In a pile of old press releases, one issued jointly by Health Canada and the Department of Finance stood out because it touted Ottawa’s unprecedented support for health care.
The source of the pride and joy was that, effective April 1, the Canada Health Transfer increased to a “record high level” of $30.3-billion. The CHT is one of several cash transfers from Ottawa to the provinces and territories.
Finance Minister Jim Flaherty crowed that “these transfers will total $62-billion in 2013-14, representing an increase of almost 50 per cent since 2006.”
Where to begin?
Perhaps by saying that, despite the date of the release, it was apparently not an April Fool’s joke. However, much foolishness is on display.
“Our Government is committed to a strong, publicly funded, universally accessible health care system for Canadians,” Health Minister Leona Aglukkaq is quoted as saying in the release.
An all-Canadian bromide, if there ever was one. But where is the commitment?
The government of Stephen Harper has taken a wash-my-hands-of-it approach to health care for years. It made some interesting moves early in its mandate, notably the funding of a Canadian cancer strategy and the creation of the Mental Health Commission of Canada, along with a big investment in immunization, with $300-million for HPV vaccine. But, in recent years, Ottawa’s only health-care interventions have been hostile ones: The ill-considered cuts in access to health-care services for refugees, the muzzling of scientists and researchers, and the slashing of jobs and budgets at Health Canada and the Public Health Agency of Canada.
The only health-related measure in which Ottawa seems to take an interest any more is transferring money to the provinces, something it has a legal obligation to do.
Yes, it has increased the amount of the Canada Health Transfer. The CHT will grow from $28.6-billion in 2012-13 to a projected $37.7-billion in 2017-18. Afterwards, the CHT will grow in line with a three-year moving average of nominal GDP growth, with funding guaranteed to increase by at least 3 per cent a year.
Those are “record” amounts if you are considering only current dollars. But if you’re going to brag, you had better know your history.
Medicare became a national program in 1957, when the federal government agreed to provide funding to all provinces for hospital care if they met certain conditions, such as universal access and no user fees. The agreement was that Ottawa would provide 50 per cent of costs. When medicare was extended to physicians’ fees five years later, Ottawa again agreed to pick up half the tab. In fact, 50-50 was the norm well into the 1970s, when the federal government began to weasel its way out of its commitment by replacing the straightforward promise to pay for half of provincial health spending by introducing complex funding formulas.
The upshot is that the federal government now covers less than one-quarter of publicly funded health spending – $30-billion of the $135-billion that comes out of the public treasury. So, actually, federal funding is at a historic low.
Let’s not forget either that the new funding deal the ministers are praising was imposed on the provinces by Ottawa. The Prime Minister refused to meet with the First Ministers to negotiate a deal. The only reason there was not more of a fuss is the whopping, 6 per cent escalator, which is well above the rate of inflation. (Coincidentally no doubt, the increase will continue until the next federal election before it drops by half.)
What is truly foolish is the Finance Minister, who preaches fiscal prudence and holding the line on spending, going around bragging about these kinds of profligate hikes. And let’s not forget that the money is being transferred with no strings attached. We’ll come back to that point in a moment.
The CHT increase is not all good news for the provinces and territories. Ottawa changed how the money is distributed among the provinces so that it will now be allocated strictly on a per capita basis, with no provision for the fact that delivering health care is more expensive where the population is older and living in remote or rural areas; that means young, fast-growing provinces such as Alberta will get a lot more money, and aging, struggling provinces such as Nova Scotia will get a lot less.
The Conservative government takes the position that health care is uniquely a provincial responsibility. In doing so, it rejects the traditional role of the federal government to level the playing field, to ensure that health services are reasonably comparable for all Canadians, regardless of where they live. In recent years, the disparities in access to care have grown substantially because Ottawa has abdicated that role.
That is a strange way of demonstrating a commitment to a strong, universally accessible health system.