Insiders say Justin Trudeau ready to freeze out Quebec and other provinces in federal health-care deals

Posted on October 28, 2022 in Health Policy Context

Source: — Authors: – Opinion
Oct. 27, 2022.   By Althia Raj, National Columnist

Federal sources say the prime minister won’t sit down with the premiers until a framework for a health deal is agreed upon with most of the provinces and territories.

The federal government isn’t too pleased with a new national ad campaign that suggests Canada’s shortages of nurses and doctors is Ottawa’s fault. I’m using polite language to describe the Liberals’ impression of the latest “misleading” and “offensive” pressure tactic by the Council of the Federation — the group of 10 provinces and three territories — as they plead for more federal health-care funding.

The radio, print, billboard and online ads launched Monday and state the “provinces and territories are doing their part,” but “need the federal government to restore health-care funding” — otherwise nurses and doctors will disappear.

It’s a bit rich to point the finger at Ottawa, say some Liberals, especially since some provinces sent hundreds of dollars to residents in the name of fighting austerity rather than invest it in health care, and others now enjoy nice surplus budgets, including in Ontario.

Prime Minister Justin Trudeau had pledged Ottawa would sit down with the provinces to renegotiate the Canada Health Transfer — federal money distributed to the provinces on a per-capita basis to help fund health care — when the COVID-19 pandemic was over. But a first ministers meeting hasn’t materialized — and federal sources say the prime minister won’t sit down with the premiers until a framework for a deal is agreed upon with most of the provinces and territories.

That’s not to say Ottawa won’t boost transfers; it plans to. But by how much and under what conditions is what’s about to be discussed with increased fervour.

Although ongoing talks have occurred between Finance Minister Chrystia Freeland, Intergovernmental Minister Dominic LeBlanc, Health Minister Jean-Yves Duclos and their counterparts, things are about to get more serious as the federal government hopes an agreement can be hatched by the end of January — in order to make it into the spring budget.

And if Ottawa needs to sign deals with only some provinces and leave others — such as Saskatchewan, Alberta or Quebec — out in the cold, as a source suggested, it’s a move the federal government is prepared to make.

The Liberals seem pretty confident they can get agreements with the Atlantic provinces and Ontario, as well as British Columbia and Manitoba. But they won’t include a one-time injection of $28 billion — as the Council of the Federation has lobbied. Ottawa disagrees with the provinces’ math, arguing it doesn’t account for $19.6 billion in tax points it has transferred to them. It says Ottawa spends about 30 cents on the dollar, not the 22 cents the provinces are complaining about.

Government sources suggest there will be money — but with “light” conditions.

Ottawa won’t allow federal cash to offset provincial money, they say. If the provinces choose to reduce their level of health-care funding, the federal government wants to reduce its transfers by the same amount. This addresses a long-standing concern by Liberal and Conservative governments that the provinces claim poverty and then reduce their own investments in health care to fund other priority areas, only to come back and beg Ottawa for more money again as the system remains underfunded.

Other conditions floated to the Star include: improving the interprovincial mobility of nurses and other health-care professionals, and requiring provinces to have a plan to recognize foreign credentials. There is no reason why a medical doctor trained abroad couldn’t do a short stint under a supervising physician and pass a language test rather than jumping through hoops and spending a year retraining, the argument goes.

Governments did show during the COVID-19 pandemic that relaxing credential requirements could work to get more health-care workers into the field. Ethel Tungohan, the Canada research chair in Canadian migration policy, impacts and activism at York University, noted Thursday at a conference on immigration organized by the McGill Institute for the Study of Canada that British Columbia, for example, had allowed foreign-trained doctors to practice under an apprenticeship model during the pandemic. The federal government also launched a temporary program, which Quebec joined, that saw asylum seekers granted permanent residency if they worked in long-term-care homes. (Disclosure: I am a volunteer member on the McGill Institute for the Study of Canada’s board of trustees.)

There are also debates to be had about the appropriate annual increase. Right now, under a deal negotiated by former finance minister Jim Flaherty, the provinces get yearly increases in federal health transfers by either the rate of GDP growth or a floor of three per cent. The provinces want much more, but Ottawa suggests three per cent is sufficient. Next year, the finance department forecast suggests the current escalator is set to increase transfers by $9.1 billion and $6 billion the year after.

There are also buckets of priority areas where Ottawa would like to see investments (some are Liberal election promises) and tangible results in mental health, virtual care, and primary care. The federal government has already promised to spend $4.5 billion on a new separate mental health transfer.

On these, there seems to be possible agreement. But Duclos’ meeting with provincial health-care ministers in Vancouver in two weeks should give Canadians a taste of the showdown to come.

Althia Raj is an Ottawa-based national politics columnist for the Star.

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