Health-care showdown all too familiar
Ontario, Quebec, Alberta agree to take $8 billion for funding — less than offered months ago
Divided and conquered, Ontario, Quebec and Alberta surrendered Friday and agreed to take only $8 billion in federal money for health care.
They join six other provinces that, one at a time, signed deals with the feds to take offers that they’d collectively dismissed as totally unacceptable just before Christmas. To be precise, they’ve taken a worse deal than Health Minister Jane Philpott offered in December.
In Ontario, federal money is about a quarter of the $50-billion health budget. There’s not really a good reason. Historically, the health transfer was a bribe to get reluctant provinces to agree to publicly funded medicare in the first place; these days, with universal care embedded deeply in the national psyche, it would make a lot more sense for the provinces to just levy the provincial taxes they need to run their own systems. We have equalization payments to help with inequalities among Canada’s regions.
The system has generally moved that way, from a 50-50 split on health funding to something closer to 75-25, with the provinces paying the bigger share.
But a quarter of a $50-billion health budget like Ontario’s is still a lot of money. So we have this ritualized farce where every few years, premiers and the prime minister (or the provincial health ministers and the federal one) get together and argue bitterly over how much federal money the provinces are prepared to accept. Somebody usually storms out.
Once upon a time, prime minister Paul Martin headed off the worst of it by going into a room with the premiers and handing them a ton of cash: a guaranteed six-per-cent increase in health transfers each year for 10 years. Stephen Harper followed up by extending Martin’s deal for a few more years but then reducing the increase to three per cent or the rate of economic growth, whichever is higher. But he refused to go into the room, just telling his antagonists how much money he’d give them and ignoring the screeches.
Last December, Health Minister Jane Philpott went into the room. She offered to increase the Harper-promised “escalator” to 3.5 per cent and to distribute a further $11.5 billion, over 10 years, among the provinces for a combination of home care and mental-health services, with some detailed reporting on what they’d done with it.
As in, she wanted something in exchange for the federal money, not just to hand over cheques. The Martin increases massively outpaced the provinces’ health spending and the feds didn’t want a repeat of that. No way, the provinces said. Take it or leave it, Philpott said. We’ll leave it, the provinces said.
Their health ministers came out of the room muttering darkly about federal perfidy. Ontario wanted 5.2 per cent a year. Anything less than the six per cent they were used to, they tried to pass off as a cut.
Since then, one by one, the provinces have decided to take it after all. First the little ones that need the money the most, now the biggest ones. Only Manitoba is left, but Premier Brian Pallister there is saying he’s open to striking a deal and at this point it’s not like he has much choice.
Ontario gets the three-percent Harper-era escalator, plus $4.2 billion for home care ($2.3 billion) and mental health ($1.9 billion), spread out over 10 years. The extra money starts small, increases over five years and then plateaus, the provincial government says.
Ontario touted an extra $100 million for home care last year as buying more than 200,000 additional hours of service of various kinds, from bathing to physio to respite care, and this averages out to more than twice that — though waiting lists are long and demand rising. The same is true for mental health: we’re slowly removing the stigma around mental illness and mood disorders, but too often that means people get up the nerve to ask for help and then find there isn’t any. Still, $420 million a year is real money.
The province will have to account for it, not just throw it into the health-care pot.
“In the coming weeks, governments will develop performance indicators and mechanisms for annual reporting to citizens, as well as a detailed plan on how these funds will be spent, over and above existing programming,” Ontario’s and the federal government’s joint statement said. “The Government of Canada and the Government of Ontario will work out the details of accountability and reporting, in accordance with a pan-Canadian approach. “
(Quebec made its own statement about its deal. It gets to use its $2.5 billion over 10 years however it pleases, because it’s Quebec, but that’ll probably include home care and mental health. The word for this is “asymétrique.” Alberta gets $1.3 billion beyond the Harper escalator, on terms similar to Ontario’s.)
Health Minister Eric Hoskins didn’t like the idea of starting or expanding mental-health or home-care programs with its share of the extra-extra $11.5 billion only to risk having that moneytap twisted close at the end of 10 years, which is an understandable worry, but ultimately Philpott was the person with money and Hoskins was the person who wanted it.
The only leverage he really had was to refuse the money, preside over the crummification of health care in Ontario, and try to explain just how it was Philpott’s fault because she wouldn’t promise even more money to come after 2027. That was the only leverage any province had.
That’s the only leverage any province ever has in these “negotiations.” That’s why they turn out the way they do. dreevely@postmedia.com twitter.com/davidreevely