Double health-care cash before attaching conditions, Quebec health minister tells Ottawa

NationalPost.com
Sept. 29, 2016
By Ian MacLeod

A new national health accord hinges on a federal agreement to first double the Canada Health Transfer to provinces and territories before they buy in to any federal spending strings, Quebec’s health minister declared Thursday.

“We will talk funding first, conditions second. That’s what we’ve already said. And that will not change in October,” Gaetan Barrette told reporters after delivering his message to a conference of health-care professionals.

A crucial negotiating session between federal Health Minister Jane Philpott and her provincial and territorial counterparts is scheduled for Oct. 18 in Toronto. The current funding formula expires in April.

But both sides appear to be digging in their heels.

Philpott, speaking to the same health-accord gathering sponsored by Canada 2020 and the Canadian Medical Association, sounded several conciliatory notes, but insisted her government is not prepared to “simply open up the federal wallet.”

Increasing heath-care costs are placing enormous financial pressures on all levels of government. A new Fraser Institute report notes health-care costs already consume an average of 40.3 per cent of provincial budgets.

On the federal side, the Canada Health Transfer (CHT) has increased by 79.4 per cent, to $36.1 billion this year from $20.1 billion in 2006-07, well above the 49.7 per cent growth in all other program spending, says the report.

The federal Liberals have offered to increase the CHT by about three per cent annually, which would boost the federal contribution next year to more than $37 billion. The money is based on equal per-capita transfers, with no adjustments for demographic and other differences between jurisdictions, and is contingent upon compliance with the Canada Health Act, which has its own set of strings.

Still, that’s down from the annual six-per-cent increases cash-strapped provinces and territories have received since 2014, when the previous 2004 accord expired. Instead of negotiating a new multi-year accord, the Harper Conservatives set the annual transfer increase at six per cent, with a reduction to three per cent in 2017. The Liberals have adopted the same position, but with a twist.

They’ve promised a $3-billion investment in home care over three years, plus additional spending on mental health services and access, technological innovation and better access to prescription medications. All over and above the annual CHT.

Barrette characterized the negotiation strategy as “the classic chicken and egg story. Before you discuss any conditions - and we will not in Quebec - we have to discuss (CHT) funding,” and not the ancillary “themes” being pushed by the federal health minister.

The negotiations, he said, “didn’t get off on the right foot because (the federal strategy) is based on themes. It’s all very nice and good to have ‘themes,’ ” but what’s really needed is a federal commitment to boost its core contribution to overall health spending to 25 per cent from the current 22 per cent.

Barrette agreed there are tremendous needs across the country to improve home care and access to mental health care, but said the limited three- or four-year federal assistance packages will eventually dry up and leave provinces and territories with programs they can ill afford.

The promised $3 billion in federal funding for better home care would, for example, amount to an additional $232 million a year for Quebec, while the province estimates it would cost $5.5 billon a year to meet all the province’s home-care needs, he said. Likewise, technological innovation may result in some isolated savings, years out, “but doesn’t solve my budgetary problem globally speaking.”

What we have on the table at this moment is very disturbing
If the federal government doesn’t blink in the upcoming talks, the already under-performing health-care system is heading into a wall, he said. “What we have on the table at this moment is very disturbing, alarming.”

A possible crack in provincial and territorial negotiating solidarity surfaced on the weekend, with Ontario Premier Kathleen Wynne saying she’s not opposed to federal spending strings, depending on “how tightly those strings are tied.”

On Thursday, Philpott stressed collaboration, not partisan politics, is needed to reach a deal.

“This is not a partisan issue, it is not something on which we need to argue about, it is something on which we need to collaborate,” she said.

However, “the facts really don’t support the issue that the major issue facing our health system will be solved simply by tossing more money at the systems that we have in place. Canada is amongst the highest spenders in the world on health care and yet we’re not achieving the kinds of results that Canadians need and deserve.

“We have an obligation as the government of Canada to do more than simply open the federal wallet. We need to ensure that the new money doesn’t simply inflate the health system. We need to find ways to put health care on the road to long-term sustainability.”

Provincial and territorial premiers, meanwhile, have written to Prime Minister Justin Trudeau asking to meet on health-care funding in advance of this fall’s first ministers’ meeting on climate change. If a meeting can be held by mid-December, they want the existing six-per-cent CHT to continue for another year.