Liberal budget cynically ignores health care
In all Parliaments, but especially in minority Parliaments, budgets need to serve as previews of election platforms and there is no doubt the federal government sought to treat this week’s budget as such. While it may appear as though the spending commitments are rather indiscriminate, and certainly the figures are eye-popping, budgets are always about choices and there seems to be rather a bit more shrewdness to this government’s choices than they might be letting on.
Keeping that upcoming election in mind, it only makes political sense to decide that if you cannot spend money on everything, you should make sure you spend it on things the voters will give you credit for. This calculation might explain why a government eager to spend money on so much, would not agree to increase health transfers as premiers across the country had been pleading for. In other words, more talking about brought-to-you-by-the-liberals affordable childcare and less talking about the quagmire of our chronically underfunded health care system (that’s someone else’s problem).
The refusal to increase transfers came as a surprise to those of us with halfway decent memories. We recall that when the Liberals were not in government, we were told that increasing health transfers to the provinces was of the utmost importance. It was explained to us at the time that if only Prime Minister Stephen Harper could get over himself and actually meet and engage with the provinces and territories, he would understand what compromise and collaboration meant. If only he would quit imposing his ideological austerity agenda on the provinces, we might actually be able to live up the promise of the Canada Health Accord, best-inthe-world universal health care, Tommy Douglas’ legacy and so on.
After the Liberals went on to replace Stephen Harper and form government, federal-provincial relations took the form of regular
Council of the Federation meetings. Hands were shaken and photos were taken. Six years later though, the meetings appear to have been ends in and of themselves. It has become clear that when the Liberals called on the prime minister to listen to the provinces and territories, they didn’t actually mean he should do what they asked.
As the pandemic raged through the country over the last year, provincial health-care budgets were stretched beyond all recognition. One-time investments plugged some holes, but the boat was still sinking. These healthcare funding challenges were layered on top of already massive provincial budget deficits and as the parliamentary budget office has pointed out, the federal government has quite a bit more fiscal capacity to carry some of the burden. So, the premiers concluded that as the share of total spending on health care went up, so too should the share of costs covered by the federal government.
Seven of them, led by Quebec Premier François Legault, came together and asked for a permanent increase of the share from 22 to 35 per cent. They were not well received. As Manitoba Premier Brian Pallister tells it, Justin Trudeau responded to their request by saying “I’m not your banker.” A jarring departure from the leader of the third party who pined for a more collaborative federalism. Surely, Pallister was confusing this prime minister with the last one.
The premiers’ ask of an additional $28 billion annually in health transfers is a big one — but negotiations always start with big numbers. This week’s budget did not commit to any sustainable transfer increase — hard to square from a government that prioritizes investment (a word that appears in the budget 484 times). The thing is, even the more spending-conscious among us understand that health care in Canada needs more long-term funding. While COVID-19 is pushing the limits of our health system to the brink, the pandemic is only exacerbating some troubling pre-existing trends.
We hear so often that we have an aging population that Canadians tend to tune it out. But it is worth thinking about what the demographic shift actually means. Our overall population is growing, but the share of that population that is made up of seniors is getting bigger. Seniors require quite a bit more, expensive care than young people do and as the share of young people diminishes, the share of taxpaying workers does too. This is a simple fact provincial governments, left and right, have had to struggle with. It is why we hear about and experience hallway health care and it is why, when disaster struck last March, medical experts across the country started ringing alarm bells about how an already-stretched hospital system would cope with Covid-19-related spiking ICU demand.
The prime minister followed up on the budget this week by clarifying that he would contemplate an increase to health care transfers after the pandemic wanes. But ICU physicians are telling terrifying stories about the limits of our health-care system today and they and their dying patients do not seem inclined to wait until things calm down. And when herd immunity is reached, ICUS are cleared of COVID patients, and we revert to the health care status quo, our demographic reality will remain unchanged.
It is perfectly acceptable to think that the role of the federal government should be limited, that it should stick to its knitting and butt out of provincial jurisdiction when it comes to matters like health care, education and childcare. But of course, we know the Liberals are eager to meddle in the nitty-gritty of locally delivered social services. Their commitment to do just that on childcare is the marquee item in their budget. The government is also savvy though, and while the Liberals can campaign on and take credit for cheap childcare spaces, they will bear little blame for our overburdened health care system. And as for answering to the premiers, maybe federal-provincial collaboration was overrated anyway.
HEALTH CARE IN CANADA NEEDS MORE LONG-TERM FUNDING.