opinionA well being deal is shut, and what follows issues moreCampbell ClarkJanuary 25, 2023

The excellent news is that the feds and the provinces are getting near a deal on funding well being care, and the most important motive that’s excellent news is that there will likely be fewer excuses for the failures.

Prime Minister Justin Trudeau has convened a gathering on well being care with the premiers for Feb. 7, and it was at all times clear he wouldn’t try this till the feds thought a deal was inside attain.

If the premiers and the PM make a deal, it doesn’t simply imply that the feds will switch billions extra to fund well being care. It implies that Canadians could have a chance to maneuver past the funding squabble and demand their governments take care of the actual query – what are you going to do about well being care?

And that’s the essential half.

The historical past of federal-provincial well being care agreements reveals that they have an inclination to enhance issues somewhat bit for a short time, however don’t really spark the large, lasting transformations that had been marketed.

When Mr. Trudeau mentioned on Wednesday that Canadians need the well being care talks to be about greater than funding, you possibly can wager he has seen polls that inform him that’s what the general public thinks: Canadians need higher care, not simply extra {dollars}, and need enchancment that lasts.

The premiers know that’s the public’s temper, too. For a very long time, they insisted Ottawa ought to simply give them $28-billion-a-year extra, no strings connected, and rebuffed federal calls for for the provinces to conform to offering new information and indicators on well being care outcomes. However the premiers modified their tune. New Brunswick Premier Blaine Higgs instructed the CBC that was as a result of public opinion demanded it.

The deal gained’t be near the $28-billion per 12 months, however Ottawa is proposing giant sums. The Ontario authorities appears to suppose it might come away with an extra $70-billion over 10 years; extrapolating that sum to all the nation would add as much as one thing like $150-billion in extra funding over a decade.

The feds will insist on paying out a giant chunk of it by particular bilateral agreements struck with particular person provinces for issues similar to psychological well being or long-term care. They need to have the ability to inform voters they improved particular kinds of care, reasonably than how a lot they spent.

However the so-called circumstances the feds will put within the settlement gained’t actually be circumstances, as a result of Ottawa gained’t threaten to chop off well being care funding. The provinces will likely be requested to specific their intention to repair sure issues, or meet sure targets, and the feds will ask them to conform to reporting on a typical set of indicators.

The essential query – the one most Canadians care about – is what occurs after that. And for a way lengthy.

The primary profit must be that the squabbling over who pays what will likely be over. Hopefully that can put extra stress, not much less, on provincial governments to ship outcomes. However Canadians need lasting enhancements.

Traditionally, a structural improve in federal well being transfers leaders to provinces rising spending on well being care within the brief time period, mentioned Livio Di Matteo, a Lakehead College economics professor.

“Then the query is whether or not it helps to handle structural points over the long-term,” he mentioned. “Historical past reveals it doesn’t.”

In 2004, prime minister Paul Martin convened a primary ministers’ summit on well being care, following on a public fee headed by former Saskatchewan Premier Roy Romanow, who argued that Ottawa ought to pump cash into the well being care system to purchase transformative change. The settlement that adopted, with main will increase in federal switch funds, was touted as fixing well being look after a technology.

Provinces did enhance their spending after that accord by a median of roughly 4 per cent per capita after inflation, Prof. Di Matteo mentioned, however when the recession hit in 2009, that determine dropped to round zero. Within the meantime, there had been structural enhancements, however not likely transformative change.

The prices of repeating that might be a lot larger now.

So it’s a superb factor that the feds lastly seem able to pony up some secure long-term funding. And will probably be an essential advance if the settlement contains results in helpful indicators that assist the general public decide progress.

However let’s hope that it focuses stress on governments to enhance care, reasonably than relieving it. What issues is what follows the cash.