Ottawa and provinces should get back to the table on health

Posted on December 21, 2016 in Health Debates

TheStar.com – Opinion/Editorials – Only from the mess of intergovernmental compromise will a better system emerge.
Dec. 20, 2016.   Editorial

In opposition and on the campaign trail, Justin Trudeau’s Liberals often rightly denounced the Harper government’s complete abdication of federal leadership in intergovernmental affairs. But after this week’s failed negotiations on a new health accord, the prime minister may be feeling some sympathy for his predecessor. Sitting at the head of the federal-provincial table is no doubt an important job, but oh how unpleasant it can be.

Squabbling over social policy is as old as our messy federation. Ottawa, as in the past, wants to impose its priorities on the provinces at the cheapest price. The provinces, as is their wont, have ganged up on Ottawa to demand more money and fewer conditions. The result: the feds stalked off in a huff and the provinces, with a few exceptions, condemned the Trudeau government as no better than the last.

So who’s in the right? Irrespective of predictable provincial bristling, the Trudeau government is certainly not wrong to want to attach strings to its contributions. Only Ottawa can secure national objectives and ensure reasonably comparable health care for all Canadians, wherever in the country they may be. That means conditional funding. Harper didn’t get that. It’s encouraging that Trudeau does.

What’s more, the conditions Ottawa is seeking to impose are wise, if incomplete. The Trudeau government offered at least $6 billion over the next 10 years for home care, doubling its campaign commitment to address this area of great and growing need. It also vowed to invest $5 billion for mental health and a half-million dollars for prescription drugs and system innovation, all key lacunas. (Sadly, a national pharmacare plan, which would likely have the biggest impact on quality, access and affordability, seems firmly off the agenda.)

But for Ottawa to play a leadership role in health reform, it will need to pay its fair share – and that’s a bar to which the current offer does not quite rise.

In addition to the targeted investments, Ottawa is proposing to increase health transfers by 3.5 per cent annually, a modest improvement on Harper’s unilaterally imposed formula but well below the 5.2 per cent sought by the premiers.

Provinces have long called for the federal portion of total health spending to rise to 25 per cent, as former Saskatchewan premier Roy Romanow recommended in his landmark health-care report. Currently, Ottawa’s share is 23 per cent. The Trudeau government’s offer would move that number in the wrong direction at a time of ballooning demand.

The Parliamentary Budget Office has warned that while reducing the federal share would stabilize Ottawa’s finances, it would do so at the peril of the provinces. The health-care transformation that the Trudeau government seems intent on undertaking is welcome, but won’t happen if the provinces aren’t getting the help they need to keep the lights on.

If no deal is struck by the next federal budget, transfers are expected to increase by 3 per cent in 2017-18 according to the Harper formula. That means a declining federal share of growing health-care costs. It means no new national home-care or mental-health plans. It means our overburdened system and those who rely on it will suffer. The provinces will need to accept some strings and Ottawa will have to pay for them. It’s a messy business, no doubt, but all parties should take a deep breath and get back to it: only from the mess of intergovernmental compromise will a better system emerge.

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