Lots of numbers, little imagination: The federal funding deal won’t fix health care

Despite the hype, the spin, and the orgy of numbers put forward, the federal government has essentially dusted off and warmed over a 20-year-old Health Accord.

In 2004, then-prime minister Paul Martin negotiated a 10-year, $41.3-billion agreement with the provinces, a deal that promised shorter surgical waiting times, better access to primary and home care, and the creation of health human-resource and national pharmaceutical strategies. It also included a 6-per-cent escalator on payments under the Canada Health Transfer.

On Tuesday, current Prime Minister Justin Trudeau offered up an eerily similar 10-year deal, with $46-billion in new funding, and a 5-per-cent CHT escalator for the first five years, falling back to no less than 3 per cent for the subsequent five. The federal government asked the provinces and territories, in return, to improve data collection and sharing, and urged them to prioritize primary care reform, health human-resource planning, mental-health care, and elder care (both home care and long-term care). The only change this time around is that Ottawa is looking to sign 13 bilateral agreements instead of one national accord.

Plus ça change, plus c’est la même chose, as the saying goes.

It’s hard to believe that 2½ years of public posturing and background negotiations produced something so utterly uninspiring and unimaginative.

Sure, there will be an infusion of money, $196.1-billion over the next decade, and that’s the headline the Trudeau government was looking for.

But most of the money will come in the form of a steady increase in the annual federal contribution to health spending, something that would happen even without a new deal.

Explainer: Here's what to know about the new health care funding deal

Going into the talks, Ottawa was talking tough about “buying change” and putting conditions on the increased funding. But the money is being offered up with no real strings attached, other than some polite requests to share data, adhere to the principles of the Canada Health Act and draft “action plans” for how they plan to spend the money. No talk of penalties or clawbacks, and no real accountability.

So, will the provinces and territories take the deal, even though it is “fiscally limited,” to quote B.C. Premier David Eby?

The answer is: Almost certainly.

But no sooner will the ink dry on the bilateral agreements than a predictable cycle will begin anew, with premiers demanding more money. As Ontario Premier Doug Ford said: “We see this as a starting point, as a down payment.”

Manitoba Premier Heather Stefanson was even more frank: “It’s never enough.”

The provinces and territories currently receive $45.2-billion annually from the Canada Health Transfer. They came into the meeting asking for an additional $28-billion a year, a huge hike.

Ottawa offered far less than that, about $19.6-billion annually on average for the next decade. That’s nothing to sneeze at. But the new monies include only $4.6-billion on average each year in “new, new” money.

Ottawa’s offer also features very limited targeting, with some money for wage increases for personal support workers, mental health and substance use, home care, and long-term care.

What’s dispiriting about the whole process is how much it has focused almost exclusively on money.

For months and years the premiers and their health ministers have been bickering about the appropriate share of federal and provincial spending, and the rates of growth in transfers.

Tuesday’s meeting of the countries’ top leaders was little more than a gathering of pencil-pushing accountants, each trying to burnish their bottom line rather than actually improve health care.

Meanwhile, waiting times grow – in operating rooms, in emergency departments, in doctor’s offices and more – and so does the suffering of Canadians.

Where is the vision? Where is the real reform that is required to get medicare back on track?

What we need from our leaders is some true leadership, for example a firm commitment that every Canadian will have ready access to a primary care provider.

That would make a real difference to health care. It’s an initiative we could cost out, invest in and measure its progress in real time.

All the public is getting out of the current approach – formulaic growth in spending – is more of the same old, same old.

With health systems collapsing around us, that’s the last thing we need.