Budget 2023 overlooks Canada’s “dirty little secret” about federal health funding

Posted on May 24, 2023 in Health Policy Context

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May 23, 2023.   By Steven Staples

The billions of dollars being poured into health care in Budget 2023 are at risk of being squandered by provinces committed to harmful privatization or using federal health dollars to pay down their deficits, MPs heard last week.

It’s a “dirty little secret” that the health care money sent to the provinces and territories under the Canada Health Transfer does not actually have to be spent on health care, I told the Commons Finance Committee on May 17. The funds are transferred into general revenues for the Premiers to spend as they wish. “How can the federal government ensure transparency,” I asked.

Speaking on behalf of the Canadian Health Coalition, I urged MPs to take action to rein in health care privatization by the provinces, and to ensure that the promised Canada Pharmacare Act is a public, universal program that covers everyone.

It was a privilege for me to appear as a witness alongside Dr. Alika Lafontaine, President of the Canadian Medical Association, as well as representatives from Canada’s Building Trades Unions, National Council of Unemployed Workers, Daily Bread Food Bank and Mississauga Food Bank.

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What follows is the text of the Canadian Health Coalition’s testimony on Bill C-47, the Budget 2023 Implementation Act.

Opening statement by Steven Staples, National Director of Policy and Advocacy for the Canadian Health Coalition to the House of Commons Standing Committee on Finance – FINA, May 17, 2023 “Subject matter of Bill C-47: An Act to implement certain provisions of the budget tabled in Parliament on March 28, 2023

Thank you, Chairperson and members of the Commons Standing Committee on Finance.

My name is Steven Staples, and I am National Director of Policy and Advocacy for the Canadian Health Coalition.

Before I begin, I’d like to thank all of the members who met with our volunteers during our Health and Hope Lobby Day in March.

The Canadian Health Coalition was founded in 1979 to defend and expand public Medicare in Canada. We are comprised of frontline health care workers unions, community groups, and experts.

I am delighted to speak to you on the topic of Bill C-47 (Budget Implementation Act, 2023, No. 1). I last met with you in October during pre-Budget consultations.

The section of Budget 2023 that we would like to address is Chapter 2: Investing in Public Health Care and Affordable Dental Care (Department of Finance Canada, 2023).

Today I would like to focus on three aspects:

Enforcement of the Canada Health Act and conditions for federal funding to provinces and territories, including reining in private, for-profit delivery of publicly insured services.

The importance of Universality, given the means-tested approach to the Dental Care program that leaves an untold number of families behind because of their income, and

The the need to extend the goal of providing public coverage of medically necessary services to include prescription medicine – through public universal pharmacare.

In October the Canadian Health Coalition recommended the government work with the provinces and territories to increase federal funding through the Canada Health Transfer (CHT) that is accountable, while improving outcomes for people in Canada through new public health care programs such as dental care, and pharmacare (Canadian Health Coalition, 2022).

We applaud the additional federal funding of $198.3-billion over ten years, including $46.2-billion in new CHT funding and $25-billion over ten years through bilateral agreements with provinces and territories.

But concerns remain that this money could yield little results in improved health care without conditions and accountability.

It’s a “dirty little secret” that the Canada Health Transfer does not actually have to be spent on health care (Macdonald, 2023). The money from Ottawa flows into the general revenue of the provinces and territories to be used as they wish.

What a sad day when the Federal Budget promises to, “Ensure that new federal investments are used in addition to provincial spending, and that provinces and territories do not divert away health care funding of their own” (Department of Finance Canada, 2023).

How can the federal government ensure transparency?

The Canadian Health Coalition is very concerned that billions will be spent on publicly insured services in private, for-profit clinics, which put Canadians at risk of user fees and extra-billing, and wastes public dollars on excessive profit-taking by inefficient private for-profit providers.

Health Minister Duclos’ annual report on the Canada Health Act cited 8 provinces violating the Act and withheld $82 million in respect of patient charges levied during 2020-2021, for medically necessary services that should be accessible to patients at no cost (Health Canada, 2023). That’s probably the tip of the iceberg.

