Calgary's Downtown Dilemma

[CalgaryTiger]

I'd say those services would be doing other things that are within their mandate, preventing other crime, helping other people, etc. My argument isn't for shifting priorities, it is "yes and-ing". Also it does matter where those dollars are spent, the City invests a lot more into downtown versus other places. It is where our institutions are. You want people in your downtown supporting businesses and services that bring in more money versus say Fat Burger and the library in Seton.

 

[Atticus]

But what's the cost of avoiding downtown? Are they simply spending money elsewhere? There's also an argument if people really are avoiding downtown. Beltline has had a huge increase in residents, Vancouver downtown real estate is incredibly expensive despite the drug problem. I'm not denying those costs exist, but if we spend 100 million building the facilities for these people, will an equal part of the budget be cut from the police? from ambulance services? Very unlikely for those cost savings to be realized.

It’s hard to directly correlate a cost of people, avoiding downtown, but one area that sticks out is East Village, which could easily be well developed by now if it weren’t for the issues in the area.
Even though the Beltline‘s population is increasing, we don’t know what downtown development would look like without these issues. I know that these homeless issues are helping hold back a lot of people from choosing to live downtown with their kids. The exact amount and cost of that is hard to say but it’s a factor for sure.

 

[CT (Chinese_T)]

Found a really interesting (and pertinent) piece from Calgary architect Stephanie White (author of "Unbuilt Calgary") from 1972.

Zoom in to read the full article if you'd like; I'll include some of the most interesting snippets below. She essentially predicted the fate of our current Downtown core back when it was just starting to happen.

 

[ByeByeBaby]

I don't believe those savings can be realized. We are not going to reduce spending on those public services. If it really was the case we can save money while building these facilities, seems like we can do this without any increase in taxes. Which begs the question why not a single North American city has effectively saved money while resolving their homelessness or drug issues.
https://www.cbc.ca/news/canada/british-columbia/sfu-study-downtown-eastside-1.3392975 This study suggests 26.5M over 5 years, for 300 of the "offenders" (their words), or 168k-247k per person. That's really not all that expensive. An expansive health facility probably has a higher level of operating costs alone.

I mean, all 50 US states don't provide public health care even though doing it would save them money, as shown by Canada's lower health care spending as a % of GDP. Every single one of them could save money while resolving their health care problems. But some of the benefit would go to poor people, so they don't. Culture is a hell of a drug.

 

[trtcttc]

I mean, all 50 US states don't provide public health care even though doing it would save them money, as shown by Canada's lower health care spending as a % of GDP. Every single one of them could save money while resolving their health care problems. But some of the benefit would go to poor people, so they don't. Culture is a hell of a drug.

This is a myth of US health care. For people that have decent jobs with good insurance, the US system has a lot of advanced therapies and very well equipped facilities. They spend more but to argue Everyone gets less is false. Some people get less, some get more, it's just a much more unequal system. I know of Canadians working in the states that chose not to move back to Canada (already willing to accept lower pay) because they were having a young child and the wait for a pediatrician here (Toronto, but still Canada) is way longer than the US.

 

[CalgaryTiger]

Every single one of them could save money while resolving their health care problems.

People do not measure the healthcare system based on their personal savings alone. Personal healthcare outcomes is the real measure. As @trtcttc has said. This situation cannot be a purely monetary thing.

Some people get less, some get more, it's just a much more unequal system.

The measure should not be, "does it save me money." The motivation for better cannot be a value for money proposition. You have to be more personal than that. Currently the way we're doing things has a negative impact on almost everyone. The only benefactors of the way things are now is the organizations and people profiting off of selling these drugs to these people. Assuming no one here is a benefactor... We are all negatively impacted by the status quo.

Edit: To clarify I'm not talking about healthcare specifically but the overall cost of the drug crisis.

 

[trtcttc]

People do not measure the healthcare system based on their personal savings alone. Personal healthcare outcomes is the real measure. As @trtcttc has said. This situation cannot be a purely monetary thing.


The measure should not be, "does it save me money." The motivation for better cannot be a value for money proposition. You have to be more personal than that. Currently the way we're doing things has a negative impact on almost everyone. The only benefactors of the way things are now is the organizations and people profiting off of selling these drugs to these people. Assuming no one here is a benefactor... We are all negatively impacted by the status quo.

We are stuck in sort of stuck with our healthcare system. There's an allergic reaction to any sort of privatization, even though countries like Germany, Switzerland, etc. run public-private systems. A public only system fails to collect additional funds from wealthy people that are willing to pay, instead they go to the US for care. It's not just wealthy people either. if employers had to pay for private plans, there'd be competition on employers to offer better insurance plans to attract workers, and paying more into the system. We're also competing with the US for physicians. People don't like to talk about this but we pay among the highest physician compensation in the world. Much higher than Germany, France, Spain, and even the UK.

