Since Confederation, our vast country has been held together with precious little cultural and institutional glue.

Growing division now hinders our ability to confront the enormous challenges we face: reconciliation with Indigenous Peoples, a housing and affordability crisis and the existential threat of climate change. We need a way to bind our country together to meet these challenges and realize Canada’s potential.

Policymaking has always played a role in nation-building, often in imperceptible ways. This is apparent when you ask Canadians what they’re most proud of.

The top answer in national polls tends to be our health-care system. How and why is it that a social program inspires such strong national sentiment?

It’s a matter of design.

Canadian pride in our approach to health care is founded on the implicit fairness of the program – its universality.

Social policies and programs can be designed in two ways: “universal” and accessible to most everyone or “targeted” (sometimes also called “selective”) and designed to meet the needs of a particular segment of the population.

Policymakers and politicians, given limited funds, need to make difficult choices about whom to include or exclude from a program. Understandably, in many cases, programs are directed where the need is greatest to maximize effectiveness and control costs.

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Universal social programs are expensive and inefficient. Why waste precious public resources by directing them to people who can comfortably afford to purchase the same social goods on the market?

However, the focus on efficiency, while important, overlooks a more subtle dimension that needs to be taken into consideration – the psychosocial effect of policies and programs that underlie Canada’s social fabric.

Our social programs can serve to unite us or divide us.

When we design an income cutoff or means test for a program, we’re drawing invisible lines that foster division between people. Universal programs, assuming they are well-run, can have the opposite effect. As evidenced by the role of medicare in the Canadian psyche, programs from which everyone benefits can strengthen our national fabric.

This relationship is difficult to gauge and its impacts are only hinted at in research, but academic literature makes a connection between universal social programs and public support, trust, unity and social solidarity. Countries with more universal welfare states have been shown to be more equal societies.

One might think that countries that prioritize targeted programs and “take from the rich to give to the poor” would do better at lowering inequality. But Walter Korpi and Joakim Palme found the opposite in the 1990s.

Canadian researchers Olivier Jacques and Alain Noël confirmed this “paradox of redistribution” in 2018 – i.e., countries do better at reducing inequality when they “take from all to give to all.⁠” It turns out that we are more generous when we can see ourselves benefiting from social programs and policies.

This has enormous implications for policymaking.

The universality and generosity of some of Canada’s core social programs that emerged after the Second World War began to erode in the 1980s and 1990s due to budgetary pressures on governments and ideological preferences for market-based solutions.

We now find ourselves in an era of seemingly permanent austerity and continuous deficit spending as the public demand for services meets the political impossibility of tax increases.

Meanwhile, our population is getting older and the relative number of working-age people is shrinking, which leads to a relative decline in the tax base and increased costs for health care and seniors programs.

Our health-care system has never been perfect. Services vary greatly depending on where one lives. Compare modern hospitals in large cities to nursing stations in remote First Nations communities, for example. Discrimination and systemic inefficiencies remain in many areas.

Yet, for all its flaws and gaps, medicare has bound us together.

However, the challenges it faces have intensified since the COVID-19 pandemic. Our health-care system is experiencing an underfunding and understaffing crisis, while privatization efforts across the country are slowly undermining access to critical health services and eroding a pillar of Canadian identity.

The federal Liberal government (under pressure from the NDP) recently announced the creation of a new dental program that will be available to households earning less than $90,000 a year.

This will almost certainly improve access to necessary dental care. But what impact will an income-tested program have on Canadian identity?

The dental-care plan is not universal, but the choice to include middle-income households – as the Liberal government also did with the Canada child benefit – broadens the number of people who stand to gain from it and therefore the number of people more likely to support it politically.

A higher income threshold may not contribute to true nation-building by creating a common sense of identity, but it is certainly an improvement over means-tested programs that target only low-income households.

Including the middle class in program eligibility forms a socio-political alliance that includes a majority of the population, thereby building popular support, which can help to create more lasting, generous and effective institutions.

Universal programs may not always be feasible given current fiscal constraints, but policymakers and politicians should consider what impact the design of policies and programs will have on our social fabric.

If we’re going to overcome our challenges and build a fair and equitable society, we’re going to need to be united.

That starts with ensuring the lasting strength and universality of our health-care system as well as expanding universal social policies, where possible, to help reduce inequality and foster unity.

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Thomas Granofsky
Thomas Granofsky is a future fellow with the Future of Canada Project at McMaster University, the founder of Rådhus Consulting and a sessional lecturer at the University of Toronto. X: @granofsky

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