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Budget 2016: still waiting for the health care litmus test

A recent Ipos poll showed that out of a list 15 of the top priority coming into budget 2016, ‘spending more on health care’ was the top priority for Canadians. As global news reported, “A provincial breakdown of the new data showed healthcare was high across the country, with the most support in B.C. (56 per cent) followed by Atlantic Canada (44 per cent), and Alberta (41 per cent). Saskatchewan and Manitoba residents were the lowest with 32 per cent ranking healthcare spending in their top three. Quebec and Ontario residents were comparable on the issue at 39 per cent and 35 per cent.”

Coming into this budget, after a dark decade of underfunding and privatization by the Harper government, health care advocates had high hopes. The Council of Canadians has participated in the CCPA’s alternative federal budget which highlighted, “The health policy commitments of the new federal government include promises to renegotiate the Health Accord, and to increase access to home care, mental health services, and prescription drugs.”  It was our hope that robust improvements and investment in some of these areas would be included today (as the bar has been set so low you can trip over it).

Quickly after lock up was released and the finance minister tabled the 2016 budget, Ipolitics ran a story titled, “Budget kicks the health spending can down the road.” Reading through the short health section in the budget documents, the big issues and the promises the Liberals had made regarding home care and palliative care, the Canadian Health Transfer, the Health Accord and so on, have been put off until another day. There is no discussion in the budget of the Premiers unanimous calls for the federal government to cover 25% of provincial health costs (at the start of medicare this was an equal 50/50 arrangement). Post budget analysis shows that despite a Liberal campaign promise to immediately invest new money in home care services to the tune of $3 billion over four years (hopefully not at the expense of acute care which falls under the CHA unlike home care services, but I digress), Finance Minister Bill Morneau confirmed, “Tuesday the government will not be making new investments in home care, indicating the government will work with provinces and territories on the issue instead.” CUPE President Mark Hancock has stated, “This budget makes no real commitment to strengthening our public health care system.”

Unfortunately, looking at the appendix tables it becomes clear that the government’s budget projections maintain the Harper government’s reduction in health care transfers to the provinces relative to the GDP. Counter intuitively the budget states, “Starting in 2017–18, the CHT will grow in line with a three-year moving average of nominal GDP growth, with funding guaranteed to increase by at least 3.0 per cent per year.” So as opposed to a fixed 6% escalator which was included in the last health accord, health transfers to the provinces will be lower when the economy is doing worse (i.e. the time when people need health care the most). We echo the CLC statement that, “The CLC said they are disappointed by that, but hopeful that continued talks between the Health Ministers will result in new, sustained funding for health care that allows our system to meet the needs,” of Canadians.

In regards to a renegotiated Health Accord, this budget does little to make clear where we are headed. Is this government planning to reflect Canadian’s top priority and invest new money into the public system in the future, or are future budgets going to follow the template of Harper’s budgets with underfunding health services and increasing two-tiered services?  It is too early to tell, but we hope the new government follows some of the suggestions the Council of Canadians have made on this topic.

So what is in the budget regarding health? We see, “Much of the health side of the budget amounts to a collection of smaller funding initiatives — $39 million for the Canadian Foundation for Healthcare Improvement to find ways to improve the healthcare system, $50 million to Canada Health Infoway to boost e-health initiatives in Canada (like online prescriptions and tele-health) and $47.5 million a year for the Canadian Partnership Against Cancer for efforts which will ‘complement the initiatives in a new Health Accord.’ Research granting councils get an extra $95 million dollars a year in new annual funding.”  To put this in context we have an over $220 billion health care system in Canada.

In regards to First Nations health the government plans to invest $270.2 million over five years to expand and enhance health facilities in First Nations communities (no word on if these will be P3 contracts or not); budget documents show that a sum $82 million to be spent in the first two years. Nishnawbe Aski Nation Grand Chief Alvin Fiddler (who’s jurisdiction includes the Kashechewan First Nation that is currently undergoing a health crisis) stated on twitter that, “$82M/year for 2 yrs won’t go far enough to address current need for health facilities in FN communities.” Scholar and activist Pam Palmater, who spoke at the Council of Canadians 2015 AGM, highlighted on twitter that, “Almost no investment on health care generally. To cover gap in FN health funds DOUBLE current budget needed. Looks like crises will worsen,” and that, “2M per year for mental health in First Nations is 3k per First Nation. Less than a dollar a person. That won’t address suicide crisis.”

 For discussion regarding funding for safe water on reserves, which has a major health impact, I will leave that analysis to the Council of Canadians amazing water campaigner Emma Liu. For nutrition issues CPJ has highlighted that, “the government has also committed to expanding the Nutrition North program by investing $64.5 million over five years to ensure nutritious food reaches northern communities. We hope that the program will also be improved so that it is more effective in reaching this goal.”

