Should we spend more on health? Only if we get better care 

Posted on September 22, 2020 in Health Debates

Source: — Authors: – Opinion
September 21, 2020.   André Picard

On Friday, Canada’s premiers met – four of them in-person, for some inexplicable reason, and the others online – and, among other things, they demanded that the federal government increase the Canada Health Transfer to $70-billion annually from its current level of $42-billion.

The additional $28-billion a year, they said, is absolutely critical.

Yet the arguments put forward by provincial and territorial leaders were feeble at best. They want more money, with no strings attached, but won’t say what, if anything, the public will get out of the deal.

Even a teenager lobbying for a hike in their weekly allowance can do better than “you should give me more money because I want more money.”

(To be clear, this “ask” is not about the pandemic; Ottawa has already pledged $19-billion for COVID-related health care measures such as personal protective equipment and testing.)

The premiers, needless to say, trotted out some well-worn rhetoric from the federal-provincial-territorial playbook.

Quebec Premier François Legault, the incoming chair of the Council of the Federation, kicked off with: “It’s time for the federal government to do its fair share.”

Ontario Premier Doug Ford said: “We’re asking the federal government to support all Canadians, be a true partner when it comes to health care.”

Manitoba’s Brian Pallister, for his part, said Ottawa needed to “resume its rightful role as a true funding partner.”

Intergovernmental Affairs Minister Dominic LeBlanc responded with his own platitudes, saying the federal government “will obviously reflect on these subject matters in the context of the government’s fiscal capacity … but the priority that premiers attach to an accessible, high-quality health care system is one that we share.”

Translation: Don’t expect any increase in the Canada Health Transfer in Wednesday’s Speech from the Throne.

That being said, how much should the federal government contribute to health care spending? What is a “fair share” in a confederation? After all, health is a provincial jurisdiction, something the premiers never tire of reminding us when they are not demanding more federal dollars.

Canadians spent $264-billion on health care services (or, to be more precise, sickness care) in 2019. Of that total, $185-billion came from public coffers, including $42-billion from the Canada Health Transfer.

In other words, Ottawa currently covers about 22 per cent of publicly funded health care.

The premiers say that number should be 35 per cent. Why? It’s not clear.

The main argument seems to be history. When medicare became a nominally national program in 1957, Ottawa agreed to cover 50 per cent of provincial spending on hospital care, with some conditions, namely that access be universal and that there would be no user fees. In 1965, the federal government agreed to also cover half the cost of physician services with the same conditions.

Over the years, the funding formula changed. Transfers for health and other social services were lumped together – which the provinces liked because it gave them more flexibility. Then, in 2004, health and social transfers were split again because Ottawa wanted more credit for its health spending. Every year since, there have been provincial demands to increase the health envelope.

There is a good argument to be made for Ottawa spending more on health. But it should only do so if the new money provides new services and more equitable access to care around the country.

In recent years, there has been a lot of talk about pharmacare – public insurance for prescription drugs. That’s one way Ottawa could get some bang for its bucks.

Another investment, especially in the wake of COVID-19, could be in elder care. There is an urgent need to expand, improve and make affordable both home care and long-term care.

Affordable child care and ending homelessness are also much-needed initiatives that would do as much to improve the health and well-being of Canadians as any additional sickness care.

In other words, there are many worthy health initiatives that Ottawa – and the provinces – could and should fund as part of the postpandemic economic recovery.

But what the premiers are proposing is that the feds absorb some of their current spending. They want Ottawa to transfer money rather than use their own powers of taxation to increase revenues.

They are literally trying to pass the buck.

This pandemic, more than anything, has exposed the shortcomings in health and welfare systems, particularly in caring for elders and other marginalized groups.

That’s what we need to fix. The last thing we need is buck-passing.

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