WEATHER ALERT

New health-care deal, same old issues

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It appears the federal and provincial governments are about to announce a new health-care funding agreement in the coming weeks. The new deal will likely be unveiled with the same scripted drama Canadians saw in 2004, the last time Ottawa and the provinces inked a long-term health-care “accord.”

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Opinion

It appears the federal and provincial governments are about to announce a new health-care funding agreement in the coming weeks. The new deal will likely be unveiled with the same scripted drama Canadians saw in 2004, the last time Ottawa and the provinces inked a long-term health-care “accord.”

The 10-year, $41-billion agreement, signed between then-prime minister Paul Martin and the provinces, was supposed to fix health care “for a generation” by reducing surgical and diagnostic wait times and expanding home care and pharmacare programs.

It fixed nothing.

The agreement provided the provinces with six per cent annual increases in the Canada Health Transfer for 10 years (which was extended by Martin’s successor, Stephen Harper, for an additional two years). In return, the provinces were supposed to reduce wait times by meeting agreed-upon “benchmarks.”

There were no penalties for failing to reach those targets. It was no surprise when wait times grew and the provinces faced no consequences. They took the money and ran.

Fast-forward to 2023, and Ottawa and the provinces are on the verge of unveiling another “historic” health-care deal. It will be big on political theatre and little on substance. There will be more money for the provinces, but not much else.

Provincial governments haven’t exactly been starved of health-care cash after the federal government ended the six per cent increases in 2017-18. Since then, provinces have received average annual hikes of about four per cent.

In 2023-24, they’re in line for a staggering 9.3 per cent increase in the CHT under the existing formula (which is calculated based on a three-year average of nominal GDP). That’s an extra $4.2 billion this year alone for the provinces — even before the unveiling of a new health-care deal.

Provinces won’t get anything close to nine per cent a year under the new agreement; it will probably be in the range of five to six per cent.

However, much like in 2004, the provinces won’t have to do much to get that money.

The federal government has little ability to control how provinces spend their health-care dollars. The only real strings attached are those found in the loosely enforced Canada Health Act, which among other things, demands health care is universally accessible. Beyond that, CHT money goes into general revenues and provinces can spend it any way they want.

The new agreement will include some window dressing. There will be language around how the provinces collect and disseminate health-care data.

Provincial governments already share wait time and other health statistics with the Canadian Institute for Health Information, a not-for-profit organization funded largely by Ottawa and the provinces. The quality of that data has improved over time and is expected to continue to get better. It’s unlikely a new health accord would have much impact on that.

Ottawa will likely continue to sign side deals with provinces in areas such long-term care, mental health and home care. There could also be some commitment to a national pharmacare program, but it will likely be minor.

The main component will be about money. Both levels of government will do their best to make it look like the provinces made concessions — an important part of the political theatre to show Canadians politicians “rolled up their sleeves” and “hammered out a deal.”

In reality, provinces will continue to spend their health dollars as they see fit.

Sadly, they will do so with the same substandard results: long wait lists, overcrowded hospitals, low-quality long-term care and staff shortages, all driven by a health-care system forced to ration care.

The reason: most Canadians, including politicians of all stripes, are not prepared to have earnest discussions about real health-care reform — the kind that would require a rethink of the Canada Health Act, including how universal health care in this country is micro-managed by provincial governments.

There appears to be no appetite to examine how universal systems operate in other parts of the world (most of which enjoy better outcomes than Canada). Canadians seem content to embrace the status quo, even in the face of substandard results.

The 2023 health accord will reflect that inertia, just as it did nearly 20 years ago.

tom.brodbeck@freepress.mb.ca

Tom Brodbeck

Tom Brodbeck
Columnist

Tom has been covering Manitoba politics since the early 1990s and joined the Winnipeg Free Press news team in 2019.

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