Provinces to blame for health care mess

Canada’s premiers were unconvincing last week in their group whine about the Harper government’s plan for funding medicare.

They argued at a two- day gathering in Victoria that the cash was insufficient. They turned noses up at a funding formula apportioning equal per- capita funding to each province.

Further, with the exception of Alberta’s Alison Redford, they groused that the unilaterally imposed deal ought to have been the subject of federalprovincial negotiation and compromise.

“Dictatorial federalism,” huffed the opposition Liberals.

But premiers should know by now, Stephen Harper is not a negotiating type of guy. He has yet to hold a single first ministers’ meeting. And since such sessions tend to be a group gang- up for federal cash, the PM isn’t likely to host one any time soon.

Besides, from Harper’s perspective, there’s nothing to negotiate. His health deal, to run from 2014- 24, will give provinces quite generous sums to help them cover roughly 20 per cent of their health costs, with no federal strings attached.

It will allow for hefty six- percent annual increases in transfers until 2016- 2017, and thereafter peg them to GDP and inflation growth.

This, when Ottawa is busy cutting spending to balance its budget.

Instead of taking the money and running, however, most premiers expressed dissatisfaction, mandating a panel led by Manitoba’s Greg Selinger to further scrutinize the funding plan.

They object in particular to the notion of equal per capita funding for all provinces, a change to past financing that allocated proportionately more money for poorer provinces.

The plan would give oil- rich Alberta much more cash than it nets now.

True, but health care is not equalization; a separate federal program exists for that.

And in the past some of these same premiers have objected to the Employment Insurance program’s unequal formula, which offers more generous terms for needier provinces.

Do they believe provinces should be treated equally or not? They cannot have it both ways.

Constitutionally, premiers have full control of health care in their provinces, with levers at their disposal to bring their health costs under control.

They can, through their Council of the Federation, coordinate provincial efforts in the interest of nationally comparable standards.

This is where their focus should be. Health costs need to be restrained. Ontario now spends 45.7 per cent of its budget on health care.

That said, on a national basis, health spending since 2009 has stabilized, consistently representing between 11.5 and 12 per cent of the country’s GDP.

Admittedly, cost containment is difficult to achieve when premiers must pander to their electorates, for whom health care is a top election issue.

But they could be doing more to bring health costs in line.

For years, experts have been jawing about a need for electronic health records and bulk provincial pharmaceutical purchases.

They’ve talked about moderating excessive pay packets of certain categories of medical specialists.

I can recall, as a young journalist, writing about the clogging of costly acute- care hospital beds by seniors who more appropriately ought to be treated in less expensive chronic care settings. That was 35 years ago.

Over and over, across Canada I’ve written of horror stories in overcrowded emergency rooms and economies that could be made if a greater number of nurse practitioners provided certain medical services.

Vested interests, union intransigence, political cowardice, bureaucracy: all these things have blocked genuine health care reform.

The premiers have a whole lot to accomplish in their own provinces before blaming Ottawa’s planned funding formula for their woes.