Premiers Hold Health Care Hostage for Political Gain

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When federal health minister Jean-Yves Duclos met with his provincial counterparts in Vancouver on November 7th, he had every reason to assume there would be a productive discussion about the various means by which the endangered health care system could be saved. After all, he had issued a statement before the meetings began, promising more federal funding would be coming to the provinces in the near future. In exchange, all he asked was that they develop a pan-Canadian action plan to increase the healthcare workforce, and to share health data.

Given that the health care system in every single province is currently on life support, one would naturally assume this promise of more federal funding would be music to the health ministers’ ears. And since the critical lack of healthcare workers and reliable data are two key problems underlying the current crisis, Duclo’s request seems all the more reasonable. But no. The ministers spent their time posturing and refusing to consider any national plan.

Meanwhile the provincial premiers hijacked the ministers’negotiations by issuing a joint statement through the Council of the Federation, declaring that what they really wanted was a First Ministers meeting with the prime minister, and a massive increase in federal funding with no strings attached. They estimated this unconditional increase would cost the federal government an additional $30 billion annually, but they gave no indication of what they planned to do with it. Adding insult to injury, a leaked document indicated this release had been drafted nearly a week before the ministers’ meetings.

Not surprisingly, Duclos was not amused. In what could only be described as an understatement, the minister declared that the premiers’ ambush of his talks with health ministers “made me very disappointed and a little bit angry.” In fact, it should infuriate all Canadians, and especially those who have had to make use of the health care system in the recent past.

Sadly, this is only the latest in a long list of unacceptable attempts by premiers to hold health care hostage, dodging any form of accountability and instead blaming the federal government for all the problems confronting the most important files squarely under provincial jurisdiction. Their purpose, once more, is to gain political advantage with their respective electorates by blaming the federal government for the current situation and refusing to acknowledge their own mistakes and failures. From the broken promises the provinces made when agreeing to the Social Union Framework Agreement in the late 1990’s, to their failure to follow through on their commitment to share data and best practices in return for the $10 billion package Paul Martin delivered to them in 2004 to “fix health care for a generation,” provincial premiers of all political stripes have shown an astonishing lack of remorse, and an even greater tendency to blame the federal government through false and misleading claims.

Canadians do not really care who is responsible for health care. They care about long waits in overflowing emergency rooms, cancelled surgeries and a lack of nursing staff to care for patients in hospitals. Nevertheless the deliberately misleading claims of several premiers about the lack of federal funding is both dangerous and counterproductive, since it focuses attention on money and not on the very real, multiple causes of the current health care crisis. This wrong-headed approach was intensified in October, when ads sponsored by the premiers through their Council of the Federation appeared in print, on social media and television, repeating these patently false claims. That they chose to spend precious dollars doing this, despite a steady stream of healthcare experts, economists and media commentators denouncing these claims, is even more concerning. 

For the record, the ad campaign claims that federal funding has “fallen”, when in fact the Canada Health Transfer has increased from $30 billion to $45 billion annually over the past decade.  Equally misleading is the premiers’ claim that “federal funding has fallen to just 22% of the cost of health care in Canada.” This is simply wrong and they know it. To begin with, they conveniently ignore a significant portion of total federal funding when they claim the federal government contributed only $43 billion to the total public expenditure of $200 billion on health care in 2021. Yes, this is the amount directly provided to the provinces through the Canada Health Transfer (CHT). But the federal government provides the provinces with more funding for healthcare in a variety of ways. For example it was the premiers themselves, in 1977, who insisted that a portion of federal funding for health care be provided separate from the CHT in the form of tax points, (tax room transferred to the provinces from the federal government specifically to be used for health care.) In 2021 this amounted to an additional $19.6 billion, for a total federal contribution of $62.6 billion or 33% of total spending. This more accurate figure takes on added significance because the premiers are demanding a federal contribution of 35%, which in reality is barely more than they already receive. The ad also does not take into account money received from the federal government by the five poorest provinces in equalization payments to help them cover the cost of health care. Nor does it acknowledge the fact that Ottawa now provides separate transfers of funds to the provinces for home care and mental health services, or that it provided them with a huge influx of extra funding during the pandemic.   

The premiers’ one-track mindset for over a decade now, calling for more money with no accountability, also flies in the face of their increasingly positive financial situation. Almost all of them are enjoying lower than expected deficits and many have substantial surpluses. In fact, the provinces collectively are in surplus this year. Yet, as a recent Globe and Mail editorial noted, several premiers are taking advantage of the surplus to hand out money to their voters, allegedly as “inflation-fighting” mechanisms, even though economists have stressed that this will only make things worse. Some premiers have even announced massive expenditures on projects many consider to be vote-buying boondoggles, such as Premier Legault’s planned tunnel under the St. Lawrence at Quebec City, or Premier Ford’s commitment to yet another super highway for Toronto’s suburban commuters. [i]   

There is another inconvenient truth which the premiers are working hard to ignore, namely that money alone will not solve most of the problems the system is currently experiencing. As the Canadian Institute for Health Information indicated in a recent release, total health spending in Canada is on track to reach a record $331 billion in 2022, or slightly more than 12% of GDP. This makes Canada the highest spender on healthcare among developed countries with universal systems, even as it remains among the worst performers.

Additional comparative context is particularly useful here to understand the extent of the malaise. The first relates to the administration of the healthcare system, for which the provinces are entirely responsible. As early as 2011 studies were demonstrating that the Canadian healthcare bureaucracy was nearly 11 times greater per capita than that of Germany.  Then there is the issue of capacity. OECD data place Canada 26th of 28 countries in terms of physicians available, 25th in terms of acute care beds and 14th in terms of nurses. Meanwhile, in a 2021 Commonwealth Fund study, Canada was ranked 10th out of 11 countries in terms of a number of health care access and performance variables, ahead only of the United States, which does not have a universal health care system.

Clearly the federal government is not wrong to insist that any additional funding it provides to the provinces should be accompanied by their commitment to “tangible results” through a set of common objectives, nationally available data and sharing of best practices. Hopefully Canadians will see through the premiers’ shameless finger-pointing and unhealthy aversion to accountability, and insist that they work with the federal government to address this alarming national crisis.  The irony is that now is the time for the premiers to take the initiative. Rather than trying to capture votes by pretending the problem is elsewhere, they could win popular support by showing leadership. In the middle of the severe and increasing healthcare crisis across the country, most Canadians will be ready to listen to reasoned arguments and prepared to accept tough measures if they believe it will address the problem. The only question is whether the current crop of premiers is up to the job.  

[i] “Some Honest Math on Health Funding”. Editorial. Globe and Mail. November 9, 2022.