Yesterday, finance and health ministers from the provinces and territories met with their federal counterparts to renegotiate the Health Accord. The meeting came on the 50 anniversary of our medicare; on December 19, 1966, parliament proclaimed the Health Care Act as the law, creating the single-payer health-care system we know today. While the federal government showed courage, vision, and prioritized the public’s wellbeing half a century ago, sadly it appears the opposite has occurred at the present time.
Coming into the meeting the provincial and territorial leaders were reported to be, “fuming over Ottawa’s plans for a one-day-only, take-it-or-leave-it negotiating session Monday that will shape the direction of health funding for the next decade.” Quebec Health Minister Gaétan Barrette stated, “We have received an insulting ultimatum from Bill Morneau...Morneau’s proposal is a road map to a catastrophe, because it will end up in a reduction of federal funding for health care across the country at a time when the needs are increasing.” In another interview Barrette stated, “There’s been no negotiations whatsoever during the last year and we are being served an ultimatum by Bill Morneau, which is totally insulting and inappropriate.”
British Columbia’s finance minister Mike De Jong echoed Quebec’s discontent stating, “The take it or leave it attitude that seems to be emanating from the Prime Minister's Office on this is not productive, it's certainly not collaborative, and really not acceptable... certainly a departure from what the prime minister indicated in terms of the approach he wanted to take." In another interview he highlight that the federal government hadn’t shown any indication of a, “willingness to have a genuine dialogue...We understand there are pressures, but that’s not an excuse to come 36, 48 hours before a meeting and say, ‘Here’s what it’s going to be, here’s what we’ve decided the agreement’s going to look like.’ That’s not an agreement.”
It seems the federal Liberal government isn’t willing to make serious and reasonable funding arrangements that Canadians and their health care system needs. Ultimately, the provinces and territories declined the federal offer of a Canadian Health Transfer (CHT) escalator being set at 3.5% (it is currently at 6%) and about $11 billion over 10 years for home care and mental health. For prospective, it is worth comparing this proposed spending on health care with the federal government’s, “enthusiasm for investing in infrastructure projects. It has announced plans to spend $186 billion on infrastructure over the next 11 years.” Quebec Health Minister Gaétan Barrette told the CBC, "what has been tabled is a reduction in funding...a reduction of $51 billion...Minister Philpott will come to your microphone and camera and say we tabled $11billion... so today the situation is very simple minus 51 and plus 11, everybody who is listening understands the math of this - Canadians are losing."
As it stands, spending on health care by governments (largely by the provinces and territories) has fallen short of inflation and population growth for six straight years. It is safe to assume this will only trend further in the wrong direction with the reduction of the CHT escalator. The Globe reports that, “The Parliamentary Budget Officer has warned that a change to the federal transfer formula that takes effect next year will put Ottawa’s contribution to health care on a declining trend. The PBO has said that single change – which shifts the growth of federal health transfers from 6 per cent to at least 3 per cent – is largely responsible for moving Ottawa’s fiscal position from unsustainable to sustainable. The flip side is that the burden has shifted to the provinces, where governments face a future of skyrocketing debt.” To put it another, the federal government is looking to balance the books at the expense of the health of Canadians at this point (as opposed to many other tools or policy changes they could make). The CBC indicates that, “Ottawa's plan to allow annual health transfers to fall from six per cent to three per cent would trim nearly $1.1 billion this year from its combined payments to the provinces.”
Canada’s Premiers have continued to call on Ottawa to boost funding on health to 25% (although an important caveat not included should be that this should be conditional on provinces not decreasing their health spending). If the provinces were to accept the Liberal government’s offer of, “a locked-in 3.5 per cent annual increases then the federal share of health funding will actually decrease from about 23 per cent right now to possibly under 20 per cent.” After the finance minister ultimatum of 3.5%, the federal government refused to accept a counter-offer from the provinces of growing the health escalator by 5.2% a year and for provincial commitments to spend on mutual priorities. The Ontario Financial Accountability Office has stated that 5.2% is the minimum transfer needed for Ontario to be able to continuing offering their current basket of public health care services. For the record the Council of Canadians has repeatedly called for a minimum of a 6% escalator and outlined the reason for this position. The Ontario government has stated that overall, “The current federal funding proposal is over $30 billion less than what the evidence shows is needed to maintain the sustainability of health care systems,” other estimates put this figure at between $40-50 billion less than what is needed.
Ontario Finance Minister Charles Sousa said it was the federal government who walked away from the table, not the provinces and territories. Essentially the federal government walked away from the wellbeing of the nation. The CBC notes that, “Without a deal, the health-transfer arrangement would likely revert to the Harper plan of at least three per cent a year.” If nothing changes, this will occur on April 1, 2017.
