Canada's premiers are missing a real chance to fix our ailing health-care system & More News Here

When Canada’s premiers doubled down earlier this 12 months on their demand for a $28 billion unconditional enhance within the Canada Health Transfer (CHT), they missed a possibility to lastly obtain the type of health-care reform our underperforming system has been advised it wants over and over.

The rationale for this demand is that the system is chronically underfunded (itself a debatable rivalry), and that is supposedly as a result of, as Saskatchewan Premier Scott Moe is keen on tweeting: “Ottawa used to fund 50 per cent of health care costs and now only funds 22 per cent of those costs.”

The premiers are additionally suggesting they’re being modest of their calls for. They’re not asking for a return of the 50/50 deal struck within the Nineteen Sixties, however solely that Ottawa up its share to 35 per cent.

As I’ve argued beforehand, the premiers’ demand essentially misrepresents the historical past of health-care financing in Canada.

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Read extra:
The disingenuous calls for of Canada’s premiers for $28 billion in health-care funding

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They have forgotten that the 50/50 deal led to 1977 with the complete consent of the provincial governments. Since then, the dimensions of the federal money switch for well being has been topic to each intense federal-provincial diplomacy and federal unilateralism.

Their deceptive tackle historical past apart, the premiers appear decided that any enhance in well being funding from Ottawa pertains to the kind of unconditional basic CHT, set at $45 billion to the provinces in 2022-23 — and never a part of an settlement that may specify priorities for motion and reform on their half.

Health accords didn’t result in change

It’s clear that nationwide accords, like these in 2000, 2003 and 2004, did little to impact real change within the system, though the 2004 Health Accord did present steady and predictable will increase within the CHT.

When the 2004 accord expired in 2017, neither the federal nor the provincial governments had been within the temper for an additional grand discount. Instead, Ottawa took a very completely different tack. It agreed to a 3.5 per cent annual enhance within the CHT (up from a three per cent from 2014 to 2017) and to present a further $11.5 billion in focused funding for enhancements to neighborhood and psychological well being care.

In order to obtain the money, provinces had to signal bilateral agreements that set out, in various levels of element, the place and the way the cash can be spent.

As a colleague and I’ve argued elsewhere, these bilateral agreements, although nonetheless imperfect, are a markedly improved approach of accelerating transparency about the place health-care {dollars} go.

They may additionally function an accountability device for measuring progress targeted not simply on fixing however truly bettering Canada’s publicly administered health-care system.

In all chance, Ottawa will need to proceed what it began in 2017 and tie any important funding enhance to a new set of bilateral agreements primarily based on priorities chosen by the provinces. It’s simply as doubtless that that is what the premiers are actually making an attempt to keep away from.

The affect of COVID-19

The COVID-19 pandemic presents us with a distinctive alternative to rethink and reform public well being care in Canada.

There is little question that the system was hit arduous — its capability was stretched, its workforce took a nonetheless uncalculated toll and all method of service supply was interrupted. Most notably, surgical wait occasions (already a significant issue in Canada’s system) had been made worse, with one report indicating Ontario alone had a backlog of a million surgical procedures.

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Read extra:
How to resolve Canada’s wait time drawback

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Furthermore, the pandemic uncovered profound issues in long-term care and neighborhood and psychological health-care methods.

It’s exactly due to so many simultaneous challenges that we must be pondering not simply of rebuilding Canadian well being care, however endeavor the mandatory and lengthy demanded modifications that might create a Twenty first-century publicly funded and administered health-care system.

There are two doubtless eventualities.

In the primary, Ottawa agrees to a important enhance within the CHT and the provinces merely take the cash with out making any of the mandatory modifications to how and what companies are delivered (a lot because the Senate concluded occurred with the $40 billion offered by the 2004 Health Accord). At greatest, which means we return to a pre-pandemic establishment by which the provincial methods proceed to lose floor.

In the second, new agreements goal the funding to remake the health-care workforce, make higher progress on main health-care reform, reconfigure long-term care, construct real community-based psychological well being care or reconfigure the continuum of care to handle wait occasions on an ongoing foundation.

Co-operation from premiers wanted

The second won’t occur with out some type of conditionality, transparency and accountability from the premiers themselves. Unfortunately, the 2017 bilateral agreements comprise no obligation on the provinces’ half to report on achievements relative to their commitments.

Asking provinces to report to the federal authorities on how they handle their constitutional tasks for well being care could possibly be taken as a violation of provincial sovereignty. But they need to not refuse to report to their very own residents.

It’s hardly inappropriate for Ottawa to insist that provinces report to their residents on any focused funding geared toward priorities the provinces themselves commit to tackling.

So, except and till the premiers agree to set out — maybe in a new set of bilateral agreements — how they intend to spend and report on the 62 per cent enhance in transfers they are demanding to truly result in real change of their respective well being methods, Ottawa ought to refuse. And Canadians themselves ought to simply say no.

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