Prepare for health care squabbling
If there are two things Canadians never tire of discussing, they would be the state of the weather, and the condition of the health-care system. It sometimes seems we have no more sense of control over the second than we do over the first.
In the speech from the throne on Thursday, read by Gov. Gen. Julie Payette, the Liberal government devoted one of five policy priorities to health care. Much of the section was taken up with concerns about gun violence. Reference was also made to gender- based violence, with a pledge to work “with partners to develop a National Action Plan.” No mention was made of lengthy wait times, patients getting treatment in hallways, or the pain endured by people on long lists for needed surgeries.
Instead the government pledged to “work with provinces, territories, health professionals and experts in industry and academia” to ensure access to a family doctor, “partner with provinces, territories, and health professionals” to improve mental health care, and “make it easier for people to get the help they need when it comes to opioids and substance abuse.”
Little in the way of detail was presented, but throne speeches commonly serve as a broad outline, with details to come later. Based on recent evidence, there will be a lot of devil in those details. Just days before the speech was delivered, Canada’s premiers met near Toronto’s airport to discuss common concerns. In the wake of what many consider the most divisive federal vote in memory, the plan was to emphasize the search for unity. In the end, the one thing they found they could all agree on was the perennial demand for more money from Ottawa. Fifteen years after then- prime minister Paul Martin’s “health-care fix for a generation,” eight years after then- finance minister Jim Flaherty surprised the provinces with a funding formula based on economic growth, and four years after the premiers wrote the newly elected Trudeau Liberals with a demand for a better deal, the provinces are still at loggerheads with Ottawa over health money, and how it’s to be spent.
Entering the premiers’ get- together, Manitoba’s Brian Pallister quickly let the air out of federal plans for a national drug plan, which the throne speech called “the key missing piece of universal health care in this country.” Pharmacare was much discussed during the federal election campaign, with New Democrats demanding a fully funded national program, and Prime Minister
Justin Trudeau promising “critical next steps” towards developing one. Pallister, however, made clear that provincial leaders have other priorities.
“Our patients are waiting longer and longer for surgeries, emergency rooms, for hips and knees, you name it. This is an issue we need to focus on. Pharmacare — we can get to that later. Let’s get the sustainable funding for health care,” he said.
What the premiers want is money and a free hand to spend it. They’re seeking a guaranteed 5.2 per cent annual “escalator” in federal health transfers, with respect for provincial autonomy and “provincial/ territorial jurisdiction.”
It’s worth noting that the premiers’ stand today is the opposite of what it was in 2004, when they were enthusiastic cheerleaders for a national plan. “A key component of excellent health care is a robust public drug plan. No Canadian should suffer undue financial hardship in accessing necessary drug treatment,” they said at the time. They called for “a significant shift in the delivery of pharmacare programs” and urged Ottawa “to assume full responsibility for these programs across the country.” Ottawa responded with a promise to “design the right nationwide approach,” but nothing came of it.
Unfortunately, the prospects for agreement are no better today. The Trudeau Liberals are in a minority position faced with conservative premiers in six of the 10 provinces, and a Quebec government with all the usual phobias about Ottawa interfering in its jurisdiction. The prime minister has shown no great facility for getting along with provincial leaders, and spent much of his campaign attacking Ontario’s Doug Ford.
NDP Leader Jagmeet Singh — whose 24 seats could prop up the Liberal minority — has insisted he’s willing to withhold support if the government fails to act on a list of demands, of which increased health-care spending and a pharmacare plan are major items. But the Liberals are already running hefty deficits, and pharmacare is anything but cheap. With Singh on one flank and conservative premiers on the other, Trudeau would need spectral powers to conjure up a solution satisfactory to both.
If he has them he’s yet to show it. Canada needs a disciplined approach and innovative ideas if quality care is to be delivered at affordable costs, rather than empty promises and political squabbling. The signs are that what we’ll get is the squabbling.