On health, premiers cherish their jurisdiction, not their responsibilities

OTTAWA—It’s time for Canadians, and particularly the media, to get serious about this whole supposed dispute between the federal government and the provinces over health-care funding. Conservatives are well aware of what first ministers’ meetings—like the one the premiers are calling for in January on health-care money—are about. They are political theatre of the most highly charged variety, offering a chance for the premiers to put the federal government on the spot in front of the whole country. Then-prime minister Paul Martin, who wanted to please everybody but ended up pleasing almost nobody, met with the premiers in 2004 and worked out a new Health Accord. Based on a promised six-per cent annual increase in federal health funding, it included a $41-billion allocation over 10 years to improve the system while also setting in motion reforms in such areas as home care, primary care, and pharmacare. Years later, Martin lamented that the provinces failed to fulfill their side of the deal. Conservative prime minister Stephen Harper clearly didn’t want premiers haranguing him on the national stage about all the things he could be doing that he didn’t want to do. He had little use for first ministers’ meetings and didn’t hold one during the last six years of his tenure. On health care, he took the position that it was in the premiers' ambit and they should deal with it. In 2011, then-finance minister Jim Flaherty sandbagged the provinces with a surprise plan to reduce Ottawa’s commitment on health funding after 2016. At the time, Flaherty said Canadians should remember there is only “one taxpayer” and Ottawa needed to ensure the health-care system would be “sustainable” in future. “We want to put the issue of funding behind us to allow us all to focus on the real issue: how to improve the system so the provinces and territories can ensure timely access to health care when needed,” Flaherty said. Now, having let the health system reach a state of near collapse where patients run the risk of dying in emergency rooms, the premiers (mostly conservatives) are determined to shift the blame to the federal government. Hence the demands for a meeting with Prime Minister Justin Trudeau and for Ottawa to pony up a lot more cash. The point the media seems unable to grasp is that this is about politics, not money or the health-care system. Ontario, for instance, has had among the lowest per person spending on health care among the provinces for years. Premier Doug Ford’s ham-fisted clampdown on decent wage increases for nurses is a blueprint for shortages of hospital staff, as has been proven. And the Ford government, which ran a budget surplus last year, is saying it can’t afford to fix the health-care system while handing out rebates on licence plate fees, reducing corporate income taxes, and foregoing $2-billion in a gas tax cut. Saskatchewan, flush with revenues from rising resource prices, is expecting a budget surplus this year and is planning to give each adult in the province $500, costing the government $450-million. Small business taxes have been reduced to zero, a $30-million-a-year tax break. The oil price spike has provided a revenue windfall for the Alberta government, resulting in a $12.3-billion budget surplus for 2022-23. Most of it is going to paying down provincial debt, but Premier Danielle Smith is also setting aside $2.8-billion over the next three years to cover a bevy of inflation-fighting payouts and rebates, such as halting the province’s gas-pump tax and sending Albertans $50 a month for household electricity costs. This while the province’s paediatric hospitals are dealing with the same crisis conditions being experienced across the country. Quebec, like most of the other provinces, was on the verge of a budget surplus this year. But Premier François Legault decided instead on $5.4-billion in new spending, most of it on anti-inflation support payments he promised in his successful re-election campaign. “The provinces now have the financial resources to properly index social assistance and other low-income transfers to inflation, fix broken long-term care systems, and rebuild health care capacity,” said Canadian Centre for Policy Alternatives senior economist David Macdonald. “There are no more financial excuses to avoid action on these fronts, only political ones.” It’s obvious that the federal government, if it follows through on its pledge to add billions more dollars to health transfers, has to set conditions to keep the premiers from squandering it on licence plate fee rebates or “Danielle dollars.” But the premiers are rejecting any federal conditions, including no-brainers like committing to sharing common key health indicators and building an advanced health data system to better plan for workforce needs. And NDP Leader Jagmeet Singh has decided to raise the political ante. Singh, who apparently missed the class on federal-provincial division of powers in Canada, is threatening to withdraw support for the Liberal minority government over the health issue. He insists Trudeau must take immediate action—not only to hand over more health funding to the premiers, but also to somehow fix the emergency, despite Ottawa’s lack of jurisdiction. Les Whittington is a regular columnist for The Hill Times. The Hill Times