Canada's health-care system pushed to the brink by federal-provincial stalemate
Canadians would be forgiven if they have completely lost faith in the future state of Medicare, following last week's meeting of Canada's health ministers in Vancouver, where talks to hammer out a resolution to fix our crumbling health-care sector collapsed in spectacular fashion, with no tentative agreement in place, nor any prospect for another meeting.
The provincial health ministers released a final communique well before the meeting with federal Health Minister Jean-Yves Duclos had even finished, indicating no progress had been made on the requested increase to the Canada Health Transfer (CHT), and called on the Prime Minister to meet with the provincial Premiers to come to a new funding agreement. On the flip side, Duclos was not opposed to the idea of more funding, but accused the provinces of not being prepared to universally agree to a coordinated national health-care workforce database, as part of any future agreement.
When parties to a negotiation air their grievances in a public forum as witnessed last week, it is obvious the level of acrimony is at an all-time high. The tension of last week's meetings were not helped by print and radio advertisements from the provinces, attributing all issues in the health-care system to the insufficient amount of federal funding.
Underpinning this squabble is the age old debate between the two levels of government, where provinces demand more federal monies, while Ottawa only agrees to those demands so long as it comes with “strings attached.” And given the administration of health-care is within provincial jurisdiction, naturally provinces push back on any conditions set out by Ottawa, and around it goes.
Meanwhile, hospitals across this country have been overwhelmed. Even before the COVID-19 pandemic, many provinces were talking about the challenges with the system, dubbed as “hallway medicine,” marked by unreasonably long wait times, limited care capacity, and human resources challenges. Once the pandemic hit, it laid to bare the inadequacies of our health-care system to handle such a surge, to the point that we are now seeing the consequences - burnout of health professionals leading to dire staff shortages (both doctors and nurses), lack of family doctors across various regions, continued cancellations of surgeries, backlog of treatments, and now periods of closures to emergency rooms.
As if those were not reasons enough for concern, Canada has recently seen supply shortages in children's pain medication. This is acutely problematic with the latest rise in pediatric care, due mostly to respiratory illnesses disproportionately inflicting children, as evidenced by the latest example seen at Toronto's Hospital for Sick Children having to reduce surgeries as a means of preserving their critical care capacity.
The Canadian Medical Association (CMA) has persistently sounded the alarm for meaningful transformation to our strained health-care system for some time now. For instance, the CMA's most recent submission to the House standing committee on Finance provided recommendations such as a pan-Canadian human resources planning strategy, the adoption of a national licencing model to expand medical professionals' mobility to work across provincial borders to improve access to health-care, along with the desired increase to federal transfers (CHT) through a new, long-term agreement with measured deliverables, just to name a few.
Besides these types of strategic recommendations though, the primary ask from the CMA has been for the federal government to be a collaborative partner with provinces to effectively reform the system. So far, these calls have seemingly been unanswered. This begs the question, how did we get to this point of federal-provincial conflict when it comes to health-care?
Much of the current strain can be traced back to the era of restraint and restructuring under Prime Minister Jean Chretien in the early 1990s, where the goal was to slay spiraling deficits and reduce the massive debt-load the country had accumulated over the previous two decades. As such, both health-care and social program transfers were significantly downloaded onto the provinces, moving the federal government away from its initial 50/50 cost sharing arrangement at the inception of Medicare, in order to balance their own books.
Unavoidably, this put tremendous burdens on all provincial budgets, and was the driving impetus behind all Premiers constantly pushing the federal government to re-up its share of the funding through increased transfers.
The last agreement the provinces made with Ottawa for increased transfers was initiated by Prime Minister Paul Martin, who ironically enough presided over the initial cuts to funding as Chretien's Finance Minister. Signed in 2004, Martin’s Health Accord was a ten-year agreement that restored partial funding from the initial cuts, with annual increase of transfers of six per cent until 2015, providing reliable, stable funding to all provinces. In exchange, Martin got the provinces to agree to benchmarks in reducing hospital wait times and a commitment to reforms in primary and home care, along with the exploration of Pharmacare.
Once Prime Minister Stephen Harper got elected in 2006, he maintained Martin's predictable funding model, but informed provinces that beyond the agreement the federal government would unilaterally reduce transfers to no more than three per cent annually after 2015. As had been noted in this newsletter before, Harper engaged in “open federalism,” meaning he kept strictly to his own level of jurisdiction, never having to engage with the provincial Premiers, leaving them to fend for themselves within their own jurisdiction. For Martin, this lack of engagement with the provinces was responsible for the abandonment of the expected reform commitments to the sector he had in place with his 2004 agreement.
Despite a 2015 promise of more frequent First Ministers meetings with the Premiers to move away from Harper's approach to health-care, the situation had not improved under Justin Trudeau's government. Harper's lowered three per cent annual increases were actually maintained by Trudeau, and worse, Trudeau had eventually reneged on his promise to meet the Premiers at a First Ministers Conference dedicated to health-care. It was not the first time.
During the height of the COVID-19 pandemic, the federal government was very responsive to providing additional targeted funding to help provinces manage their overflows with covid cases, which was outside the framework of the CHT. At the time, all provincial governments were demanding permanent increases to the federal health transfers, and once again Trudeau promised such a meeting would have to wait until Canada was “through the worst” of the pandemic crisis. All Canadians are now wondering where the Prime Minister is in holding true to this promise with the pandemic mostly behind us, while the fires in the health-care sector continue to rage on.
However, Trudeau is not the only problem. Provinces insisting that an increase to the CHT alone will principally fix the current situation is utterly misplaced. According to a report by the Fraser Institute, though Canada has the most expensive universal health-care system amongst the top high-income countries in the OECD, its overall performance is ranked modest to poor, suggesting Canada is not getting “value for money.” Based on this study, it is clear simply pouring more bad money into what is an already broken system is not the solution, despite what the provinces' advertisements would have us believe.
All this to say, genuine health-care reform is desperately needed in this country, and Canadians expect their leaders to work together when dealing with a crisis. Political posturing and talking points need to end, with all sides treating this with the seriousness it deserves by having a First Ministers Conference as soon as possible.
Putting aside the provinces' demands for an uptake in federal transfers, the Premiers have also consistently called for dialogue, taking the Prime Minister up on the promises he had made in the past. And so, the expectation at this stage should be that Trudeau fulfill that promise, convene a national discussion, and finally demonstrate leadership on this issue, as had been shown by his predecessor Paul Martin. The future of health-care depends on it.