Get Ottawa out of health funding

Rather than coming to next week's first ministers meeting over health funding with their hands out, the premiers should turn their backs on the Canada Health Act and dare Ottawa to get out of the health-care funding business entirely. This would pave the way for long-overdue innovation in medicare to reduce wait times and ensure Canadians have access to quality care in the future.

It was less than a generation ago when Prime Minister Paul Martin promised to “fix health care for a generation” with a $41-billion deal that saw the Canada Health Transfer (CHT) increase by six per cent per annum over 10 years.

Like the early years of the Soviet Union, Martin's socialist fix for a broken socialist system saw some initial success. Yet less than 20 years later, our health system is in even worse shape: per capita spending has increased by around 50 per cent, and wait times have risen proportionally.

At the turn of the century, health care was in crisis and no less than three commissions were struck, some of which proposed some fairly innovative solutions. Martin's solution allowed the provinces to shelve these efforts and rest on their laurels for the next two decades.

Now, here we are again, with the same broken system, the same proposed fix and the expectation that this time it will somehow turn out differently.

On Feb. 7, Prime Minister Justin Trudeau will sit down with his provincial counterparts to try to hammer out a new funding formula. The provinces want Ottawa to increase its share of health funding to 35 per cent, from the current 22 per cent, a demand that would cost our already indebted federal treasury about $28 billion a year — an increase of over 60 per cent.

In a statement, the premiers claimed the provinces are “taking action to innovate and improve health-care systems.” Yet most of those supposed innovations have been far from revolutionary.

Ontario, for example, recently unveiled a plan to expand the number of minor surgeries and diagnostic tests performed outside hospitals. While the proposal received much pushback from the left, it merely continues a trend that started in the 1990s.

Premier Doug Ford also announced that his government would table legislation to allow health-care workers licensed elsewhere in the country to immediately start working in Ontario. This is an action other provincial governments should emulate, but Ford has already stated his intention to try to poach doctors and nurses from other provinces, which does little to improve Canadian health care as a whole.

Alberta's “Healthcare Action Plan” also relies heavily on finding ways to train and attract new doctors and nurses, outsourcing surgeries to rural hospitals and chartered surgical facilities, and better managing ambulatory services.

None of these are bad ideas — training and recruiting new doctors and nurses is especially critical if this country hopes to even maintain current levels of service given the Liberals' high immigration targets — but they hardly represent the type of outside-the-box thinking that will put our health system on a sustainable path.

Nowhere is there much talk of defunding procedures that aren't medically necessary or allowing private options for those who can afford it, in order to decrease the burden on the public system.

In fact, one of the reasons why provincial health budgets have ballooned so much is because they've steadily increased the number of services paid for or subsidized by the taxpayer. These pressures will only increase when the federal government introduces pharmacare and expands its socialized dental program.

One of the major problems with Canada's current health-care funding model is it allows the provinces, which are constitutionally responsible for health care, to blame federal funding levels for their own failures.

One way to address that problem would be for Ottawa to replace the CHT with a transfer of tax points to the provinces, as a recent report written by Peter Nicholson, a former adviser to Paul Martin, for the University of Saskatchewan's Graduate School of Public Policy recommends. This would entail reducing federal taxes by a certain amount and allowing the provinces to raise them without increasing Canadians' overall tax burden.

If that means the provinces start disregarding the Canada Health Act, so what? “There is essentially zero risk of back-sliding into a U.S.-style system,” Nicholson writes. Instead, provincial governments would be free to adopt the European model in which private insurance and providers are used to help lessen the strain on the public system.

Of course, this federal government is never going to give up the CHT, which gives it control over an area of provincial responsibility and ensures the provinces comply with its strict universality requirements; it would have far less ability to penalize non-compliant jurisdictions using tax points.

Yet given that only about one-fifth of provincial health budgets currently come from Ottawa, there has arguably never been a better time for provincial governments to start taking responsibility for their overspending and poor outcomes by freeing themselves from the constraints of the Canada Health Act and deciding for themselves which services they can actually afford to offer, and how the private sector can be leveraged to improve care and save costs.

Only then will we actually be able to fix health care for generations to come.

THE SAME BROKEN SYSTEM, THE SAME PROPOSED FIX.