PM and premiers haggle over billions — but the future of health care needs more than money

Tuesday’s first ministers assembly on well being care resulted in a disagreement over cash. Due to course it did.

“One of many issues we did see at present was that there wasn’t rather a lot in the way in which of recent funding,” Manitoba Premier Heather Stephanson mentioned when the premiers emerged from their assembly with the prime minister.

An hour later, Justin Trudeau appeared earlier than reporters and described what his authorities was providing as “a significant federal funding in well being care.”

The premiers had been demanding that Trudeau’s authorities instantly improve annual transfers to the provinces by $28 billion — an infinite sum that nearly actually would require the federal authorities to both increase taxes or make important cuts to spending in different areas.

WATCH | ‘That is the supply’: PM discusses health-care pitch to premiers

The federal supply is way lower than that. However the provinces couldn’t fairly have imagined they might get what they requested for.

And the query of which stage of presidency covers what share of the price of public well being care is probably not a very powerful challenge going through well being care in Canada proper now. (Not that figuring out that may ever maintain prime ministers and premiers from haggling when issues get powerful — as issues clearly at the moment are.)

“Everyone knows that cash alone will not be the reply,” Trudeau mentioned Tuesday.

Granted, that’s precisely the form of factor a main minister may say when he’s solely ready to supply a lot. However he’s not mistaken.

WATCH | ‘We’re somewhat upset,’ says Manitoba premier

Trudeau picks up the place Martin and Harper left off

When Paul Martin got down to “repair” well being look after a “era” in 2004, he convened a primary ministers convention to strike a grand cut price. After three days of tense and dramatic negotiation, Martin had a much-ballyhooed accord. 

Seven years later, as the top of Martin’s deal approached, Stephen Harper dispatched his finance minister, Jim Flaherty, to shock the provinces with an announcement that federal transfers for well being care would quickly cease growing on the price agreed to by Martin. The premiers didn’t have to love it, however there could be no negotiation.

Trudeau’s method splits the distinction between Harper and Martin. The premiers demanded a gathering, so Trudeau gave them two hours. However he used that point solely to put out his phrases. For every province, there’ll now be bilateral negotiations between well being and finance ministers geared toward filling within the particulars.

By way of {dollars} and cents, Trudeau’s supply really exceeded Martin’s “repair.” Martin’s accord amounted to $41 billion over ten years. Trudeau is providing $46 billion in new cash over the following ten years.

Flaherty lowered the annual “escalator” for the Canada Well being Switch to a few per cent. Trudeau is providing to boost it to 5 per cent for the following 5 years. That might quantity to a further $17 billion for provincial governments. One other $25 billion is being put aside for separate offers with every province, geared toward directing funds towards a set of particular priorities, together with main care, psychological well being and hiring extra medical doctors and nurses.

However the sad noises coming from the premiers on Tuesday, Trudeau’s hand is strengthened by the absence of an alternate proposal on the federal stage.

Pierre Poilievre’s Conservatives have had virtually nothing to say about these negotiations with the provinces. Over the past federal election, the Conservative Celebration was ready to supply an unconditional $60 billion enhance to federal transfers over the following 10 years. However the Conservatives don’t appear focused on repeating that dedication now.

In response to latest developments in Ontario, Jagmeet Singn’s NDP has raised issues about the usage of privately owned clinics inside the public system. The Trudeau authorities has been keen to interject when provinces enable non-public cost for essential providers – as within the case of Saskatchewan – however non-public supply will not be a brand new phenomenon and isn’t in clear contravention of the Canada Well being Act. 

Transferring past {dollars} and cents

When Martin struck his deal in 2004, the federal authorities additionally created the Well being Council of Canada, a panel of specialists charged with monitoring efficiency and innovation throughout the health-care system. The Harper authorities ultimately minimize funding for the council in 2013. However in one in every of its last reviews, the council famous that whereas more cash had been invested over the earlier decade, tangible enhancements had been few.

“Though the sources to enhance our well being system and the well being of Canadians had been made obtainable, the success of the well being accords in stimulating well being system reform was restricted,” the council reported.

Trudeau will not be proposing to revive the well being council. However the federal phrases embody new requests for information and knowledge from the provinces and a dedication to producing annual reviews on progress and “frequent indicators” — similar to the share of Canadians who’ve entry to main care, wait occasions for psychological well being providers and the variety of new physicians, nurses and nurse practitioners.

“What will get measured will get completed,” Trudeau mentioned on Tuesday, maybe hopefully.

Making good use of that information would require actual and sustained follow-through — and information shouldn’t cease flowing with a change of presidency. (The Trudeau authorities’s personal “mandate tracker” is little greater than a distant reminiscence.) But it surely shouldn’t price a lot to do. And if something goes to drive change, it’s going to be efforts to carry the system accountable to Canadians’ calls for for higher.

There can be some days or perhaps weeks now of arguing over these billions. However it will be a mistake to think about {that a} struggle over huge numbers is the one factor that issues right here.