A health proposal that doesn’t rise as high as its rhetoric

To open the federal government’s long-awaited proposal on health-care funding was to know what it feels like to be a provincial premier. Ottawa was pledging to send the provinces tens of billions of dollars, over and above the already-planned increases, and yet it was underwhelming.

The additional sums in the package are roughly what Prime Minister Justin Trudeau’s Liberals promised in their 2021 election campaign – $21.3-billion over the next five years – although it will lock in those additional federal increases over a whole decade.

It’s just that Mr. Trudeau had made it sound like there’d be much more. He’s been talking about the sorry state of health care, with sad examples, and promising to change all that. Provincial officials seemed to think they were getting more than what was eventually announced.

Quebec Premier François Legault said that just before Christmas, Mr. Trudeau told him he would propose a substantial additional sum. “Obviously, he doesn’t have the same definition of ‘substantial’ as me,” Mr. Legault told reporters.

Of course, you do have to count all this money as substantial. It will ease the strain on provincial health budgets. But it won’t buy transformational change that will fix all that ails a health care system in crisis.

In the context of the expectations that the Prime Minister himself set, this deal was middling. Meh.

Many of the premiers said it wasn’t enough – British Columbia’s David Eby called it “fiscally limited” – but several also said it was better than nothing and, essentially, that they will take what they can get. Ontario’s Doug Ford said the money won’t transform health care but the certainty of additional future funding will be important to provinces.

The 10-year federal-provincial agreement won’t settle the squabbling over health care funding. Mr. Legault said the money will help, but there will still be long-term questions about the sustainability of health funding. He said he will take it up with future federal governments. Perhaps Conservative Leader Pierre Poilievre can expect Mr. Legault will be asking whether he is willing to promise more if he is elected.

To be fair, no PM of any major party would ever meet the provinces’ funding demands. Their call for an additional $28-billion a year, plus increases of 5 per cent a year would amount to $353-billion over 10 years.

And the Liberals are putting forward the most significant injection of federal funding in nearly 20 years. The $46-billion in additional sums comes on top of other, already-planned increases which will add $196-billion over the next decade. That is a large sum, even if some of the increases are intended to account for inflation.

But in the context of the roughly $217-billion the provinces spend on health care, it is not a massive shift. The additional sums announced Tuesday amount to about 2 per cent now. PEI Premier Dennis King said his province’s health care budget is going up 12 per cent this year, and new federal money will pay for 4 or 5 per cent.

The $196-billion in increases suggests the feds will be paying a larger portion of Canadians’ health care costs over the decade, in predictable sums. The package includes a higher floor for annual increases, of 5 per cent instead of 3 per cent.

The feds will insist on some new data reporting by the provinces and will deliver the lion’s share of the money through one-on-one agreements in areas such as family health, and the provinces are supposed to report on how they do – but even Mr. Legault said the conditions aren’t really conditions. That suggests hope for greater transparency, without jurisdictional bun fights.

So Mr. Trudeau’s Liberals have taken a step to bolster the sustainability of health-care funding, but not provided the basis for the grand change he seemed to be promising lately. In the 2021 election campaign, he promised to spend roughly this much, and 17 months later, with the strains on the health-care system, the sum has not changed.

Even with all those billions, Mr. Trudeau didn’t scale the heights of his rhetoric.