Could Canadians lose universal access to health services over the next decade? That’s what the Canadian Health Coalition fears if the Trudeau government doesn’t honour an election promise to negotiate a National Health Accord with the provinces and territories.
Adrienne Silnicki, coordinator of the national coalition, which includes the Nova Scotia Health Coalition, says its members “are deeply concerned about the future of Canada’s universal, single-tier public health care system.”
Since December, Ottawa has negotiated and announced a total of eight individual agreements with five provinces, including Nova Scotia, and the three territories.
In response, the Canadian Health Coalition joined the Nova Scotia Health Coalition and five other provincial groups to warn these bilateral deals will not provide enough money to sustain Medicare and will force provinces to raise provincial taxes, cut services, and increase privatization.
“The process violates an election promise to work collaboratively with the provinces to come up with a new Health Accord,” said Natalie Mehra, executive director of the Ontario Health Coalition. “We are sorely disappointed the federal government has not only abandoned a Health Accord but abandoned negotiations at this point.”
Under the previous funding formula, federal transfers to the provinces for health care increased by four to six per cent per year for the past decade. Nova Scotia Premier Stephen McNeil has indicated the new 10-year deal will see annual increases in the three to four per cent range here.
In addition, Nova Scotia will receive approximately $28.8 million annually in targeted funding for homecare and mental health. That’s welcome, but “a drop in the bucket on an annual budget of $4.5 billion,” says Chris Parsons, executive-director of the NS Health Coalition.
The actual text and details of each bilateral agreement remain secret until larger provinces such as Ontario, Quebec, and Alberta finalize their side deals with Ottawa. What has been reported publicly by the provinces is the percentage increase for health care transfers which they expect to receive over the next decade.
The Institute for Fiscal Studies and Democracy at the University of Ottawa is headed by Kevin Page, the former Parliamentary Budget Officer who became a thorn in the side of successive Harper governments by submitting Ottawa’s fiscal plans to rigourous scrutiny. Earlier this week, the Institute released its analysis of the Health Transfer numbers, and that analysis worries members of the Canada Health Coalition.
“The Institute reported a 3.7 per cent funding increase on average over 10 years, and that includes the money for mental health… it’s based on Trudeau’s final ‘take it or leave it’ offer from December 2016,” said Natalie Mehra, executive director of the Ontario Health Coalition. “That’s the escalator funding for Canada as a whole. But there is a broad consensus that the actual need is 5.2 per cent. That’s what the provinces and territories agreed upon based on projected ageing, utilization increases, and inflation costs. That number is supported by the Conference Board of Canada and the Financial Accountability Office of Ontario. That’s billions of dollars a year away from what Ottawa offered in December — far too little to meet the need.”
The difference between the Provinces’ initial ask of 5.2 per cent and the 3.5 per cent Nova Scotia accepted works out to about $604 million for 2018-19, according to Chris Parsons’ calculations. Over the next decade, that figure will change, but it provides a glimpse of the magnitude of the problem.
So why did Nova Scotia accept the terms on offer from the federal government last December?
In an email statement from the Nova Scotia Finance Department to the Halifax Examiner, Marla MacInnis wrote, “We believe this was the best deal we could get from the federal government and it helps to address our priorities in home care and mental health care. The agreement also includes a clause that ensures if any other province or territory reaches an agreement with the federal government that contains better financial terms, Nova Scotia will get those terms.”
Health Coalition members refer to that as the “Me, Too” clause. It appears reassuring, but citizens don’t know the terms of each of Ottawa’s deals with the various provinces. And they may never know. Health advocacy groups worry that this lack of transparency will contribute to the short-changing of Canadians in public funding for adequate health care.
“There was an opportunity to join…with other provinces and be tough negotiators,” says Chris Parsons of the Nova Scotia Health Coalition. “But instead of taking a leadership role, our provincial government was one of the first to take a side deal that was bad — not just for Nova Scotia but for the country as a whole. (It accepted) a massive cut when we need additional funds to provide rural doctors and fix a crumbling hospital [the Victoria General in Halifax].”
Parsons still holds on to a faint hope, though, stating, “Since these deals aren’t signed off yet, we think there is an opportunity for the provinces to step back, form a united front, and force the federal government back to the table. Asking for real leadership from our federal and provincial leaders isn’t too much when you consider the burden of cuts in health care fall on the backs of patients, their families, and the people who work in the system.”