“As Premier, the buck stops with me,” Ontario Premier Doug Ford said Wednesday, after the military reported horrific shortcomings in five long-term care centres.
But apparently he didn’t mean the whole buck. Mr. Ford said he will fix problems in long-term care, but added, “we need the Prime Minister’s help to fix this problem, because no province can do this alone."
The question that statement should raise in the minds of every Ontarian is: Why the heck not?
Everyone, it seems, is calling for Prime Minister Justin Trudeau to jump in and do something about long-term care. Even Mr. Trudeau sometimes makes it sound like he should. The problem is that the PM can’t fix it. And he can’t be held to account for it.
Only one type of figure can be held responsible if the many now-obvious shortcomings in long-term care are not fixed: provincial premiers. That means you, Mr. Ford. And every premier in every province.
That’s not just because health care is the province’s sole jurisdiction under the Constitution.
It is because the provinces organize the health care system, pay the salaries, set budgets, hire staff and make the rules, protocols, and standard operating procedures – or they’re responsible for those who do. It makes sense, because they’re closer to hospitals and patients and long-term care centres than the feds.
So why is Mr. Ford shrugging off one of his government’s core responsibilities, and acting like Ontario can’t work without help from grown-ups in Ottawa? Because he wants money. He said so, in a press conference on Thursday.
The thing is, Ottawa doesn’t have some special store of cash that Ontario can’t access. It has taxpayers. If the feds pony up billions for long-term care, it’s going to do the same thing Ontario would, and add it to the deficit. Unlike some provinces, Ontario doesn’t have a particularly old population or a particularly weak economy, so it won’t make much difference to Mr. Ford’s taxpayers which government pays.
The premier doesn’t want the budget trouble. He doesn’t want a bigger deficit, or to shift resources from other things, or to raise taxes. He doesn’t want his voters to be faced with the hard choices about the costs of long-term care.
Mr. Trudeau can offer money. He’s been pumping it out the door lately. But it’s the same money. And he still can’t fix long-term care.
The PM should be held accountable for lots of things in this crisis and beyond: financial supports, deficits, decisions on closing the border, and, because Ottawa has that general responsibility for “peace, order, and good government,” the coordination of the emergency public-health response.
Calling on Ottawa to fix long-term care will only muddy the waters about who really is responsible.
To be fair, there are some legitimate bases for the impulse. Provinces from coast-to-coast seem to have huge shortcomings in long-term care. “How’s that working?” asked New Democrat MP Don Davies, the party’s health critic.
He’s right, it’s not working well. The COVID-19 crisis hit long-term care centres, especially in Quebec and Ontario, and exposed pre-existing problems. Quebec Premier François Legault, who ran on reducing immigration to the province, is so desperate to hire thousands of orderlies that he is trying to recruit immigrants, even musing that asylum seekers who take the job might get resident status.
The NDP argues the federal government should amend the Canada Health Act, setting “elevated national standards” for long-term care, and offering the provinces more funding.
Medicare certainly could use an update. And provinces can – and will – ask Ottawa to pay a bigger share of health-care costs. But up to now, the Canada Health Act has existed to enforce a handful of principles, like publicly-paid care and inter-provincial portability, not detailed standards like the ratio of nurses to long-term care residents. The talks to change that won’t be quick, or easy.
Most importantly, that shouldn’t get in the way of the provinces fulfilling their duty. Fix the problem.
Mr. Ford should know Ontario needs more public support workers, for starters. Since the military found problems his health department didn’t, he needs to revamp inspections. There’s a lot more.
The best way for citizens to ensure those sorts of things get done is to have only one butt to kick if it doesn’t. Like it or not, that can only be a premier.