Perhaps the best example of the expression “like trying to herd cats” in Canadian politics is attempting to get all the premiers to agree with the federal government. On the other hand, when it comes to collectively disagreeing with the feds, they herd willingly and easily. So full credit to PM Trudeau for getting them all to accept his proposal for $46.2-billion over 10 years to help shore up Medicare.

No doubt their compliance has been inspired by Canadians’ devotion to their health-care system. Medicare is iconic in this country. A survey by the Environics Institute of the importance of various symbols of Canadian identity put our healthcare system as number one, just ahead of the Charter of Rights and Freedoms. (The monarchy was at the bottom of the list and even hockey was well below Medicare.)

Unfortunately the iconic symbol has been looking a little battered lately after being beat up by the pandemic, and the citizens are getting restless. We have been letting our political class know its condition isn’t acceptable.

Ottawa will top-up the Canada Health Transfer (CHT) and offers new money directed at four priority areas: family health services, health workers and backlogs, mental health and substance abuse, and a “modernized health system.”

Wisely, the feds have required the provinces to commit to improving how health data is “collected, shared, used and reported to Canadians to promote greater transparency on results, and to help manage public health emergencies.” Otherwise, no dipping into the enhanced CHT.

The provinces and territories will also have to develop action plans detailing how funds will be spent and how progress will be measured in order to access the funding for the shared priorities. Ottawa will be able to judge whether or not the new funding achieves better outcomes for Canadians. There are to be no blank cheques.

On the other hand, each province will have leeway to tailor the money to achieve the objectives the way that best suits its particular situation. This provides a degree of provincial autonomy while discouraging a ganging up on Ottawa.

The money is far less than what the premiers were asking for, but isn’t it always? As Nova Scotia Premier Tim Houston put it, “We know the reality. The money that’s there is there, so no point in dragging the feet. We’re just interested in moving forward.”

Nonetheless, it may well not be enough. $46.2-billion over 10 years really isn’t all that much in a system that spends over $330-billion a year. Our per person expenditure is above average for 38 countries in the OECD, less than Germany and the Netherlands and way, way, way less than the U.S., but more than others including Sweden, Australia and the UK. Our total spending as a percent of GDP is second highest behind the U.S.

But perhaps the most interesting number is public spending as a percent of total health spending, public and private. Canada’s public spending is only 75 percent compared to a number of other countries including Sweden, France, Germany, and the Netherlands whose governments spend 85 percent. This suggests we have considerable room for more of a government contribution, although the GDP numbers suggest our spending could be spent more efficiently.

The current offer is, as As the head of the Canadian Medical Association Dr. Alika Lafontaine put it, a “ray of hope.” It’s a good start.

Event the leader of the opposition, Mr. Poilievre, thinks so. Usually the ardent tax-cutter and critic of all things Trudeau, he has promised that if he becomes PM he will give even more money to the provinces.

So kudos to all of them. Despite the usual political posturing for their bases back home, they made the system work. They got the job done. Or at least the first part of it. Now they have to produce results. Canadians will be watching closely.

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