While health care was not the subject of much attention or debate during the federal election campaign, prime-minister-designate Justin Trudeau's Liberals made some noteworthy promises, and have some important decisions to make in the weeks and months to come.
After almost a decade of Stephen Harper's Conservatives insisting, dogmatically, that health is strictly a provincial jurisdiction, the biggest change in Ottawa will be philosophical or cultural – the arrival of a government that believes Ottawa has a key leadership role to play in health care.
But Mr. Trudeau is much less of a centralist and much more of a diplomat than his late father, who, among other things, greatly reduced health transfers to the provinces and introduced the Canada Health Act in 1984 to crack down on extra-billing by the provinces.
The incoming PM has, quite deliberately, avoided confrontation with his provincial counterparts, especially on health issues, instead promising a new era of co-operation and dialogue.
That will get him only so far because the provinces, above all, want more cash to help them pay their health bills, which, in many cases, are gobbling up close to half of provincial budgets.
Mr. Trudeau has promised to promptly negotiate a new health financing deal, but has not made any firm financial commitments or set a deadline other than to say he will convene a first ministers conference every year.
Since 2004, the Canada Health Transfer, which currently sits at $34-billion, has increased by six per cent per annum, but that is slated to drop to three per cent in 2016. Just as important, the Conservatives switched to allocating health dollars on a strictly per capita basis (rather than accounting for demographics affecting health costs), which has greatly disadvantaged poorer parts of the country like the Atlantic provinces (where Liberals swept the seats.)
The Liberals will have to decide quickly both how and how much they will pay out in health transfers.
The big political challenge for Mr. Trudeau will be to figure out what conditions, if any, Ottawa will place on the transfer of those dollars.
The Liberals' most significant health promise was to invest $3-billion over four years to bolster home-care services. The only way to do that, practically, is to earmark money, something the provinces resist.
Before the election, the most dominant discussion in the health field was about pharmacare – extending universal health coverage (which currently only covers hospital and physician services) to prescription drugs.
Mr. Trudeau approached that Pandora's box cautiously, promising only to "improve access to necessary prescription medications" in conjunction with the provinces. He spoke mostly about doing bulk buying to bring down costs, but also made clear that his priority will be to ensure patients with so-called "catastrophic" costs for expensive drugs used to treat cancer and arthritis get help.
Another pressing, sensitive issue for the new government is the need to introduce right-to-die legislation before Feb. 7. (The anniversary of the Supreme Court ruling that struck down the law criminalizing assisted death.) The Liberals have committed to appointing an all-party committee to draft a new bill but there is very little time to do so.
There is, of course, much speculation as to who will take on the role of Health Minister. The presumed front-runners are Dr. Hedy Fry and Dr. Carolyn Bennett, who have both done yeoman's work for years and know the health file intimately. However, putting a doctor in the job is not a given; with the sensitive negotiations that await, the job could go to an elder statesman like John McCallum or Ralph Goodale. (Let's not forget that two of the most influential health ministers in history were Marc Lalonde and Monique Bégin, a lawyer and sociologist, respectively.)
The Liberals are also likely to bring back the position of Public Health Minister – a nice plum for an up-and-comer – specially given that they have made a number of promises related to the social determinants of health, such as investments in affordable housing and long-term care facilities, a national food policy, a health promotion strategy to reduce obesity, and a vow to significantly bolster health spending for aboriginal peoples.
Finally, we can expect, in short order, some symbolic gestures in the health field, such as ending the legal battle with Insite and granting licences to other supervised injection facilities, and reversing the cuts to the Interim Federal Health Program, a program under which Ottawa covers the health costs of refugees. The latter is a move that would fit perfectly with plans to welcome more refugees to Canada, and which would underscore Mr. Trudeau's election night rallying cry that "a Canadian is a Canadian is a Canadian."
Editor's note: An earlier version of this story stated Justin Trudeau vowed to convene a first ministers conference on health within 60 days. In fact, he did not set a deadline.