Dr. Jane Philpott, the federal Health Minister, is earnest. You can imagine the family doctor providing steady, optimistic compassion to suffering patients under the worst conditions. As a young MD in Niger, she no doubt did. On Thursday, when she gave a speech about a new federal-provincial health accord, it was an optimistic call to look beyond budget challenges to transform the system with home care, mental-health care and innovation.
Dr. Philpott told her audience at an Ottawa health-care conference that if they'd come to see a squabble with the next speaker, Quebec Health Minister Gaétan Barrette, they'd be disappointed. But Dr. Barrette didn't disappoint. He had a blunt assessment of Dr. Philpott's approach to federal-provincial talks: "It's a trap."
The two MD/ministers couldn't be more unalike. They're the champions of two mismatched positions on Canada's health-care system. Dr. Philpott presses Ottawa's demand for transformation, and new services, and Dr. Barrette responds with the provincial view that burgeoning demands mean the provinces need more money just to cope.
Where Dr. Philpott is hopeful, Dr. Barrette, a radiologist, seems like he's used to breaking the news of grim realities. He once responded to a controversy about a shortage of baths in Quebec's long-term care facilities by declaring, "I've given people sponge baths in bed and I can guarantee you they were just as clean as in a bath."
He's clear, sharp-witted and so outspoken he is regularly required to make public apologies for things he's said.
But in his task of breaking hard news, he makes an effective spokesman. As much as Dr. Philpott wants to talk about how innovation or home care could save money, Dr. Barrette responds with grim realities. Provincial health ministers are already controlling costs by limiting services, and the "magic word" of innovation isn't going to make it all better, he said.
"Today I will put you in my shoes," he told the conference, organized by think tank Canada 2020.
The two doctors are in one sense playing familiar roles. The provinces want Ottawa to provide more money, while the federal government wants to negotiate guaranteed changes to the health-care system.
That was the tension in 2004, when then-prime minister Paul Martin negotiated a long-term health-care accord. That deal provided annual increases of 6 per cent in federal health transfers to the provinces, but it runs out in 2017. After that, the annual increases will be tied to economic growth – probably closer to 3 per cent. The provinces say that's not enough.
Dr. Philpott, in her earnest way, insisted health ministers should be talking about health care. Think about how many people need mental-health care, she said. Think about how you can reserve a nail-salon appointment on your smartphone, but not a doctor's appointment. More people want home care, and it can cost as little as $42 a day, compared with $840 a day for hospital care. And, she said, the feds will put in some money to help – $3-billion over three years.
Dr. Barrette did a pretty good job of puncturing the hope. That $3-billion works out to $232-million a year for Quebec, and would be swallowed up by ordinary annual cost rises that pay for infrastructure and salaries. Provincial health ministers already keep costs down by limiting supply. In other words, they limit services and allow waiting lists.
Home care? Every province knows the need, he said. But Quebec is putting $1.35-billion into home care, and if it provided home care to everyone who needed it, he said, it would cost $5.5-billion.
Innovation? It can improve care or cut waiting lists, but it never really brings the budget down, he argued. It certainly won't slash costs in a few years. Transformation would be possible after a decade of federal funding increases, he said, but right now, provinces need more money just to meet existing challenges. Ottawa should forget about talking about services and conditions on a federal-provincial health accord, until it talks about the money to pay for it, he said. Dr. Philpott's focus on services, he said, is a trap to distract from talking about funding.
And, in part, he's right: Ottawa wants provinces to start talking about what it might change before it puts more money on the table. For now, the two doctors have radically different prescriptions.