by Chantal Hebert
If truth is the first casualty of war, then Ottawa and the provinces must really be at war over health-care funding, for neither side is being straight with voters.
Both the federal government and its provincial counterparts are claiming to be fighting the good fight on behalf of patients. Each is implying that the other is letting greed get in the way of bettering the health system. That, in both cases, is very much like the pot calling the kettle black.
Prime Minister Justin Trudeau’s government is planning to follow through on Stephen Harper’s plan to cut by half the annual rate of increase of the health transfer to the provinces.
If they want a top-up of federal money, they will have to invest in the priority areas identified by the ruling Liberals in their election platform. But if they do, the provinces will still be receiving less money than the funds they would have been getting under the current formula.
To justify his approach, the prime minister has claimed that the provinces, or at least some of them, are diverting federal health dollars to other spending priorities.
“In terms of health care, Canadians are concerned about the fact that federal health-care dollars do not always flow to our health-care system,” Trudeau told the House of Commons last Wednesday. But that statement is, at best, a figment of some spin doctor’s imagination.
True: the federal health transfer has been increasing by 6 per cent a year for more than a decade, while provincial health spending is, on average, going up about 3 per cent a year. But the prime minister’s math would only add up if the federal government were footing the total provincial health bill. In fact, it contributes no more than 23 cents to the dollar.
The provinces have been picking up most of the tab for the rising costs of the system under the 6-per-cent escalator regimen and they will do more of that under the Harper/Trudeau formula.
In response, a number of them have been warning that the slower growth of the health transfer will either negatively affect the quality of care or force them to take dollars out of other programs to fund medicare.
It’s clear education or child-care dollars could have to be diverted to the health system.
Quebec, in particular, has been vocal on this issue. Health Minister GaÈtan Barrette claims that sick people could bear the brunt of the federal decision and that front-line services could further deteriorate.
But what Barrette does not say is that he is part of a government that has been determined to eliminate a provincial health-care levy before it next meets voters in 2018.
In fact, according to La Presse, news that the levy will be totally eliminated a year earlier than initially planned is expected to be the centrepiece of Tuesday’s provincial fiscal update.
The total cost to the Quebec treasury of the gradual removal of the health levy is estimated at $759 million. Eliminating it 12 months early would cost the province $200 million in health-designated revenues over the next fiscal year.
It is hard to reconcile Barrette’s concerns about a slower-growing federal health transfer with the decision to move full-speed ahead with a tax cut achieved by pulling out a plank of the provincial health-funding infrastructure.
All in all, the first full-fledged federal-provincial conversation about Canada’s health system in more than a decade is off to a poor start.
Some analysts have compared that conversation to a dialogue of the deaf. But perhaps the worst feature of the current negotiation is a collective case of wilful blindness. Neither side is willing to look in the face the reality that billions of federal and provincial dollars have failed to bring about the transformational change they were supposed to usher in.
From timely access to care, to finding a family doctor, the results – despite the generous dispositions of the 2004 health accord – are underwhelming.
Beyond the facile but ultimately misleading explanations of the prime minister, the federal response boils down to offering a distraction from the enduring ailments of the system with a few rose-coloured Band-Aids. The provinces, for their part, are insisting that more of the same expensive medication will eventually work.
When all is said and done, their only real disagreement revolves around how to best sweep the issue under the rug for a few more years.
Chantal Hebert is a national affairs writer. Her column appears Tuesday, Thursday and Saturday.
Copyright 2016-Torstar Syndication Services