The federal and provincial governments appear deadlocked in their negotiations on the future of health care in Canada, and Prime Minister Justin Trudeau’s latest comments suggests he will not be the one to blink first.
In a year-end interview with The Canadian Press Monday, Trudeau said he’s not willing to kick health-care reform down the road any further, even as provincial premiers clamour for more federal funds to bolster their ailing health systems.
“It wouldn’t be the right thing to do to just throw more money at the problem and sit back and watch the problem not get fixed because we didn’t use this moment to say, ‘No, no, no, it’s time to improve the system,’” Trudeau said.
The stalemate is happening while children’s hospitals across the country are inundated with kids suffering from respiratory diseases. In some cases hospitals have been overwhelmed by the calamitous combination of record numbers of sick patients and critically low numbers of staff to treat them.
The problem goes back more than a year, when provinces first demanded a sit-down with the prime minister to talk about long-term and sustainable funding increases after pandemic strain left them with large backlogs and a burnt-out workforce.
They want to see Ottawa cover 35 per cent of health-care costs across the country, up from the current 22 per cent, by increasing the Canada Health Transfer.
Trudeau told them those discussions should wait until after the pandemic, but dedicated $2 billion in one-time funding to tide them over during the Omicron wave.
Now the prime minister says the system needs reform, and he’s not going to give up the money unless the provinces commit to change.
“Canadians are right to look at all orders of government and say, ‘This is terrible, you guys really need to solve this,’” Trudeau said.
Health Minister Jean-Yves Duclos made an overture to the provinces last month, offering an increase to the federal health transfer in exchange for improved data sharing across the country.
The meeting ended without progress.
Imposing performance measures on the Canada Health Transfer to provinces is more or less unheard of, said Haizhen Mou, a professor at the University of Saskatchewan who studies health policy.
It’s understandable that provincial leaders don’t want to change that precedent, she said in an interview Tuesday.
“I don’t think the federal government has the right to impose such performance indicators on the broad kind of health transfer,” she said, but added that she understands why the Liberals don’t want to continue to put money toward a system that’s not working.
A more politically palatable situation might be to offer targeted funds for specific priorities and sign individual agreements with each province, she said, rather than treating with them as a group.
That’s what the Paul Martin government did in 2005 to address wait times, and what Trudeau did in 2016 to fund mental health and homecare services in the face of similar circumstances.
In 2016 the provinces were united as they pushed for an unconditional increase to the health transfer, “but in the end they broke apart, the alliance broke,” Mou said.
The government signed a bilateral agreement with New Brunswick and other provinces followed suit. Mou thinks its only a matter of time before that happens again.
“I’m not sure how long they can hold out because the revenue, the power of the fiscal capacity, is still in the federal government’s hands,” she said.
Health-care advocates, including nurses and doctors’ associations, have echoed Trudeau’s call for a plan to transform Canada’s broken system and to do it quickly.
“Patient care is suffering while health-care working conditions for nurses and other health workers deteriorates,” said Canadian Federation of Nurses Unions president Linda Silas, after talks between health ministers ended last month.
“It is absolutely critical that we put aside politicking and get down to productive discussions around concrete solutions to the health-care staffing crisis.”
Trudeau was asked Monday how he plans to kick-start the negotiations if he won’t sit down with premiers, but he appears to feel it’s up to provincial and territorial leaders to take the next step.
“We’re absolutely willing to invest much more in health care, but there has to be clear commitments and results that are going to change things for Canadians,” he said.
—Laura Osman, The Canadian Press