The premiers need to take charge on health care, rather than just beg for more money

Posted on October 18, 2016 in Health Debates

NationalPost.com – Full Comment
October 17, 2016.   KELLY MCPARLAND

Canada’s provincial and territorial health ministers are set to gather in Toronto today to assess our country’s health-care system and its needs for the future. There is no prize for guessing their conclusion. They will demand more money from Ottawa, and react with studied outrage should it be refused.

That’s what they’ve always done. In 2004, when prime minister Paul Martin unveiled a generous 10-year funding package, he termed it a “fix for a generation.” It provided for guaranteed increases in health transfers of six per cent a year for a decade — a rate far above the increase in inflation. The aim was to give the premiers plenty of time and adequate resources to address the pressures that were already evident in programs across the country: lengthy waiting lists, overcrowded emergency rooms, an aging population and the rise in costs associated with new methods, drugs and technologies.

When the Conservatives took office, prime minister Stephen Harper honoured the Liberal pledge and extended it. The Tories would continue the six per cent annual increases until 2017, after which the rate would change to a minimum of three per cent, still well above inflation. During last year’s election, the Liberals decried the Tory policy as inadequate, but since taking office have adopted it as their own. “Three per cent is a reasonable escalator for next year,” Health Minister Jane Philpott said recently. “Three per cent is actually significantly higher than the growth in health spending across the country, which averages anywhere from zero to two per cent.”

Rather than use the opportunity to introduce improvements and get costs under control, the provinces have let the time slip away. Many of the challenges of 2004 remain: overcrowded waiting rooms, overbooked specialists, frustrating waits for care, constant cost pressures. The danger that an aging population and longer life spans will eventually overwhelm the system is still very real. With health costs already consuming 40 per cent or more of provincial budgets, something has to give.

Yet as the date of today’s get-together drew closer, the provinces made clear their determination to stick with their usual tactics: they want more money and they intend to gang up on Ottawa to get it. Rather than accept the three per cent increases promised by the Harper and Trudeau governments, which would lift the federal transfer to $36.1 billion this year from $20.1 billion in 2006-07, they have contrived to treat the increase as a reduction, arguing they would have received even more billions if the Martin plan had been extended unaltered.

In a letter to Prime Minister Justin Trudeau last month, the premiers demanded a face-to-face meeting. They asked that it take place before a scheduled summit on climate change, enabling them to withhold cooperation on Ottawa’s environment efforts unless they get satisfaction on health care.

Trudeau, to his credit, rejected the demand. The premiers will have to content themselves with Philpott, who will meet them Tuesday. In his response to their letter, Trudeau took a swipe at Harper, citing “a decade of federal disengagement by the previous government.” Nonetheless, he has been quick to realize that summits with the provinces inevitably devolve into demands for ever-increasing transfers of cash. Even Philpott’s pledge to provide an extra $3 billion for home care only managed to raise provincial hackles, as the premiers complained, perversely, that Ottawa was trampling on their jurisdiction. In their view, the federal government’s role is to send the money, no strings attached, and let them spend it however they see fit, whether it is on health care or otherwise.

Trudeau would be foolish to do so. There is no reason to believe the premiers, having failed to take advantage of 13 years of generous increases, would treat additional transfers any differently. There is probably no area of public policy that has been more extensively studied than health care, and there is no shortage of ideas or expertise available, though some proposals might be controversial, unpopular or politically sensitive.

It’s time for the premiers to do their job. Health care in Canada is their responsibility, and it is up to them to operate and maintain the system in the most efficient, effective and accessible state possible. They are failing in that duty. Handing over the keys to the federal mint would only give them an excuse to continue disguising their failure by burying it under a growing mound of money.

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