Surprise, surprise: On the issue of health care, even though it’s taking the money, the province doesn’t believe the federal government has provided enough.
Surprise, surprise: Neither the province nor the federal government has provided enough thought to how that money will be spent.
We are where we are, in quite the mess, because we are papering over the problems with the familiar remedy of more money. (Note: Our currency is polymer, but it will never sound right to say we’re polymerizing the problem).
The health-care system in our country is sadly broken. Access to primary care takes more ingenuity than getting a front-row Taylor Swift ticket… for her entire tour. Wait times for some surgeries are no longer measured in weeks or months, but years. Almost every hospital emergency room in our region has been shuttered at one point or another in the last year.
Two things we know: The fixes, if they can indeed be achieved, will take at least a generation, and money doesn’t hurt but isn’t the real remedy. Thus, Monday’s agreement by the provinces to accept what Ottawa offered isn’t from anyone’s perspective a sustainable solution.
Our nutty federation of 14 jurisdictions works against it, as does our domestic labour pool that can’t properly tap into our immigrant fount, as does our aging demography of both longer-living and longer-needing patients, as does the reactive and not proactive nature of our system to treat but not outflank inevitable health decline, as does the basic technical and infrastructural expense of good care. And more.
For at least two decades, as we could foresee but not forestall where we sit today, the federal-provincial debate on health care has focused on the money and the respective shares of the burden and not on how well it is used. Our federation habitually does not play well together and acts out of local self-interest more than the national one. The transfers from on high to down low do not necessarily get spent on the intended object. And the result is a clumsy patchwork of care for Canadians, not just along an urban-rural divide but the geographic boundaries themselves. Those differences are also disparities in access and effectiveness.
What’s more, in today’s political context, in Justin Trudeau and David Eby, we have leaders at either end of their tenures – a prime minister trying to survive, a premier trying to surface, and both seemingly prepared to cast aside concerns about public finances to make a splash.
Last week saw the national leader at last convene the other first ministers for the first time in four years, and for a whopping two hours, laying a proposal on the table without any foreshadowing of its details and kicking the can slightly down the road to say a deal will emerge in the weeks ahead. It did so earlier than expected. This is horrible governance. Trudeau didn’t learn the lesson of his father at the table to wrangle a constitutional deal, it seems.
The expectation was that we were in for a king tide of cash that would make the pandemic spending seem like the first feeble wave ashore. When someone naughty leaked in advance of the meeting the $100 billion figure as the likely new sum to the provinces, I was reminded of that anecdote in former finance minister Bill Morneau’s book that said Trudeau loves round numbers – that’s why we got the $500 weekly sum for the unemployed in the pandemic.
T’was not to be, though, even if $46.2 billion is more money than everyone reading this column will earn over a lifetime. Taken with the planned increases, it’ll mean $191 billion over a decade that moves from the federal to provincial treasuries. Sounds like a lot, but bear in mind we spend $300 billion annually on the system, an amount sought in increases by the provinces.
Blame can be apportioned with almost every element of the system of care, but it’s worth focusing on the provinces, because they are the real gatekeepers of our health industry, and they need to be answering for more than they are at the moment.
The provinces have better balance sheets than the federal folks. Most, like B.C., are in surplus territory with comparably better debt-to-GDP ratios yet have deflected the attention in recent months through a siege of commercials for Ottawa to go back to the 1970s level of 35 per cent of health financing from the 22 per cent now.
The trouble with all of the outstretched hands – Ontario Premier Doug Ford called it a “down payment,” for heaven’s sake – is that the core issue in the system has less to do with money and more to do with managing it. Nothing to be heard from the premiers last week bred confidence that there is a serious evaluation of efficient delivery amid the shower of cash.
The Canadian system isn’t anything to boast about: 10th of 11 countries in the most recent Commonwealth Fund assessment, only ahead of the United States. Then again, efficiency doesn’t grab attention like an expenditure.
The best health systems in the world depend on four principal factors: Barrier-free universal coverage, significant commitments to primary care, few administrative burdens, and an investment in social services – nutrition, education, child care, housing, transportation, community safety and worker benefits – to help keep people from the system itself.
Nothing in the federal announcement or the provincial response gave any indication that the preventative health opportunities will be pursued, that the administrative impediments will be confronted, or that the basic nature of primary care will be fortified any time soon. There is no serious talk about tackling pan-Canadian issues – training and credentialing of professionals, the mobility of doctors and nurses across jurisdictions, among them. There is merely some data-sharing in the wind.
The lessons of federal-provincial cooperation acquired in the pandemic have been quickly forgotten. Rather than continue to work together, we are back to the adversarial times of self-interested posture and complaint. You’d think they’d learned.
Kirk LaPointe is publisher and executive editor of Business in Vancouver and vice-president, editorial, of Glacier Media