Everywhere you turn, you read in the news – or discover through bitter personal experience – that Canada’s health care system is in crisis.
Emergency rooms are filled with children suffering from the flu, COVID-19 or other viral respiratory diseases. For two months, until Tuesday, Manitoba refused to accept critically ill children from Nunavut, because its pediatric intensive-care unit in Winnipeg was so overcrowded. In Ontario, there’s a backlog of more than one million surgeries. There are nursing shortages in every province. Several million Canadians don’t have a family doctor.
It’s a situation that needs a co-ordinated response from the provinces, who deliver health care, and Ottawa, the caretaker of the Canada Health Act.
Instead, Canadians are being subjected to the dismal spectacle of two levels of government jousting in the media over how much more cash Ottawa should throw into the provincial pot. Worse still, having chosen to mostly talk about money rather than systemic reforms, the provinces can’t even be straight about the basic math involved.
The premiers launched an “awareness” campaign in October that claimed that “federal funding has fallen to just 22 per cent of the cost of health care in Canada.” As others have pointed out, that figure is based on the amount of money Ottawa sent the provinces and territories via the Canada Health Transfer last year, as a share of total public health care spending over the same period.
But it conveniently fails to mention that the provinces benefit from nearly $20-billion a year in “tax points” – taxation room Ottawa transferred to the provinces in 1977, in lieu of cash, specifically for health care. When that’s taken into account, as it should be in any holistic analysis, Ottawa’s support for health care clocks in at 33 per cent of total spending. That’s less than the 35 per cent of health spending the provinces want the feds to pay for, but not by much.
Nevertheless, the provinces keep insisting otherwise. What’s more, the premiers’ ad campaign suggested that federal funding is shrinking, when it’s not, and that as it shrinks, which it isn’t, doctors and nurses will “disappear.”
Based on their convenient math, the provinces in July asked for an additional $28-billion in annual federal funding. It’s a number that comes with the implication that, without a large, immediate and permanent increase in the federal cash infusion, the provinces won’t be able to prevent a worsening of the shortages and queues plaguing health care.
Leery observers will note that the provinces are crying poor at a time when they are recording much lower than expected deficits, or even budget surpluses – in fact, the provinces are collectively in surplus.
The premiers have chosen to blow some of their windfalls on cheques to voters under the guise of inflation support (Quebec, Saskatchewan), or eliminating such things as car registration fees (Ontario). The provinces are also engaging in multi-billion dollar political boondoggles, such as Quebec’s plan to tunnel under the Saint Lawrence River at Quebec City, or Ontario’s intention to build yet another superhighway in the Toronto suburbs.
Every provincial dollar spent on vote-buying projects is a dollar that can’t be spent on health care. The premiers would prefer to have Ottawa – which, for those just joining us, is still in deficit – run an even larger deficit, so that it can hand those extra borrowed funds over to the provinces.
The provinces aren’t exactly making a great case for themselves. Nevertheless, the country’s health care system is in a bad way, marked by such things as a shortages of nurses and decades of deliberate underinvestment in hospital capacity. The big fix is going to require major reform, which nobody wants to talk about, and minor increases in spending – which governments would prefer to focus on.
This week, at a federal-provincial health ministers meeting in Vancouver, Ottawa said it is prepared to increase the Canada Health Transfer, but it asked for a modest quid pro quo: a national health data system that all provinces contribute to, and a national human resources action plan.
And yet not even something as sensible as that is a given in Canada: The provincial ministers rejected the conditions on Tuesday, and the money that went with it.
Canada has a health care crisis whose root cause is a leadership crisis.