When asked about what happens next, Morneau stated, "We don't have next steps to lay out for you.” Further he wouldn’t, “respond directly to questions of whether a failure to immediately deliver a Health Accord counts as a broken promise for the Liberals. But he did haul out the biggest numbers possible in front of the TV cameras...” While the federal government hasn’t confirmed if they would negotiate with provinces individually, New Brunswick health minister, Cathy Rogers, indicated her province will seek a bilateral agreement. This would be a dangerous and short sighted path to head down that would jeopardize the equality between provinces for health services. Others, like P.E.I. Premier Wade MacLauchlan, have called for a first ministers’ meeting and believes more work can be done to reach an agreement. Hopefully this can occur, but all parties need to be willing to the wellbeing of Canadians ahead of political games.
At the current junction, there will no doubt be a lot of spin in the coming days on why the negotiations failed. Below are some editorialized thoughts on the matter.
-Our public healthcare is as sustainable as we want it to be and remains the number one priority for Canadians. The proposal we have seen brought forward today by the federal government is both risky and irresponsible. Underfunding our healthcare will only lead to further erosion of the foundation of medicare and usher in increased privatization of our system.
- During the last election campaign, the Liberal platform promised, “only to work collaboratively with the provinces to negotiate a new health accord, including a long-term agreement on funding.” So much for real change and sunny ways. The Trudeau government is fulfilling the Harper legacy of underfunding health care. Underfunding public healthcare is a choice and it ultimately speaks to the values of the government. It needs to be remembered that the figures and budget lines being proposed aren’t just numbers, but the wellbeing of our families, friends, and communities.
-The provinces do need to come to the table and find areas where more accountability can be achieved. Far too often funding isn’t tied to achieving evidence based standards to produce the best outcomes for patients. Certain provinces continue to turn a blind eye to violations of the Canadian Health Act. The federal government is within their right to demand accountability, and attach strings to funding. But, these strings needs to be negotiated and in place for the best outcomes of all patients - not political promises. As it stands the federal Liberal have given no indication of what these strings would be and if they include public delivery of care.
-The federal health minister spoke multiple times about ‘health transformation’ and ‘efficiency’, but these buzzwords serve little purpose. There are changes that need to be made to protect, strengthen, and expand our universal public health care, this much is true. Yet, these changes call for adequate and predictable long-term funding, along with a sincere willingness from all parties to put the public’s health first.
-It is a major disappointment to see increased funding for home care and mental health used by the federal government in political gamesmanship. The narrative from the federal health and finance ministers is that the provinces have walked away from funding for these areas. This couldn’t be further from the truth. What they walked away from was inadequate funding for the health care system as a whole. The false dichotomy created by the ministers only serves a political agenda, and not the public. Hopefully, Canadians will see through this intellectually dishonest framing of the issues. What is needed is robust funding for both the system as a whole and areas like home care and mental health.
-Further, the federal money being offered for home care and mental health needs to be examined. These two issues are indeed important, and for that reason should not be proposed with ‘sunset funding’. Both areas need to see a real long term funding commitment, not just funding that fits with election cycles and campaign promisess. Additionally, as homecare and long-term care in a community setting fall outside of the Canada Health Act, there should be concerns that much of this funding could go towards for-profit care providers and how it could make it more difficult to bring homecare under the medicare umbrella. Simply shuffling people out of hospitals isn’t the answer, and the evidence is clear that moving post-surgical wound care out of a hospital setting does not work. Further, details remain missing on what the earmarked $1 billion for home care infrastructure would entail. Lastly, there is no information on what mental health services would be included with this funding. Until more details are brought forward and there is transparency from the federal government on what they are proposing, all Canadians should be asking questions.
-Despite over 90% of Canadians being in favour of a national drug program (universal pharmacare) and the health accord representing the ideal time to set the framework to being the program, little was said by the federal government on this topic. At one point there seems to have been a proposal for $544 million over five years for prescription drug and "innovation" initiatives, however it is unclear what exactly that would entail. What is clear is that this is far from the universal pharmacare program Canadians have long been calling for. As it stands, we are the only nation with a universal health system that doesn’t include prescription drugs; evidence shows us that Canadians are literally dying because they cannot afford their medication. We have written a ground breaking report on this topic which you can read about here.
-Finally, you have to wonder how serious the federal government was in the first place about having a successful renegotiation of the health accord. The Prime Ministers and the PMO seem to be taking a direct page out of the Harper government’s playbook with unilateral declarations, reduced health funding, insufficient negotiations, and ultimatums. All Canadians should be concerned about what comes next.
To read more on the health accord see:
- Health care transfer payments to be discussed at federal-provincial summit
- If you care about medicare you should pay attention to this
- Trudeau refuses to meet with premiers to discuss health care funding
- Trudeau keeps Harper's health care funding formula
- What is next for health care in Canada after the Council of the Federation