Canada’s health care crisis demands leadership. Our premiers have chosen finger-pointing

If wasting money on repeating half-truths is the best that Canada’s 13 provincial and territorial premiers can do in response to the current health care crisis, what hope can there be that there will ever be meaningful reform?

But unfortunately, that looks to be all they’re offering. A new ad campaign launched by the Council of the Federation comes with a blame-shifting slogan: “As federal health care funding disappears, so do our doctors.” (A second version replaces the word “doctors” for “nurses.”)

Finger-pointing is not leadership. Neither is crying poverty while, in some cases, racking up record surpluses.

If provincial and territorial leaders really believe that an injection of cash would stem the exodus of physicians and nurses, they should be cracking open their chequebooks, not simply demanding that the federal government do so.

But they know full well that an influx of dollars, federal or otherwise, is not going to magically slow the disturbing collapse of the beloved medicare system. At least not without a plan. And planning, not advertising, is where the premiers should be focusing their efforts.

What is needed is fundamental structural reform, and the power to implement such changes rests almost entirely with the provinces.

Instead of acting urgently – which is what the current crisis in health care requires – the provinces and territories have opted to engage in tedious bellyaching about how the bill should be split, conveniently ignoring that there is just one taxpayer.

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In its ad campaign, which appears on social media, in newspapers, on radio and billboards, the Council of the Federation makes two central claims: that “federal funding has fallen to just 22 per cent of the cost of health care in Canada, and it continues to decline,” and that “provinces and territories are doing their part, but we need the federal government to restore health funding now, to keep our systems strong.”

Health care spending totalled $308-billion in Canada last year, with roughly $220-billion coming from public coffers. The Canada Health Transfer – cash that Ottawa sends to the provinces and territories – clocked in at $43-billion in 2021. That’s where the 22-per-cent calculation comes from. But the premiers’ math conveniently ignores that they receive another $19.6-billion in tax points (a transfer in income-tax room from the feds to the provinces), not to mention equalization payments.

As for the claim that federal funding is falling – well, in the past decade, the Canada Health Transfer has jumped by one-third, to $45-billion from $30-billion annually, though overall spending has grown even faster.

For the past couple of years, the provinces have been demanding the Canada Health Transfer be increased by $38-billion annually. This ask is based on their dubious belief that Ottawa should be funding at least 35 per cent of public-health spending.

Let’s be clear: Postpandemic, Ottawa can and should invest more in health care. They’ve also given every indication they are willing to do so. But the demand that Ottawa should invest so much more, and that the new money should come with no strings attached – this is ludicrous.

Prime Minister Justin Trudeau’s insistence that new spending lead to “tangible results” is entirely reasonable, though the feds need to be much more explicit about what an accountability mechanism would look like.

The Canada Health Transfer is important, but it’s not the be-all and end-all. Ottawa has already created separate transfers to bolster home care and mental-health services, and it sent the provinces wads of cash for pandemic relief.

Ottawa has also started negotiating funding agreements province-by-province. The premiers’ willingness to do so shows they are not as united as their ad campaign suggests.

Next week, federal Health Minister Jean-Yves Duclos will meet with the provincial and territorial health ministers in Vancouver, and hopefully, they will come up with some concrete actions to address the human resources calamity in Canadian health care. The provinces need to do more than make vague promises to improve interprovincial mobility of nurses and doctors, and to streamline the accreditation process for international medical graduates.

The provincial health ministers also need to do more than parrot the premiers and mindlessly demand more cash. They need to agree on a framework for renegotiating the Canada Health Transfer, and related health transfers, with an emphasis on reform, accountability and performance measurement.

Until they do that, there is no point in the Prime Minister sitting down with the premiers. But that needs to happen, and soon – if there is no deal by the end of this year, it is highly unlikely there will be money allocated in the spring budget.

For the provinces and territories, “doing their part” has to consist of a lot more than bombast.