Doctor Pay by Country 2025

Discover population, economy, health, and more with the most comprehensive global statistics at your fingertips.

worldpopulationreview.com

Everybody Covered: What the US can learn from other countries’ health systems

What the US can learn from other countries’ health systems.

www.vox.com

 

[CalgaryTiger]

People don't like to talk about this but we pay among the highest physician compensation in the world. Much higher than Germany, France, Spain, and even the UK.

You do have to pay a premium to get people to come here versus other places. I love it here for the overall quality of life but I do get that if you're a doctor there are some pretty great places in this world you can live and work for a system that isn't as complicated as ours.

It's not just wealthy people either. if employers had to pay for private plans, there'd be competition on employers to offer better insurance plans to attract workers, and paying more into the system.

I mean, if you have a job where your employer would be willing to pay for a private plan, you're likely in the top 10 percent of earners, someone I would consider wealthy.

Also, our current system is private. It is just single-handily paid for by the government. I could be open to people paying the private clinics for surgery ahead of waiting in line, I'd need assurances about a certain percentage of public spots in line. I don't know how many people opt to pay for a private surgery now. I could be wrong but the money whatever part of what use to be AHS is in charge of surgeries would get for someone paying the premium you'd charge, is that really worth it? Is there any benefit to doing that surgery here, you're just moving the person up in line, the number of people in line isn't changing? If someone cannot wait and want to pay someone somewhere else to do their surgery, go right ahead.

Anyways this is off topic... So to bring it back.

Even though I've talked about money and how the true cost of the opioid crisis is impossible to calculate, it isn't about money. Sure, we need to spend more of it to try everything we talk about but it is about the fact that the opioid crisis has affected so much in a negative way. It would be great if East Village was built out and thriving. Imagine if Victoria Park was built out and the Events Centre was the last thing to be added and not the first. There has been a ton of effort and real dollars spent on trying to reverse what that architect @CT (Chinese_T) predicted. None of that will matter, no amount of "design can fix that issue", is going to fix the opioid crisis. To properly realize our societal investment in city building, the people that are the reason why East Village still languishes, need to be part of that investment.

 

[Surrealplaces]

This is a myth of US health care. For people that have decent jobs with good insurance, the US system has a lot of advanced therapies and very well equipped facilities. They spend more but to argue Everyone gets less is false. Some people get less, some get more, it's just a much more unequal system. I know of Canadians working in the states that chose not to move back to Canada (already willing to accept lower pay) because they were having a young child and the wait for a pediatrician here (Toronto, but still Canada) is way longer than the US.

Just on my own observations, but yeah, the health care system seems to be better in the US, for about 25-33% of the population in my estimation. I personally know people who have fairly average jobs (bank teller), who get better health care than I do in Canada. That said, it comes down to what our overall goal is. If the overall goal is to make sure everyone has a decent level of health care, Canada comes out ahead.

Also for some of those who are getting better health care (like my bank teller friend), that's for a lot of general stuff. For heavier issues like operations or cancer, etc..it can come down to doctors and insurance people arguing whether the treatment is needed or what type should be done as insurance companies haggle over trying to save money.

 

[trtcttc]

Just on my own observations, but yeah, the health care system seems to be better in the US, for about 25-33% of the population in my estimation. I personally know people who have fairly average jobs (bank teller), who get better health care than I do in Canada. That said, it comes down to what our overall goal is. If the overall goal is to make sure everyone has a decent level of health care, Canada comes out ahead.

You do have to pay a premium to get people to come here versus other places. I love it here for the overall quality of life but I do get that if you're a doctor there are some pretty great places in this world you can live and work for a system that isn't as complicated as ours.


I mean, if you have a job where your employer would be willing to pay for a private plan, you're likely in the top 10 percent of earners, someone I would consider wealthy.

Based on income a bank teller job is probably not within the top 25-33% of income earners. And definitely not the top 10 percent. The vast majority of people in the US are covered by private plans. 65% of individuals in the US are covered by private plans. That doesn't include retirees which are covered by Medicare (another 19%). The US system has its issues, but to suggest the majority of people have no coverage is incorrect.

Health Insurance Coverage in the United States: 2023

This report presents data on health insurance coverage in the United States in 2023 based on information collected in the 2024 CPS ASEC.

www.census.gov

Also, our current system is private. It is just single-handily paid for by the government. I could be open to people paying the private clinics for surgery ahead of waiting in line, I'd need assurances about a certain percentage of public spots in line. I don't know how many people opt to pay for a private surgery now. I could be wrong but the money whatever part of what use to be AHS is in charge of surgeries would get for someone paying the premium you'd charge, is that really worth it? Is there any benefit to doing that surgery here, you're just moving the person up in line, the number of people in line isn't changing? If someone cannot wait and want to pay someone somewhere else to do their surgery, go right ahead.

