Imagine a health system in which everyone was allocated the same number of doctor, hospital and diagnostic appointments and hours -- regardless of their health or need.
It wouldn't take many seconds to dismiss this as an absurdity. Yet when it comes to federal funding for health care, one size fits all is exactly Ottawa's position.
Starting in 2014-15, the cash portion of Ottawa's Canada Health Transfer (CHT) will be distributed to the provinces on an equal per-capita basis. There will be no regard to the relative strength of provincial tax bases (a new development) nor any allowance for the relative health or demographic age of provincial populations (a longstanding problem).
You may say there's a difference between allocating medical dollars and medical appointments. But the dollars pay for the appointments. If there aren't enough federal bucks to make up for differences in provincial wealth or health, care will be rationed more severely in provinces with weaker finances, older populations and more illness.
Until the Harper government changed the rules a year ago, the health cash each province received was balanced with a second part of the CHT -- a share of taxation Ottawa ceded in the 1970s, when it reduced its share of the total tax base by 13.6 per cent for personal income tax and by one per cent for corporate tax, leaving the provinces to assume this share.
These transferred "tax points" were worth more, on a per-capita basis, in provinces with higher incomes. So Ottawa used the cash portion of CHT to provide some balance. Provinces with lower per-capita tax transfers got more per-capita cash (and vice versa). When CHT tax points and cash were added together, each province got the same total per-capita value.
Now, Ottawa is treating the tax transfer windfall as ancient history and redefining fairness so only the cash will be distributed on an equal per-capita basis. Next year that will mean $1 billion more for Alberta, which already has the lowest health burden as a share of GDP.
This will come out of growth in health cash for other provinces, falling hardest on those such as the Maritimes, with the lowest-value tax transfers and the highest health-cost burdens.
In the end, that's not a viable way to fund universal health insurance. Provinces do need to be more efficient and innovative in health-care delivery. But only Ottawa can provide the key element of financial stability that bridges the inevitable unequal distribution of health and wealth in the real world.
-- The Canadian Press