Here is a health care to-do list for the federal government

Posted on December 17, 2022 in Health Policy Context

Source: — Authors: , – Opinion/Contributors
Dec. 17, 2022.   By Pat Armstrong, Hugh Armstrong, Contributors

This system deteriorated when the matching money dependent on the broad conditions — including no fees for necessary care — gradually disappeared.

The major question in the federal/provincial/territorial debate on health care funding should not be on whether there should be conditions but on what these conditions should be. The federal government should set conditions on federal funding, with funding withheld or returned when these conditions are not met.

We got universal, accessible medicare — our most popular social program — half a century ago because the federal government set broad conditions and required accountability, while still allowing each jurisdiction considerable flexibility in applying the conditions. The big provinces especially were hostile at first but came around because they could not resist the promise to have half their hospital and doctor costs met by the feds.

This system deteriorated when the matching money dependent on the broad conditions — including no fees for necessary care — gradually disappeared, in part due to the obscure transfers of federal tax points in place of some of the federal money.

What we need now is for the federal government to:

  1. Require each province and territory to have a plan for its funding. “Just give us the money” is not a plan and each jurisdiction claiming it knows best should be embarrassing, given the state of their services today. Saying they would perform well if they had more money denies the money they have spent on tax cuts and other giveaways of public money.
    The plans should promote system change. Justice Emmett Hall, the chair of the 1960s Royal Commission on Health Services, recommended that the most efficient way to deliver publicly funded services was by covering them all. It is clear that such a plan would include dental care, pharmacare, primary care, long-term care and home-care. This would not only support access to necessary care but would also encourage care at the appropriate level.
  2. Establish a more effective structure for provinces and territories to share promising practices and scale them up to the national level where appropriate. We worry about licencing barriers for health care providers educated in other countries while each Canadian jurisdiction sets its own regulations that limit movement across the country, to name just one example of internal inefficiencies. As the Hon. Monique Bégin so succinctly put it when she was minister of health, we are a country of successful pilot project that disappear. We need to build on them together.
  3. Develop a national health care labour force strategy that facilitates the integration of federal/provincial/territorial strategies and that recognizes that the labour force extends well beyond professionals to include the full range of people working in care. There have been decades of calls for such a plan and multiple suggestions on ways to move forward. We know enough to do so now.
  4. Understand that health care is not a business like the rest. It is about people who need and people who provide care, doing so on the basis of their acquired skill and experience. Public services should not be organized on the principles of for-profit services but rather should recognize the specificity of care and of our shared responsibility as well as our shared benefits. This means, as a minimum, ensuring that funding does not go to profit, that we build surge capacity into the system and that we attend to the conditions of work which are the conditions of care.

The “we-are-all-in-this-together” approach promoted early in the pandemic — and in the post-Second World War era that brought us medicare — has been replaced by “not in my backyard.” Addressing health care means getting over “it’s all about me” and moving on to how can we build a public health-care system that works across the country and for our populations in all their diversity.

Pat Armstrong is a distinguished research professor emeritus at York University. Hugh Armstrong is a distinguished professor emeritus at Carleton University.

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