Or have co-pays. Most people can pay $30 to see a doctor, but multiply that by the number of doctor visits, that's billion in additional revenues to fund our healthcare system. It's the same with highways. We shouldn't have toll free roads and extremely expensive tolls (i.e. 401 and 407 in Toronto) but rather every highway should have a basic toll amount so users are assuming some cost-sharing responsibilities while injecting funds into the public system.

 

[CalgaryTiger]

The US system has its issues, but to suggest the majority of people have no coverage is incorrect.

Again this isn't the thread for this but as Surreal said, there's a difference between a basic level of coverage and coverage equal to what we have here or coverage equal to jumping the line for an elective surgery. The majority of people, do not have that. My cousin lives in Idaho, is a teacher, and was not covered for cancer treatment. If they lived here, that isn't even a thought so not everyone is covered for everything.

Most people can pay $30 to see a doctor

I don't want people paying to see a doctor $30. To you, that's nothing to someone that's a choice between a meal for their family or getting the fungus on their toenail treated. I also don't believe in toll roads, unless there's a viable alternative you're just taxing poor people who don't have a choice.

To bring it back to the subject at hand, in the states, I'm not sure what happens to a person doing drugs downtown and overdosing, here they go to a hospital. That takes a spot away from someone who does actually pay taxes (how we fund healthcare). How you account for that cost, I don't know.

I actually don't know why or how the US healthcare system was brought into this, I don't really want to talk about it.

 

[Surrealplaces]

Based on income a bank teller job is probably not within the top 25-33% of income earners. And definitely not the top 10 percent. The vast majority of people in the US are covered by private plans. 65% of individuals in the US are covered by private plans. That doesn't include retirees which are covered by Medicare (another 19%). The US system has its issues, but to suggest the majority of people have no coverage is incorrect.

People in the US have coverage, must a case of what the level is. For Canada it's fairly consistent for all parts of the country, and for all income brackets.

For my friend the bank teller, she's probably not in the top 3rd of income earners national, but probably is for her location (South Carolina). I also don't know what she pays for insurance payments. Much of South Carolina's a pretty low cast area to live in, but for a bank teller in NYC, San Fran, Washington, Boston etc.. it could be a different situation.

Not to ramble on too much here, but I agree the US health coverage isn't as bad as we often think it is, but also Canada's system has it's benefits. Mostly that Canada's system more even and consistent whereas the with the US it can vary a lot depending on what part of the country you live in and the plan you have, what you can afford etc..

 

[trtcttc]

I don't want people paying to see a doctor $30. To you, that's nothing to someone that's a choice between a meal for their family or getting the fungus on their toenail treated. I also don't believe in toll roads, unless there's a viable alternative you're just taxing poor people who don't have a choice.

To bring it back to the subject at hand, in the states, I'm not sure what happens to a person doing drugs downtown and overdosing, here they go to a hospital. That takes a spot away from someone who does actually pay taxes (how we fund healthcare). How you account for that cost, I don't know.

I actually don't know why or how the US healthcare system was brought into this, I don't really want to talk about it.

We can move on from the healthcare point but I find these arguments of it's the difference between putting food on the table or doctor pretty weak. Lots of things cost $30. Vehicle registration is about $100, we collect lots of fuel taxes, we charge people money to use transit, we charge people to use rec facilities, we charge for access to national/provincial parks, we charge for day care and so on. We also provide exemptions for low income individuals.

I don't think we can start discriminating against people that fund healthcare and people that do not. I wonder if we should really have drug treatment only facilities, like how the new Bridgeland facility is long term care + medical services for seniors. Their symptoms and treatment are fairly consistent, which you could do for a lot less than the cost to admit a patient to Foothills emerg. And easier to provide wraparound services at the same time.

 

[darwink]

I wonder if we should really have drug treatment only facilities

Yeah. I remember hearing but can’t remember where that 40% of emergency capacity was now being absorbed by the opioid crisis/adjacent patients.

I think a lot of problems that we have, we try to dream up complicated causes and similarly complicated solutions. For Canada, rolling back rents and multifamily prices, along with addressing the opioid crisis at scale would go a long way to solving many other problems that are partly just the result of those two crisis.

 

[CalgaryTiger]

I was getting hyperbolic in the end and fair enough about the argument being weak. I agree, lets move on.

A fee of some kind isn't what I don't like, I'd just need it structured a certain way. I think we want our cake of low taxes and to eat it too in high-quality services when those two things simultaneously just don't work. Maybe fees are the bridge to fix that issue but I doubt a fee would be enough to bridge the gap. Private healthcare has its place but it has to be setup in a way to create positive outcomes. Whether that's more money in the system, increased capacity in the system, etc.

I'm trying to think of additional services that could have synergies with addiction treatment and I'm struggling, mostly because I don't know what addiction treatment actually looks like. It is a blind spot.