As many of you have likely seen, read or heard, the Council of the Federation — which is made up of the first ministers from each province and territory — met in Victoria, B.C. to discuss the 2014 health care accord and hopefully find common ground on their response to the federal government’s unilateral move on financing the Canada Health Transfer.
Maude and I found ourselves beside Christy Clark in the middle of a media scrum when she announced optimistically that the first ministers had made some progress finding a common ground. What they did agree on was that the actions of Finance Minister Jim Flaherty in late December were “unprecedented and unacceptable” but it sounds like that was about it — according to Alberta’s Premier Alison.
What the first ministers can’t agree on is how the Canada Health Transfer should be funded. The federal government and Alberta are saying per capita funding post-2017. Alberta, supports this option because of their growing young and high-income-earning population. Alberta doesn’t need to need to worry as much about continuing-care options and looking after people who can’t afford prescription drugs. But for provinces like British Columbia with a high aging population and the province with the most people who are unable — due to cost — to fill their prescription drugs, a per-capita-based funding formula is not going to fund their health care in a way that addresses current and pressing needs.
Now before I work my messaging into the box of right-wing government, let me be very clear about what I mean when I suggest that an aging population needs to be considered in the Canada Health Accord: there does need to be available funding for a reformation of the structure of health care in Canada. When medicare was created, the population was much younger than it is today — hence the two stages to Tommy Douglas’ health-care plan. Concerns about the aging population weren’t front and centre in the health-care debate. Today, there are lots of options for looking after our aging population: community care, home care, long-term care facilities. The reason an aging population costs provinces is because of the way we have structured health care. What the studies suggest is that we should be building more public long-term care homes and investing in home-care professionals. We know that by keeping people out of the hospital — those who don’t need to be there and can have all of their needs met at home — is not only better and more preferable for the patient, but it is much more cost-efficient for health care.
I also need to be clear when I’m talking about the costs associated with an aging population. The seniors are becoming health care’s newest scapegoat and not only is it unfair and shameful, it’s also untrue. Several studies show that Canada’s aging population costs us 0.8 per cent per year — an entirely sustainable amount — not something that’s crippling the system.
But that’s not what you’ll hear the premiers say while they’re arguing for additional health-care financing and looking to have a conversation with the federal government. Other than compensation for a growing population, some premiers are calling for a continuation of equalization funding. This is especially important for poorer provinces like those in the Maritimes. Provinces with a small population still need money for infrastructure and costs associated with the adoption of new technology. Per capita funding is not going to ensure that those provinces with high health-care needs are able to deliver them in the most appropriate way.
Premiers Dalton McGuinty (ON) and Saskatchewan’s Brad Wall are arguing for an “innovation fund” that would allow provinces to implement some of the reforms needed. However, there have been no details on what this innovation looks like. If McGuinty continues with his models of privatization and public-private-partnerships (P3s) the reforms may not save us any money at all and as studies have shown, care delivered by for-profit providers is of lower quality than publicly delivered services. What we need to argue for is science and evidence-based reforms.
The big worry with Harper’s current funding formula is the reduced role the federal government is playing in health care. As Romanow pointed out in an opinion article last week, when the promises first signed the Canada Health Act, they were told they’d have a 50-50 sharing arrangement with the federal government. Since then the federal government’s financial contribution has fallen to 20 per cent and in a recent report, parliamentary budget officer Kevin Page said the new formula proposed by Flaherty will get the federal contribution to as low as 11.9 per cent.
But it’s not just the funding that concerns us. The Harper government should be using the 2014 health accord negotiations as an opportunity to set new national standards on health care to make sure provinces are meeting the needs of Canadians and reinforcing the Canada Health Act which stipulates that Canada must have a portable public health-care system. If the federal government walks away from their obligations to health care under the Act, then Canadians can expect an increasing fragmentation of health care across Canada. We need a federal government who will implement national standards of care and address urgent needs by implementing stand-alone legislation on continuing care, pharmacare, dental care and mental health services. And we need a federal government who will hold discussions and conversations with the provinces instead of unilaterally making decisions and then walking away from the table.