Will health care be a priority in the next election? There’s reason to think it might, due to record wait times for surgery, overflowing emergency rooms and the doctor shortage.Tijana Martin/The Canadian Press
Before every election, pollsters ask the public to say what they think is the most important issue. And every time the public dutifully answers: health care. By the time they get around to voting, however, health care is typically long forgotten: Elections in this country are decided by a hundred other things, most of them unexpected.
Will the next election be any different? There’s reason to think it might. The crisis in health care – the record wait times for surgery, the overflowing emergency rooms, the shortages of doctors – has been massively accelerated by the pandemic. That’s moved it from a merely important issue to a five-alarm emergency.
There’s polling data to back that up, but if you really want to know what’s on the public mind you only have to read the body language of politicians. The escalating war of words between the provinces and the federal government over health care funding is one sign. So is the sudden warning by federal NDP Leader Jagmeet Singh that he would withdraw his party’s support for the Liberal government unless it took action to resolve the crisis. So, in its way, has been the Conservative Party’s silence on the issue.
The lesson politicians of all parties have absorbed is that, while it’s rare that an election is won on health care, it’s always possible to lose on it. The public is skeptical that any party has a magic-bullet solution to health care. But what they want to know from every party is that it will not at least make it worse.
Mr. Singh’s gambit should probably be seen in the context of Monday’s by-election in the riding of Mississauga-Lakeshore. Much commentary has focused on the headline result: not only a victory for the incumbent Liberals – not wholly surprising, as they have won the riding in nine of the last 10 general elections – but by an increased margin, 14 per cent compared to 6 per cent in 2021.
That increase, however, had less to do with a decline in the Conservative vote – it dropped by little more than a percentage point – than with the collapse in the NDP vote, from 10 per cent to 5 per cent. Whatever legislative gains the NDP may try to point to from their supply-and-confidence deal with the Liberals, progressive voters appear to be giving the governing party the credit – a perennial hazard for the smaller party in such arrangements.
Mr. Singh can see what’s coming. The Liberals may well try to run as the “saviours of medicare” using whatever agreement they eventually wring out of the provinces; a win for pseudo-separatist Danielle Smith’s United Conservative Party in next May’s Alberta election might add a bit of “who governs Canada” to the mix. In such a campaign the NDP risks being an afterthought.
The by-election result also points to another potential factor: fear of the Conservatives, leading to a stampede of NDP voters into the Liberal camp – an eternal Liberal ambition, given fresh impetus, perhaps, by the Conservatives’ choice of the polarizing Pierre Poilievre as their new leader. That, too, means Mr. Singh needs to start aggressively differentiating himself from the Liberals in a way that gets the voters’ attention.
Of course, if there’s anybody who should be concerned by the Conservatives’ tendency to scare certain voters, you’d think it would be the Conservatives. Mississauga-Lakeshore, as others have pointed out, is the kind of riding – suburban Ontario, to be precise – the Conservatives have to win to have any hope of forming a government. And while the party’s share of the vote in the riding may not have declined by much – after months of bad news for the government, on everything from clogged airports to inflation to Chinese influence operations – that conceals some other shifts in the vote.
It wasn’t only the NDP vote that collapsed: So, too, did the People’s Party of Canada vote, to just 1 per cent. That may seem to validate Mr. Poilievre’s hard-line pitch to the populist right, but if the net effect is to lose more centrist voters to the Liberals than you gain from the PPC – while simultaneously scaring progressive voters into the Liberal camp – it might be time to re-examine the strategy.
An election framed as “who will save health care,” moreover, is not one traditionally calculated to the Conservatives’ advantage. Is there a way for the party to stake out its own ground on health care, rather than keeping mum and hoping to distract the public with other issues?
The point that should always be borne in mind about the raging federal-provincial tussle over health care – Ottawa insisting that any increase in federal transfers should come with certain conditions, the provinces demanding that the money should have no strings attached – is that both sides are wrong.
The feds have no business attaching conditions to the money, or not the sorts of detailed interventions they tend to prefer: The last thing the provinces need, as they struggle to match the supply of health care resources to insatiable demand, is Uncle Ottawa looking over their shoulder.
But neither is there much point in the feds making such transfers without strings. That amounts to two levels of government spending the same money twice.
It’s true, for once, that the provinces need more money, or at least they will, as the average age of the population continues to rise. Spending on health care already accounts for nearly half of provincial own-source revenues – a ratio that will only grow worse in the years to come.
But experience teaches that increasing federal transfers, in the absence of fundamental reforms, does little good: The money simply goes to increased compensation for health care providers. And as long as the feds remain the paymaster, that tendency will continue. The provinces can always blame Ottawa for any problems in the system, no matter how fast federal transfers increase, on the grounds that they just didn’t increase fast enough.
How to square this circle, allowing provinces access to more funds to deal with the rising costs of health care while retaining some incentive to spend it more wisely? Stop sending the money from Ottawa to the provinces. Rather, make it part of the provincial tax base. Convert federal cash transfers into tax “points,” permanently reducing the federal share of income tax revenues and raising the provinces’ share.
To be effective, however, the conversion must be complete: A portion of federal transfers was converted into tax points in the 1970s, only to be conveniently forgotten in provincial calculations of Ottawa’s share of the health care burden. The time has come, rather, to get out of the cost-sharing business altogether: to make it clear that the provinces, and the provinces alone, are responsible for health care.
What is needed in health care, above all, is accountability for results. That will never be the case so long as the federal-provincial blame game is allowed to continue. Conditional transfers had their place, in the days when public health care was still under construction. In the present crisis, the emphasis needs to shift.
It is their own citizens to which the provinces should be held accountable, not to Ottawa. A federal Conservative Party that carried that case to the public might at last stop playing defence on health care, and start to lay claim to the issue in its own right. At the very least, it would be contributing to the debate, rather than ducking it.