Why a health-care report was dead on arrival in Ottawa
TheGlobeandMail.com – Globe Debate
Jul. 22, 2015. Jeffrey Simpson
When the Harper government has something to brag about, we hear about it, endlessly. When the government has something to hide, the information comes out without ministerial comment on a Friday afternoon.
So it was last week that the Prime Minister’s Office buried a long, detailed report about federal innovation in health care that the government itself had commissioned.
The Advisory Panel on Healthcare Innovation, chaired by former University of Toronto president and dean of medicine David Naylor, was to have been released at a news conference in Toronto on July 14.
The day before the news conference, however, the PMO cancelled it and decided to release the report without notice on the Health Canada website on July 17. Just as the PMO hoped, the report received little attention.
Health Minister Rona Ambrose, who was to have spoken about the report, was gagged. The posting on her department’s website was timed so that it appeared only after the provincial premiers had finished their final news conference in St. John’s, in case the report gave any or all of them ammunition to embarrass the federal government. Such is the way this government works.
It’s not hard to figure out why the Naylor report displeased the government. The panel was given a difficult, bordering on impossible, job: recommend innovations without Ottawa spending any more money.
The panel’s mandate read that recommendations “must not imply either an increase or a decrease in the overall level of federal funding for current initiatives supporting innovation in health care.”
The Naylor panel ignored the mandate, explaining in its report that “although it was not an easy decision, we did not follow this guidance.” Later, it warned that “absent federal action and investment, and absent political resolve on the part of provinces and territories, Canada’s health-care systems are headed for continued slow decline in performance relative to peers.”
To that end, the panel recommends creating a Health Innovation Fund with a $1-billion yearly budget to invest in changes to the health-care system in conjunction with willing provinces and health-care institutions.
Such a fund would be just about the last thing the Harper government desires. This government is running on balancing the budget. Adding $1-billion a year in spending would not be what the government wants.
Such an investment fund would have little political profile – nothing as sexy as, say, national pharmacare (which the panel cursorily debunked). It would also run the risk of provoking premiers who screamed in St. John’s for more cash transferred from Ottawa to them, without strings attached.
For 2017-18, the federal government has announced it will reduce the increase in Ottawa’s annual health-care transfer to the provinces from 6 per cent to something in the range of 3 per cent to 3.5 per cent, depending on economic growth. The provinces would likely not appreciate losing money from Ottawa with one hand, and then getting some, but only some, of it back through the Innovation Fund.
The Harper government was hoping for change-on-the-cheap from the panel: innovation that would cost nothing but improve the system. It certainly has no interest in an expanded, direct federal role in health care, having made it abundantly clear that health care is for the provinces, except for Ottawa’s responsibility for aboriginal and veterans’ health, public health and drug approvals.
Moreover, provincial health budgets are rising on average now by only 2 per cent a year, compared with 7 per cent a decade ago, far below the 6-per-cent increases in transfers still coming from Ottawa.
The premiers would love the transfer to return to 6 per cent, as would the federal New Democrats. That would be the single dumbest move any federal government could make, given the lamentable experience of the 2004-11 period when money gushed out of Ottawa but bought little improvement in the health-care system. The Naylor panel noted, as have many observers, that the money improved things for providers, but not for many patients.
The Naylor report covers all the ground about the manifold weaknesses and sturdy strengths of the Canadian system compared with other countries. It hails, quite rightly, some aspects of the U.S. system, especially the co-ordinated care of the best health organizations such as Kaiser Permanente.
Its broad recommendations, however, are dead on arrival in Mr. Harper’s Ottawa, which is why the report slid into the public domain with such little notice.
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