Help the aged through a new health accord
TheStar.com – Opinion/Editorials – With federal and provincial officials now negotiating a new health accord it’s essential for Canada to improve care for its seniors.
Aug. 26, 2016. Editorial
Canadian health care faces a rare opportunity — and a daunting challenge. Officials at the federal and provincial level are quietly working toward a new national accord with potential to reshape medicare in this country.
If properly done, the process will produce a stronger, more efficient health care system better serving the needs of both the sick and the healthy. Expect the opposite if turf wars prevail; if inadequate funding leaves vital parts of the system starved of cash, and if established interests use this opportunity to give themselves a raise instead of investing in better patient care.
With negotiations expected to last for several more months, the outcome of this process remains far from clear. But provincial and territorial officials are, at least, talking with a Liberal government in Ottawa elected on a pledge to negotiate a new health pact.
That, in itself, marks a welcome change from years of intransigence under former prime minister Stephen Harper. Under his misguided leadership, the federal level disavowed any responsibility for shaping the health care system. When an earlier $41-billion health accord, negotiated by Paul Martin’s Liberals, expired in 2014 Harper refused to do the hard work of negotiating a new deal.
Instead, he simply continued existing transfers of money, with annual increases of 6 per cent, to be followed by a reduction, to about 3 per cent, as of 2017. That formula was issued unilaterally, without consulting the provinces. And transfers came with no strings attached, meaning the federal government effectively abandoned leadership in the realm of Canadian health care.
It’s vital for Ottawa to oversee the evolution of medicare. That’s the best way to set shared national priorities and establish universal standards suited to Canadians’ 21st-century needs.
Prime Minister Justin Trudeau appears to understand this, with his party campaigning on a pledge to “provide the collaborative federal leadership that has been missing during the Harper decade.” Key to this is negotiating a new health accord, including a long-term agreement on funding.
Now comes the hard part: actually hammering out a deal.
The only immediate commitment made by the Liberals was an investment of $3 billion, over four years, “to deliver more and better home care services for all Canadians.” But there was no mention of that in the federal budget this spring, a document notable for its lack of attention to expanding Canada’s health care system.
Health Minister Jane Philpott explained that promised changes to home care are part of ongoing talks toward a health accord. Fair enough. But it’s essential for the federal contribution, in any new deal, to go beyond just this.
Ottawa’s health care transfers to the provinces and territories totaled $34 billion last year, about 22 per cent of public spending in this area. At one time it was a 50-50 split. And Canada’s provincial premiers, as recently as July, have urged the federal government to cover at least 25 per cent.
That seems reasonable to expect from a new accord, especially given growing pressure on Canada’s health care system from an expanding, and rapidly aging, population.
One worthwhile change, forcefully advocated by the Canadian Medical Association earlier his week, would be for Ottawa to deliver additional health care funding through a special “top-up” based on each province’s population of seniors.
Health transfers are currently issued on a per-capita basis, failing to take into account far heavier costs associated with caring for the aged. This gives provinces with a younger population, such as Alberta, a break while failing to adequately compensate those with more old people, including British Columbia and Ontario.
The Conference Board of Canada made a compelling case for a demographic top-up in a report last fall, calculating that it would cost Ottawa about $8.6 billion over five years.
Currently, “there are large discrepancies across the country when it comes to the health care services available to seniors, particularly in pharmacare, home care, long-term care and palliative care,” warn authors of the report. “As Canada’s population continues to age, this situation is likely to worsen.”
One goal of a national accord is to eliminate, or at least ease, such discrepancies. To that end, it would make a great deal of sense to introduce some form of demographic top-up. This represents just one opportunity inherent in negotiating a new health accord. It remains to be seen if it will actually be delivered.
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