If the premiers and the PM make a deal, Canadians will have an opportunity to move beyond the funding squabble and demand their governments deal with the real question – what are you going to do about health care?NICK IWANYSHYN/The Canadian Press
The good news is that the feds and the provinces are getting close to a deal on funding health care, and the biggest reason that’s good news is that there will be fewer excuses for the failures.
Prime Minister Justin Trudeau has convened a meeting on health care with the premiers for Feb. 7, and it was always clear he wouldn’t do that until the feds thought a deal was within reach.
If the premiers and the PM make a deal, it doesn’t just mean that the feds will transfer billions more to fund health care. It means that Canadians will have an opportunity to move beyond the funding squabble and demand their governments deal with the real question – what are you going to do about health care?
And that is the important part.
The history of federal-provincial health care agreements shows that they tend to improve things a little bit for a little while, but don’t actually spark the big, lasting transformations that were advertised.
When Mr. Trudeau said on Wednesday that Canadians want the health care talks to be about more than funding, you can bet he has seen polls that tell him that’s what the public thinks: Canadians want better care, not just more dollars, and want improvement that lasts.
The premiers know that is the public’s mood, too. For a long time, they insisted Ottawa should just give them $28-billion-a-year more, no strings attached, and rebuffed federal demands for the provinces to agree to providing new data and indicators on health care outcomes. But the premiers changed their tune. New Brunswick Premier Blaine Higgs told the CBC that was because public opinion demanded it.
The deal won’t be close to the $28-billion per year, but Ottawa is proposing large sums. The Ontario government seems to think it could come away with an additional $70-billion over 10 years; extrapolating that sum to the entire country would add up to something like $150-billion in additional funding over a decade.
The feds will insist on paying out a big chunk of it through specific bilateral agreements struck with individual provinces for things such as mental health or long-term care. They want to be able to tell voters they improved specific types of care, rather than how much they spent.
But the so-called conditions the feds will put in the agreement won’t really be conditions, because Ottawa won’t threaten to cut off health care funding. The provinces will be asked to express their intention to fix certain problems, or meet certain targets, and the feds will ask them to agree to reporting on a common set of indicators.
The important question – the one most Canadians care about – is what happens after that. And for how long.
The first benefit should be that the squabbling over who pays what will be over. Hopefully that will put more pressure, not less, on provincial governments to deliver results. But Canadians want lasting improvements.
Historically, a structural increase in federal health transfers leaders to provinces increasing spending on health care in the short term, said Livio Di Matteo, a Lakehead University economics professor.
“Then the question is whether it helps to address structural issues over the long-term,” he said. “History shows it doesn’t.”
In 2004, prime minister Paul Martin convened a first ministers’ summit on health care, following on a public commission headed by former Saskatchewan Premier Roy Romanow, who argued that Ottawa should pump money into the health care system to buy transformative change. The agreement that followed, with major increases in federal transfer payments, was touted as fixing health care for a generation.
Provinces did boost their spending after that accord by an average of roughly 4 per cent per capita after inflation, Prof. Di Matteo said, but when the recession hit in 2009, that figure dropped to around zero. In the meantime, there had been structural improvements, but not really transformative change.
The costs of repeating that would be much higher now.
So it’s a good thing that the feds finally appear ready to pony up some stable long-term funding. And it will be an important advance if the agreement includes leads to useful indicators that help the public judge progress.
But let’s hope that it focuses pressure on governments to improve care, rather than relieving it. What matters is what follows the money.
Campbell Clark