transformation of its provincial government health care system with its creation of Ontario Health Teams which will replace the LHINs.  The LHINS (Local Health Integration Networks) were created in 2006 to create regionally integrated health delivery systems to essentially streamline services.  The move to a regional approach in Ontario at the time was a bit late given that most other provinces that had gone the regional/decentralization approach had done that in the 1990s and in the early 21st century began to move away from the approach.  This continual restructuring of health care service delivery in Canada has if anything been quite disruptive and we are now about to undergo another round of it in Ontario.

The LHINs were to have jurisdiction over hospitals, community care access centres, various community health services as well as mental health and addiction.  However, they were not given jurisdiction over physicians, public health, diagnostics or the provincial drug spending plans.  This made the LHINs only a partial health integration network and in the end that was probably their undoing as the seamless one stop shopping system of care never really fully emerged. 

 As for the OHTs which are going to replace the LHINS, according to the provincial news release, this is “an administrative step only and not a merger of the LHIN boundaries. Further, there will be no impact to patients' access to home and community care or long-term care placement as Ontarians continue to receive the care they need from the care providers they have built relationships with at the 14 LHINs. These changes are a means of streamlining the regional oversight as an interim measure as the government continues to work toward moving home and community care supports out of bureaucracy to integrate them with Ontario Health Teams.” The Ontario Health Teams will be responsible for all of a patient’s care including primary and emergency care, home and community care, palliative care, cancer care, residential long-term care and mental health and addiction services. 

An OHT is a team of health care providers working together to deliver at least three types of health services – the initial call expressed a preference for a minimum of primary care, hospitals, home care and community care.  The aim is to create a truly integrated health care system for Ontarians with seamless transitions.  How many of these teams will ultimately emerge will depend on the population size covered.  If there are about 250,000 people per health team – a not unreasonable number given the Northwest LHIN covers that amount – then there would be about 60 teams ultimately.  Eventually, if all of this pans out,  I suspect there will be anywhere from 50 to 70 of these teams covering the entire population of Ontario and they will report to a new centralized oversight agency – Ontario Health.  Given population aging and the impact of new technologies and drugs on health care costs, part of the goal will also be to contain rising costs by eliminating duplication streamlining transactions costs and thereby slowing the rate of provincial government expenditure growth.

How is all this going to go?  Will it be effective in improving services? Good questions.  We have been reforming health care for two decades in Canada to deal with access, coverage and sustainability of the system and all the same issues still seem to be there – physician shortages, long waits for services, hallway medicine – and total spending has still grown though spending growth has moderated over the last few years. Will this time be different? We will have to wait and see.  In the meantime, this is as good a time as any to look at the Ontario health system and its spending in more detail.  Over the next few weeks, I will devote a number of blog posts to health spending in Ontario to provide some context for spending in the system as well as review where we have been over the last few decades.  Visit this page for updates.