Prime Minister Justin Trudeau said early last year that provincial demands for major increases in health care transfers would have to wait until Canada was “through the worst” of the pandemic crisis.
That time is now, say provincial and territorial premiers preparing to meet next week as the Council of the Federation.
The health care system is in crisis, says the Canadian Medical Association (CMA), which points to temporary emergency-room closings due to shortages of doctors and nurses. Some medical staff have left the profession, partly due to pandemic-related burnout.
“How bad does it have to get and how many people need to die because they couldn’t access health care before we actually see some action?” CMA president Katharine Smart said in an interview. She added that Ottawa and the provinces must act quickly to tackle the many structural problems with health care.
“We need to move forward now,” she said.
British Columbia Premier John Horgan, council chair, said in an interview on Tuesday he will tell his colleagues Ottawa has given no substantive response on their health care funding concerns.
“We get lots of `We’re working on it,’ but we have not seen any outcomes,” the NDP Premier said.
“If someone [from the federal government] wanted to show up in Victoria, we’d be happy to hear what they had to say, but I’ve had no indication they have fully grasped the importance of this.”
In the absence of a substantive federal response, Mr. Horgan said, provinces may look at different modes of delivering services that could raise questions related to the Canada Health Act, which lays out federal goals for publicly funded care.
Mr. Horgan, who recently announced he will step down as Premier after five years in the job, said the issue was unresolved when he arrived and he expects it will be unresolved when he leaves.
“If the federal government says everything is fine, they’re delusional. That means we’re going to have to find another way, and I don’t know what that would be,” he said.
For several years, the premiers have urged Ottawa to increase its share of total government health care costs from 22 per cent to 35 per cent.
The premiers estimated in a 2021 report that this would mean increasing the size of the annual Canada Health Transfer (CHT) by more than $27-billion a year, plus an annual increase of 5 per cent.
As a group, they expressed disappointment in April when Finance Minister Chrystia Freeland’s 2022 budget did not address their requests.
It was in response to similar expressions of provincial disappointment to Ottawa’s April, 2021, budget that Mr. Trudeau said negotiating a new CHT arrangement “needed to wait until we’re through the worst of this crisis.”
Quebec Premier François Legault’s press secretary, Ewan Sauves, specifically referenced that promise in a statement to The Globe this week.
“We’re there. It’s high time for him to do his fair share and increase transfers to 35 per cent,” he said.
Newfoundland and Labrador Premier Andrew Furey has a tangible perspective on health care. He is also an orthopedic surgeon, regularly practising to maintain his medical credentials.
“In my work in the hospitals, I see that the workforce is tired, they’re exhausted, they’re stressed, coming out of the pandemic, with increased pressures because of inflation and budgetary restraints,” Mr. Furey said in an interview on Tuesday.
He said that, as a physician, he sees that patients don’t know or care who funds their treatment.
Of Mr. Trudeau’s wish to wait until Canada is through the worst of the pandemic, Mr. Furey said, “I wouldn’t say that COVID is over, but a large portion of it is behind us and I think that now is the time to have these important conversations.”
The CHT is the largest federal transfer program to the provinces and territories. Its current federal formula is based on a three-year moving average of growth in nominal gross domestic product (GDP), with a minimum increase of 3 per cent annually.
Unlike real GDP, nominal GDP includes inflation, meaning the current period of higher-than-normal inflation will automatically lead to significantly larger federal health transfers than might have been expected a year or two ago.
In a June report, TD Economics forecasted nominal GDP at 12.7 per cent in 2022, compared to real GDP growth of 3.7 per cent. That forecast for nominal GDP growth is much higher than the 7.7 per cent used in the April budget.
The budget projected the CHT would increase from $45.2-billion in the current 2022-23 fiscal year to $56-billion in 2026-27. That works out to an average annual increase of 5.3 per cent over that four-year period.
While the federal government has delayed talks on long-term health transfers, it did approve billions in short-term health transfers to the provinces for pandemic-related spending.
Federal Health Minister Jean-Yves Duclos outlined Ottawa’s bargaining position during a March speech in which he announced a one-time $2-billion payment to help provinces manage pandemic-related backlogs in the health system.
During that speech, he noted that in 1977, Ottawa agreed to transfer some of its tax room or tax points to the provinces so that they can more directly fund health care.
Mr. Duclos said the survival of Canada’s public health system is at risk unless governments act “quickly and decisively.”
Yet the minister also claimed that Canadians don’t want a “sterile fiscal debate” and that he was not interested in a “numbers war” with the provinces. Ottawa’s top five priorities in the talks, according to Mr. Duclos, are addressing backlogs by hiring and keeping health workers; increasing access to primary health care; long-term care and home care; mental health and substance use; and improved digital health and virtual care.
Mr. Duclos called these five points “fundamental,” while adding references to promises of national dental care and pharmacare, which are core priorities of the NDP, the party that has agreed to support the minority Liberal government on confidence votes.
In an e-mail to The Globe, Mr. Duclos’ office restated the position that Ottawa wants to work in collaboration with the provinces and that Canadians are not interested in a fiscal debate. The minister’s office said Mr. Duclos is not scheduled to attend the premiers’ meeting next week because he was not invited.
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