Protecting publicly funded health care is shaping up as a last-ditch stand

OTTAWA—You need to be extra careful these days when you’re slicing up those celery sticks or onions. God only knows what would happen if you cut yourself badly. You’d probably have to drive yourself to the hospital. And your chances of getting adequate attention in the emergency room? Who knows? So, health care is a disaster—both from a policy point of view and a very personal point of view. Few doubt it’s a national crisis. In a recent poll by Abacus Data probing whether Canadians really think this country is “broken,” concerns about the medical system outweighed everything else. Abacus found 66 per cent of people said medical services are worse than a few years ago, with nearly half saying medical care is “much worse.” It was the only topic, among several questions about air travel, government services, and other matters, where the intensity of dissatisfaction reached that level. But for all that, Canadians don’t seem to have much of a handle on who bears responsibility or what to do about it. In the high-stakes political manoeuvring that has been a feature of health-care federalism for many decades, the federal government remains an important player. But health care is the responsibility of the provinces, even though lately the premiers have been trying to convince Canadians that today’s shocking surgical wait times and emergency room shutdowns can be traced to a lack of funding by the Trudeau Liberals. In that vein, the premiers came to Ottawa on Feb. 7 unified in their demands for a huge increase in federal medicare transfers to the provinces. This despite the fact that many of the provinces are running budget surpluses or are close to breaking even, fiscally. It’s pretty clear that, regardless of how many people are suffering in a failed health-care system, most premiers believe they can get more political credit for direct handouts to voters than spending provincial dollars for incremental improvements in hospitals and health personnel. Saskatchewan, for example, expects a $1-billion budget surplus this year and is handing out $500 cheques, costing the government $450-million, and small business taxes have been eliminated, a $30-million-a-year tax break. New Brunswick is flush with a record $862-million budget surplus, but Premier Blaine Higgs is spending $300-million of that windfall on a “New Brunswick Advantage Savings Fund” to generate future investment returns. Quebec, like most provinces, was on the verge of a budget surplus but opted for $5.4-billion in new spending, most of it on anti-inflation support payments. In Ontario, Premier Doug Ford’s government ran a budget surplus last year but maintains it needs financial help for health care while providing rebates on licence plate fees, reducing corporate income taxes, and passing up $2-billion in a gas tax cut. This weak—not to say embarrassing—bargaining position held by many premiers may have contributed to their decision to grudgingly accept the $196-billion, 10-year health-care funding plan offered by Prime Minister Justin Trudeau. The provinces’ buy-in appears to be a bit of a short-term political win for the federal Liberals, but Trudeau’s effort to protect the single-payer, public health system may be more of an uphill slog than ever. While agreeing to the terms of the new fed-prov health agreement, Ford is, for example, moving ahead with an aggressive plan to increasingly convert medicare in the province to privately run, for-profit services. And much of the public has no trouble making the connection between the provincial government’s underfunding of the system and Ford’s objective. More than half of Ontarians (54 per cent) believe the provincial government is intentionally ruining public health care to make private care look better, according to a new Angus Reid Institute survey. Two in five respondents in Alberta (43 per cent) and Saskatchewan (42 per cent) and half in Manitoba (49 per cent) are of the same view, the poll indicated. In any case, there’s no doubt that the deterioration of medicare during COVID-19 has opened the door for attempts to expand American-style private care in Canada. While the Angus Reid survey found 39 per cent of those surveyed are dead-set against more privatization, 28 per cent favour more private health care, and 33 per cent are unsure, saying they might be open to more private options but are worried about negative impacts for low-income people and a worsening of shortages of health staff. Holding off the push toward private care will take measurable results. Accountability for health-care spending has been a central aspect of health-care federalism for 20 years, but has never been substantially realized. The latest agreement with the provinces prioritizes new requests for data from the provincial governments and a requirement for annual reports on “common indicators” showing progress on such issues as increasing health staff, providing better access to primary care, and trimming wait times. The future of public health care may depend on Trudeau’s ability to break the mould and translate these commitments into actual improvements for Canadian patients. Les Whittington is a regular columnist for The Hill Times. The Hill Times