APTN has  provided analysis stating, “The federal budget unveiled by the Justin Trudeau Liberal government Tuesday failed First Nation children and families, says Cindy Blackstock, the tireless children’s advocate behind the successful human rights complaint against Ottawa over its underfunding of child welfare services on-reserve… On the surface, the Liberal budget commitment to invest $634.8 million for child welfare on reserves appears like a big figure, but scratch a little and a different reality emerges. The number is spread out over five years, with the largest amount appearing in the fiscal year after the next federal election which is scheduled for the fall of 2019.” This is one of the many social determinants of health that needed to be addressed and fully invested in.  Further Blackstock has stated that, “the budget document is as clear as mud in explaining how it plans to implement these proposed reforms. She said it doesn’t come close to meeting the Truth and Reconciliation Commission’s (TRC) calls to action, which listed reforms to the child welfare system as a top priority. ‘This falls far short,’ said Blackstock. ‘It doesn’t provide a clear pathway as to how they are going to achieve that within the confines of the (Canadian Human Rights Tribunal) order.’”

In regards to trade the budget stated, “The Government recently completed the final steps of the Canada-European Union Comprehensive Economic and Trade Agreement. Canada and the European Commission are committed to swift ratification so that our citizens can quickly reap the benefits of this high-quality agreement. The Trans-Pacific Partnership (TPP) would offer opportunities to grow Canadian trade with Asia Pacific countries, enhance North American production and improve job quality in Canada.”  These deal will have a massive impact on our health care, increase costs and create a policy chill for new initiatives (like a full and comprehensive national pharmacare plan).  The Council of Canadians has written extensively on this issue in regards to health and new analysis from allies continues to emerge that these are net-negative deals for the health of our nation.

Overall, much of the talk following the budget will no doubt be right wing hyperbole and defrosted talking points regarding ‘reckless spending’ by the Liberals. Unfortunately this has the double effect of limiting important discourse on the budget and making it look more progressive than it is. The $29.4 billion deficit sits at around 1.5% of Canada’s GDP, which is much less than the 3.5% of GDP deficit the Harper government put out in one of their budgets. This budget also comes at a time when interest rates in Canada and around the world are at record lows.  Lastly, it is important to put spending into context and check it against government spending as percentage of GDP over time. The first fiscal plan included in the budget ends, “in the year 2020-21, with federal spending at one of the lowest rates in the past 65 years—15.1% of GDP, slightly higher than 2014-15’s all-time low level of 14.2%.”

What is worrying overall, and specifically for health care in Canada, is the continuing trend we are seeing to marginally invest in our social safety programs.  Spending on social programs is set to rise to just 14.6% of GDP one year from now (in the 1970s this was around 20%). We are not seeing a turnaround in the downward spiral, but at best a brief flatline before they fall back down to 2015 levels by 2020. This comes at a time when the health of Canadians is getting worse, make no mistake about it. 1 in 7 Canadian children live in poverty (this rate places us 15 out of 17 similar nations). In Canada, 30,000 people are homeless on any given night, with an estimated 50,000 hidden homeless. Roughly 40,000 Canadians die prematurely each year as a result of social inequality (equal to 110 Canadians dying a day). To be fair the new Child Canada Benefit and the improvement to the Guaranteed Income Supplement for seniors are a couple of positives steps the individual level to affect the SDOH, but this shouldn’t be confused with investing in the social programs we all use as a community.

By putting these figures in a historical and contemporary context it shows that while this budget is being framed as for the middle class, it does not rebuild the public social safety nets -like medicare- that Canadians (including the middle class) depend upon. Compounding the matter this comes at a time when the wealth gap between the working class and the rich is growing with the wealthiest 20% now control nearly 70% of all wealth in the country. The top 10% own almost half of all wealth. This income gap has accelerated in the last 10 years, the wealth of the top 10% of Canadians increased by 42%. And what is the result? Poor men and women are, respectively, 67 and 52% more likely to die each year than their wealthy counterparts. Real change would be investing in our social services like public health care and not being afraid to raise the revenues needed (or just start closing things like the $750 million CEO stock option tax loophole this budget kept and the finance minister stated won’t be touched in future budgets).

At best this budget has kept our public health care system on life support for the time being, but has not provided the treatment it desperately needs.  The ‘real change’ litmus test has yet to be met in regards to health care, and we will have to wait and see what the outcome of Health Accord discussions will hold for the future.  With this being said, many of the policies and budget lines revealed today do point to a need to have a ‘health in all policies’ approach implemented in Canada. From international trade issues to funding for First Nations communities, and everything in between, we need to address the impact policy choices have on the health of our nation.  It is also clear that a shift needs to occur from an individualistic approach to health, to a population health approach.  This would result in an investment into the social security nets and programs we all use and need throughout our lives. As writer Michal Rozworski astutely points out, “this budget reads like new technocratic consensus…  The decades-old framework — low taxes on business and the rich, targeted rather than universal social services, and government that doesn’t challenge the structural conditions that create inequality — remains in place… with this budget the Liberals have rolled back Harper but left Chretien and Martin untouched.”