For health policy wonks, 2011 ended not with a whimper, not with a bang but with a wallop. Federal Finance Minister Flaherty thumped the federal government’s 2014 Accord ‘offer’ on the table. A special kind of offer, in fact a fait accompli: there’ll be no negotiation, no debate, no to-ing and fro-ing. This is what you’ll get. And what you get is a temporary (up to 2017) continuation of the existing 6% annual increase in federal health funding to the provinces and then a lottery increases in line with growth in the economy. So the psychopaths on Wall Street get to decide not only how to wreck the American and indeed the world economy, but also (indirectly) how much the provinces will get from the federal taxpayer.
We don’t know yet whether there’ll be a new Accord with high sounding rhetoric about how the federal government, provinces and territories will work together on addressing any health policy issues, but Prime Minister Harper has said there’ll be ‘no strings attached’ to the new deal. But just what does ‘no strings’ mean? Presumably the five Canada Health Act conditions remain. Health minister Aglukkaq still talks about provincial accountability though both inside parliament and outside so there’s a bit of a disconnect in the federal rhetoric still.
So is ‘no strings attached’ a good thing? Is it reasonable that there be no debate about how to improve health care in Canada at this once-in-a-decade opportunity? No re-jigging of what Medicare means, say addressing the lamentable state of home care or the lack of a national Pharmacare scheme?
The supporters of ‘no strings’ will say this gives the provinces the autonomy they need to set their own priorities for their own health care needs. But it has been said that Medicare has replaced the railroads as a unifying force in Canada. How much diversity is a good thing? If we have too many provincial separate paths, when will Medicare cease to have a meaning or ability to act as a unifying force?
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The move is a strategic one. It subverts the discussion about “how much” and turns it to one of “how”. Undoubtedly the funding won’t be enough. It hasn”t been enough and in particular I fear there is no amount of funding to recapitalize a system that is in need of big investment.
What is the strategy – to ulitmately allow the federal government to get out of the heatlh care business. One only need look at the previous importance of the health portfolio and the heavyweight ministers who held it in comparison to now to understand that health in the mind of the PMO is barely a junior ministry. The federal government is anxiously waiting to get out of the health discussion – it’s not winnable and it will become our key discussion in the next 10 to 15 years as we struggle to understand how we reinvent health care in Canada. It’s a no-brainer – get out.
But how? Easy – selectively reduce the federal input into the overall health file untill one day some bright province says, ” boy, the federal government isn’t contributing very much, why do they have anything to say at all? – in fact doesn’t that mean that the Canada Health Act is invalid?”. Of course this will happen – it is only a matter of time.
It’s not just the feds – there are large numbers of groups of many stripes who think that they will win or gain freedom on the otherside of a failed Canadian Health Care system. That IHFs are being bought up en mass in Ontario is a first simple sign that someone with deep pockets beleives that the lock on public delivery is soon to be broken.
Where does one start with this blog. A few points:
– 6% per year will likely exceed the combination of population growth and inflation for the foreseeable future allowing time for the provinces to get their priorities straightened out on the spending side.
– Health Care delivery in Canada is a Provincial matter. If you want to make it into a force for national unity, perhaps you should go chat with Quebec and Alberta about getting on board! In the meantime, providing billions of dollars on a per capita basis (i.e. to ALL Canadians – equally), isn’t a bad way to unite the country. Unless, of course, by ‘unity’ you mean directing more resources to populations and jurisdictions that are in special need of more redistribution-mediated ‘unification’.
– It takes a pretty big leap of logic to make the link between ‘psychopaths’ on Wall Street and Canadian federal government support of Health Care through transfer of funds and tax points to the provinces. Please enlighten us on how this works.
– Paul Martin’s capitulation to the provinces the last time around didn’t quite solve Home Care or ‘Pharmacare’ problems either did it? In fact, it delayed meaningful change by allowing costs to continue to grow at an unsustainable rate.
– Now that the funding is in place, the real debate on how the money is spent over the next decade can begin.
Does this announcement mean that health care will become viewed as an envelope of funding for future Federal governments? How will issues of national standards, portability of services, regional variations in ability to pay etc….. be addressed? It will be interesting to see how the Provinces decide to move forward in light of this announcement.