Consistent Challenges - Different Domains + Quick Hits
Takeaways from the CSA Policy Pathway Conference and Quick Hit reading recommendations
Happy Friday! Yesteday I had the pleasure of attending the CSA’s excellent Policy Pathways Conference on Advancing Canadian Health Care. CSA pulled together a stellar line up from across the Canadian healthcare space, covering a huge range of topics with some thought-provoking discussion and debate. While my day-to-day work isn’t in the healthcare space, there were a startling number of takeaways that are highly relevant to technology and innovation, as well as the broader topic of an inclusive economy and society. Today I highlight some of them before sharing a few quick hit reading recommendations.
Consistent Challenges - Different Domains
Crisis fuels change but we need concrete stories to break out of the status quo
The morning’s keynote was by Dr. Alika Lafontaine, an Indigenous phyiscian, healthcare leader, and changemaker. He went deep into mental models and how systems change actually happens. One of his central points was how crisis fuels transformative change - and that at a time of crisis we need to tell concrete stories about plausible futures that can break us out of the status quo.
We are definitely in a moment of crisis - in healthcare and far beyond. But we aren’t telling enough concrete stories. I frequently complain to people who will listen that so many conversations in the policy world ends up arguing that we need a national strategy for X, Y or Z. What those strategies should contain in detail, how they relates to different policy levers and different levels of government when it comes to implementation, and what the concrete vision of the future that we need to build toward is - those are too often missing.
There is inequitable access to innovation and solutions
The inequitable access to healthcare, and in particular the latest innovations, came up in a few contexts over the course of the day. While there have been startling advances over the past 50 years in drugs and technologies - too many of these are often out of the reach for major portions of the population - in particular those who are low income, non-binary, and/or racialized. Furthermore, where you live matters, with one speaker pointing out that geography remains the primary driver for inequitable access to healthcare.
Speakers emphasized that this is not just an issue of procurement and technology adoption (though those are certainly issues I could write plenty on). It is also an issue of broken systems. In many cases, innovations might be available, but accessing them in practice often relies on being in a wealthy, urban area with a doctor who is not-burned out and is capable of navigating the system for you. Without that, what is in theory available, isn’t actually there in reality.
We need to look more at the importance of access to innovation and the role of systems. When it comes to inclusive innovation, we must not only remove the barriers that prevent people and communities from participating as innovators, we also have to ensure that everyone is able to benefit from the end results of innovation. That means tackling an array of systems, gatekeepers, policies, and regulations that prevent equitable access to innovation.
It also means encouraging innovation that doesn’t drive inequality - either through extractive and rent-seeking business models (on which, see more below) or through only providing high paying jobs to those doing R&D without providing broader employment and spillovers to a region.
We have a big problem with accountability
The other keynote of the day was from Dr. Collen M. Flood, the Dean of the Faculty of Law for Queen’s University, on modernizing the Canada Health Act. A major part of her argument, and a big part of the discussion in the following panel, was around the fact that we have a big problem with accountability that needs to be solved.
When it comes to the CHA, this flows from a lack of accountability from the provinces for the delivery of care, and from the federal government for the flow of funds. Accountability though is a much, much bigger problem, and one that I would argue is central to a lot of the issues Canada is facing.
As the Globe and Mail’s Secret Canada project last year demonstrated, Canada has a broken freedom of information system with all levels of government often working actively to avoid scrutiny and accountability. We have governments that pivot mid-mandate with an eye to politics and without consultation or consideration for economic and social impacts. And when it comes to new policies and programs, including those with very expensive price tags, they are often not accompanied with any transparency of goals or theory of change, making any real accountability impossible. This all means expensive policy failures and no real prospect of learning from past mistakes. The ultimate result is that Canadian governments are failing to deliver an inclusive, growing, and prosperous Canada. Whether it is in healthcare, or in so many other policy domains, we need better than that.
Quick Hits
Are regulatory moats Canada’s form of corruption? - Very closely tied to issues of transparency and accountability is this piece from
. While Canada might not have envelopes stuffed with money being handed to bureaucrats, that doesn’t mean that we don’t have situations where policies are made for private benefit rather than for the public good. Robin argues that regulatory moats are a major example of this, with businesses lobbying for anti-competitive regulations that make it harder for new businesses to enter markets. This is particularly an issue in the technology space - with the impact of the EU’s data protection regulation, for example, ultimately benefiting the big tech firms it was designed to rein in as they had the resources to meet regulatory hurdles while smaller competitors didn’t.Innovation amnesia: Technology as a substitute for politics - This article probably deserves an entire post to disect. It makes a compelling case and gets into some of the underlying theory around how the “valorization of technological innovation” creates an amnesia that makes claims of historical rupture with the past, undermines existing institutions that facilitate collective power among less powerful people, and then extracts value that extends existing structural inequities. The author, Nathan Schneider, argues though that this process can be resisted and that “well-organized people might enter the power vacuums that amnesia leaves to establish policies and norms that extend, rather than contract, their collective power”. This seems very important in our current moment. A hat tip to
’s must-read substack for surfacing this.How dividend recapitalization undermine Canadians productivity and prosperity - In this piece for the Globe and Mail, Rachel Wasserman, a business lawyer and research fellow at the Canadian Anti-Monopoly Project, looks in the weeds at financial levels and how they are used to extract value rather than put it to productive uses. As Rachel writes, “If we are serious about improving productivity in Canada, we must consider the impact this extractive behaviour is having on our economy, especially when it isn’t even really benefiting that many Canadians.” It is great to see more light being focused on these parts of the financial system that act to make our economy less inclusive, less productive, and less prosperous.