Prime Minister Justin Trudeau’s handlers ensured all the right props were in place for Tuesday’s press conference to tout his government’s “massive investment in not just the present of health care, but the future of health care.” There were (thankfully empty) hospital beds behind him, and health care workers who nodded sympathetically at his prepackaged bromides.
No amount of stagecraft could hide the brutal reality: Mr. Trudeau had just pulled a fast one on the provincial and territorial premiers who had gathered in the capital for what had been billed as a historic meeting aimed at fixing health care, but which may instead go down as the moment Canada’s national myth of universal health care expired with a whimper, not a bang.
The $46.2-billion “offer” of new federal health care funding over 10 years that Mr. Trudeau put before the premiers amounted to a clever sleight-of-hand that left them largely speechless. Apart from Ontario Premier Doug Ford, who seemed to have had prior knowledge of the offer and looked eager to move on to other matters, most of the others were too stunned to say much.
After two years of carefully co-ordinated efforts aimed at mobilizing public opinion in favour of an epic increase in federal health care transfers, Mr. Trudeau effectively called their bluff. The premiers could continue to cry in their milk or swallow Mr. Trudeau’s bitter pill, knowing full well that Canadians have probably had enough of their bellyaching.
For a federal government that rarely passes up the chance to spend more when it could spend less, the offer put on the table on Tuesday was an out-of-character nod to fiscal responsibility. Mr. Trudeau scheduled barely two hours to meet with the premiers, signalling from the outset that he was not interested in negotiating with them.
Based on recent trends, public and private spending on health care will exceed $4-trillion over the next 10 years, based on total spending of $331-billion in 2022. Ottawa’s added contribution of $46.2-billion over that period is the opposite of a game changer. It completely ignores the demographic time bomb on the horizon.
The percentage of the Canadian population over 65 is projected to rise to 23.1 per cent in 2043 from 18.5 per cent in 2021. In 2022, per capita health care costs were 3.3 times higher for Canadian seniors than for those between the ages of 15 and 64. An ever-increasing proportion of older Canadians, living longer than ever, will put relentless pressure on the system.
Add in the health care costs for millions of new immigrants, the soaring expenses of new drugs and treatments that medical science will yield, and the generous salaries of evermore health care bureaucrats and it becomes hard to see a way out of this problem that does not involve breaking once and for all the taboo of privatization.
Indeed, Ottawa’s offer includes a lot of talk about sharing data and measuring progress and (loosely) attaching strings to bilateral agreements on shared priorities. It is silent on experimentation with alternative forms of delivering publicly funded health care services. This amounts to tacit encouragement for the provinces to test the limits of the Canada Health Act. But it is doubtful that this will be enough to fix the system.
There are those who argue that Ottawa should just cut off the provinces and be done with it. That it should get out of the business of funding health care – an exclusive provincial jurisdiction – and force the provinces to raise their own taxes. They point to health care transfers that have grown faster than overall provincial spending on health care as proof that some provinces have been diverting federal funds intended for health care into other programs or tax cuts. This argument obscures the long-term fiscal pressures that most provinces are facing, which are much greater than Ottawa’s, in spite of current budget surpluses.
It also ignores the fact that the 2004 health accord that saw Ottawa inject $40-billion in health care over 10 years followed nearly a decade of cuts that began with the 1995 federal budget. Federal cash transfers were slashed by 10 per cent in 1996 and cut again in 1997. They were frozen for another three years after that. Our health care system never recovered from the hospital and bed closures, nursing staff cuts and reductions in medical school programs that followed Ottawa’s 1995 budget. Our capacity shortfalls compared to peer countries were laid bare during the pandemic. Ottawa’s disinvestment in 1995 had catastrophic results.
No, money alone is not the solution. But Tuesday’s first ministers’ meeting was a moment of truth. Instead of a generational fix for health care, we got another Band-Aid on a bleeding system. To borrow the CBC’s new slogan, maybe it’s a Canada thing.