Liberals get it right with focus on home care

Posted on in Health Policy Context

TheGlobeandMail.com – News/Politics
Jan. 28, 2016.   Jeffrey Simpson
The Liberal government has made so many ambitious promises that a mixture of relief and surprise greets the discovery of promises it could have made, but did not.

Take health care, an important area of social policy where the Liberals, being Liberals, made a host of smallish promises. However, several big promises the party did not make are as interesting and important as the ones it did.

For example, the Liberals did not promise a national pharmacare program, as did the New Democrats, and as advocated by Ontario’s Liberal government.

The Liberals did not promise, as do the NDP and health-care unions, to restore annual 6-per-cent increases in federal transfer payments to the provinces for health care. The Liberals did not mention by how much the transfers would rise, but it will be something less than 6 per cent. The final number will emerge from tug-of-war negotiations with the provinces.

Those negotiations have not yet begun. At last week’s meeting of provincial health ministers, to which federal Health Minister Jane Philpott was invited, she shooed away any mention of money, which, at this stage of the game, is the correct approach.

Meanwhile, the provincial health ministers said they would work on what a national prescription-drug plan would look like and cost – the cost having squelched the idea of national pharmacare in the past.

Several academics, often quoted in the press, believe that national pharmacare would save money. Almost nobody else does, which is why the idea has never got off the ground. Quebec has discovered that its public plan, more elaborate than any other, costs a lot more than anyone had anticipated.

Prime Minister Justin Trudeau’s instructions in Dr. Philpott’s mandate letter are much more limited. Since Ottawa spends in the order of $1-billion on drugs for aboriginal people and the military, let Ottawa join the provinces in more bulk drug purchases to lower costs. She is also to “explore” the idea of a national formulary – an excellent idea since no logical reason exists for every province to have one. Again, though, this is far from national pharmacare.

What the Liberals do want is directed spending on home care. Here, the federal-provincial negotiations will be fascinating and perhaps consequential for patients.

The federal Liberals are always tempted to put strings around the health-care dollars Ottawa sends to the provinces. Ottawa doesn’t deliver health care to Canadians (except the military and aboriginal people) and it’s paying a smaller share of overall health-care spending than years ago.

Yet the Liberal itch to influence, if not direct, how federal transfers should be spent never dies. The trouble is that every time previous Liberal governments pulled out string to wrap around the transfers, at least some of the provinces said: Just give us the cash and stuff the strings away. We do health care; you write cheques. We set priorities; you help pay.

This time, though, the provinces are aware of their burgeoning number of older citizens, an increasing share of whom need or prefer to be cared for at home rather than in institutions. Provinces need to save money too, and care at home costs less than care in a hospital bed. Home care also keeps some patients from emergency rooms and reduces calls to paramedics.

The strategic health-care plans of almost every province underscore the importance of home care. So do provincial health-care budgets, which are giving new money to home care and little or none to hospitals.

Now, along comes a federal government willing to hand over money – how much remains to be seen – in what the minister’s mandate letter describes as a “long-term funding agreement” that would “support the delivery of more and better home-care services.”

Beefing up home care is what Ottawa wants. It seems to be what the provinces want. But will the provinces sign an agreement that binds them to spend at least some of the federal money for this purpose only? Or will the provinces offer vague assurances that cannot be monitored? Perhaps some (hello, Quebec) will say: Give us the money to spend as we wish, health care being provincial jurisdiction. Maybe home care; maybe not. We’ll decide.

Home care is the correct priority in a health-care world with endless priorities and incessant demands. Can the often-disputatious Canadian governments pull together around this common objective?

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