If you care about medicare you should pay attention to this

Today the provincial and territorial health and finance ministers met in Toronto to discuss the Canada Health Accord and the future of medicare (tomorrow important negotiations on a new health accord begin with the federal government).  While this meeting may not appear as seductive as some other issues, it deserves our full attention as -it is not exaggeration to say- the future of medicare is at stake.

At a press conference, representatives from the Council of Canadians, Ontario Health Coalition, and Canadian Doctors for Medicare, all highlighted the importance of a robust and fair Health Accord. Council of Canadians Health Campaigner, Michael Butler, highlighted, “The provincial, territorial, and federal health ministers have a historic opportunity before them.  Medicare is at a crossroads and we need to put the health of Canadians first as negotiations progress. The health of our friends, families, and communities is too important for the reckless game of chicken that is happening between the federal and provincial governments.”

Unfortunately, Quebec Health Minister Gaetan Barrette stated, "no serious negotiations" have been held with the federal government yet on a health accord. Ontario Health Minister Eric Hoskins, added that, “that provinces and territories now pay for approximately 80 per cent of health services delivered in this country...The portion of the federal contribution is declining with their current position to decrease the escalator down to three per cent.”

Despite the talk of ‘real change’, the federal Liberal government has insisted on using the funding formula that was unilaterally declared by Stephen Harper Conservative government. Starting with the 2016-17 fiscal year, “annual funding would increase at the rate of growth in Canada's nominal GDP, with a commitment to at least an additional three-per-cent each year.” Not only does this not cover the costs to adequately maintain our medicare, it means that in times of economic turmoil (when Canadians need their public health care the most) there will be less money available. As well, the changes in the funding formula that are scheduled to start in the next fiscal year will cost, for example, Ontario $1 billion and $39 million for Manitoba. In 2012 the parliamentary budget officer projected that if the Harper/Flaherty's formula was “if maintained indefinitely, the federal share of health spending would gradually decline.”

Briefing notes for Health Minister Jane Philpott obtained by the CBC, show that “the federal government is coming to this week's meeting armed with numbers to question the case provincial governments are making for a six-per-cent annual increase in health care funding.”

The CBC also reports, “ahead of Tuesday's potential showdown with federal Health Minister Jane Philpott, provincial health and finance ministers are rejecting the three per cent annual funding boost committed by the Liberals. Provinces say health funding should be a 50-50 split with the federal government, but the provinces are now footing about 80 per cent of the bill.”

While a 50-50 split is a long way off, the provinces and territories have previously called for the federal government to 25 per cent of the total cost to governments of health care in Canada. While the, “Trudeau government says the federal share has increased in recent years, but, according to their data, for 2015-16 it will sit at 23.5 per cent, still short of the provincial goal.” It is worth noting that while 25 per cent federal funding is an important goal, it needs to be matched by shared provincial investment of in health care.  For example, due to de-investment in health care system by the provincial government in Ontario, the federal share is now over 25 per cent according to estimates. What is needed is real commitment from all levels of government. Our public health care is as sustainable as we want it to be, but we need predictable and fair funding from governments.

In a Communiqué, the provincial health and finance ministers stated that,

“Based on this unilateral federal decision made in 2011, the rate of CHT funding growth will be cut from 6 per cent to a new floor of 3 per cent beginning next year. The negative budgetary impact for all provinces and territories will be over $1 billion in the first year alone, and this figure is projected to increase to a cumulative impact of over $60 billion over the next ten years. This will put pressure on provincial-territorial health systems stability and long-term sustainability.

Finance Ministers and Health Ministers re-iterated Premiers call to the Prime Minister to hold a First Ministers' Meeting on health care sustainability and to reach a long-term agreement on health care funding.”

At the same time provinces need to come to the table.  Health Minister Philpott made the fair demand that, "I have a responsibility as the health minister for Canada to invest in health, to help improve health systems ... but when we are going to my finance minister to ask for more money, I need to be able to tell that finance minister it is going to be used for health."  The funds from the Canadian Health Transfer can’t go to general provincial revenue as they did under the last health accord, but need to be tied to depoliticized national standards for patient care.

There is serious concern regarding the Liberals’ biggest election promise, $3 billion over four years for home care and palliative care. While this carrot is being dangled in the negotiation (with little detail), tied funding for home and palliative care cannot come at the cost of acute care.  We have seen in multiple provinces that seniors are being shipped out of hospitals into the community setting where private for-profit health companies can operate outside the Canadian Health Act.  What we need is rational funding for a continuum of care to meet the need of patients in whatever setting is best for their health.

In her press conference today, Minister Philpott didn’t mention the pressing need for a universal pharmacare program to be included in the health accord. Council of Canadians Health Care Campaigner, Michael Butler explained, “Canada is the only country in the world with universal public health care that doesn’t have a national prescription drug program.  Polls show 91 per cent of Canadians know that this is wrong and support universal pharmacare.  You can’t get more of a mandate than that and no policy change will have such a major transformative effect on the health of Canadians.  Not only would it save over $11 billion a year, it would improve affordability, safety, and appropriate prescribing of medically necessary drugs for patients.  We can’t afford not to do this and now is the time.”

The Council of Canadians has long called for a renegotiated health accord that puts patients first (see here, here, here and here, among other posts for more detail). It is time for all of Canada’s health ministers to commit to health of current and future generations.