Furthermore, data uncovered by a public interest group in Quebec, IRIS, revealed the cost of a carpal tunnel surgery averaged $908 in the private sector compared to $495 in the public sector; a short colonoscopy cost $739 in the private sector compared to $290 in a public institution. This is our health care money (“Some medical procedures,” 2023).

Yet the federal government has been silent on this matter. In fact, remarks from the Prime Minister about Ontario’s privatization were very worrisome.

One of the five principles of the Canada Health Act is universality. The Budget says, “Canadians are proud of our universal publicly funded health care system. No matter how much money you make, or where you were born, or what your parents do, you will receive the care you need” (Department of Finance Canada, 2023).

Why does this principle of universality not apply to dental care? The Canadian Health Coalition applauds the $13-billion committed to this program – the result of unprecedented collaboration between political parties. But there is unfinished business: what about the self-employed, the gig workers who have no benefits, but have a family income of over $90,000?

We asked the Parliamentary Budget Office how many families will be left behind. They know the number, but wouldn’t share it with us.

Finally, we look forward to the Canada Pharmacare Act being passed this year, and were disappointed to not have it acknowledged in the Budget. In October we requested $3.5-billon for essential medicines, as recommended by the 2019 government-appointed Advisory Council on the Implementation of National Pharmacare, also known as the Hoskins Report after its chairperson, Dr. Eric Hoskins.

When the Act is brought forward, we expect it to reflect a commitment to public universal coverage. The Health Minister said, “Under the Canada Health Act, it is made clear that no Canadian should be paying out of pocket for medically necessary services” (Health Canada, 2023). Prescription medicine is nothing short of medically necessary and should be covered for everyone, whether you are inside a hospital or not.

Thank you and I look forward to your questions.


An Act to implement certain provisions of the budget tabled in Parliament on March 28, 2023 (Budget Implementation Act, 2023, No. 1): 44th Parliament. (2023).

Canadian Health Coalition. (2022, October). Written Submission for the Pre-Budget Consultations in Advance of the Upcoming Federal Budget 2023. [Brief]. Retrieved from Canadian Health Coalition website: https://www.healthcoalition.ca/wp-content/uploads/2022/11/Bilingual-CHC-Pre-Budget-2023-Submission.docx.pdf

Department of Finance Canada. (2023). A Made-in-Canada Plan: Strong Middle Class, Affordable Economy, Healthy Future: Budget 2023. Retrieved from https://www.budget.canada.ca/2023/home-accueil-en.html

Health Canada. (2019). A prescription for Canada: Achieving pharmacare for all – final report of the advisory council on the implementation of national pharmacare. Retrieved from https://www.canada.ca/en/health-canada/corporate/about-health-canada/public-engagement/external-advisory-bodies/implementation-national-pharmacare/final-report.htm

Health Canada. (2023). Canada Health Transfer Deductions and Reimbursements – March 2023. [Backgrounder]. Retrieved from https://www.canada.ca/en/health-canada/news/2023/03/canada-health-transfer-deductions-and-reimbursements—march-2023.html

Health Canada. (2023). Statement from the Minister of Health on the Canada Health Act. Retrieved from https://www.canada.ca/en/health-canada/news/2023/02/statement-from-the-minister-of-health-on-the-canada-health-act.html

Macdonald, D. (2023, February). No strings attached: Canada’s health care deal lacks key conditions. Retrieved from The Monitor, Canadian Centre for Policy Alternatives website: https://monitormag.ca/reports/no-strings-attached/

Some medical procedures cost more in private clinics, Quebec study finds. (2023, April 24). The Canadian Press. Retrieved from https://montreal.ctvnews.ca/some-medical-procedures-cost-more-in-private-clinics-quebec-study-finds-1.6368157

Steven Staples is the National Director of Policy and Advocacy for the Canadian Health Coalition


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