Canada’s health care system is complex, costly and it is an evolving creature. Health is important for individuals and the health of a nation’s population is equally important. The two go hand in hand. The development and evolution of a national system was slow and bumpy. There are benchmarks, a key one the 1984 Canada Health Act. It sets out appealing criteria: universality, accessibility, portability, comprehensiveness, and public administration. Federal cost sharing, however, decreased significantly over the last few decades, as has national leadership in health care.
Currently the primary federal contribution reaches the provinces via the Canada Health Transfer (CHT) and comes in block funding in the form of tax points and cash transfers. The First Ministers in 2004 signed a 10-Year Plan to Strengthen Health Care (better known as the Health Accord) in response to the aftermath of the drastic cuts of the 1990s. Increases were made by the federal government in the base adjustment, topped by an annual six percent escalator. The Harper government respected the agreement in terms of cost sharing, but has made no attempt during its tenure in office to incorporate Home Care, Pharmacare, or Long Term Care under the CHT.
In 2011, the late Jim Flaherty, Minister of Finance, announced that the CHT would continue to grow at six percent annually until 2016-17. But beginning in 2017-18 the CHT will grow in line with a three-year moving average of nominal gross domestic product (GDP) growth, with funding guaranteed to increase by at least three percent per year. Unless the ground rules change the CHT won’t be reviewed until 2024. The change in the funding formula was not negotiated with the First Ministers and subsequently the federal government did not renew the Health Accord and let it expire earlier in 2015. The federal Parliamentary Budget Officer (PBO) projected in his 2013 Fiscal Sustainability report the impact of the new arrangement from 2012 until 2087. He advised that the CHT as a percentage of provincial-territorial and municipal spending will decline to 12 percent during the last 25 years of the period noted (the CHT contributed 20.4 percent of all medicare costs in 2010-11). Dr. Chris Simpson and Owen Adams opined that it will be just a question of time before the provinces and territories challenge the federal government’s moral authority to enforce the Canada Health Act when their contribution to the funding of medicare is eroding quickly. Provincial and territorial governments will find it increasingly difficult to provide quality health care when facing an aging population.
The Canadian Health Coalition interprets Harper’s plan as an intention to eliminate national health care. The CHC points to Harper replacing the equalization portion of the Canada Health Transfer (CHT) with an equal per capita transfer. Alberta gained in the short term because of its unique growth in population to date; other provinces already face demographic challenges and find it difficult to provide quality health care. The CHC forecasts a cut of billions of dollars in federal funding into the future with an eventual reduction to less than 12% in years. The CHC also forecasts an accompanying withdrawal of federal enforcement of national standards contained in the Canada Health Act. Enforcement of standards is a concern at present, for example, in cases of double billing.
There are two primary issues that warrant attention in relation to health care: funding and ideology. The party in power has demonstrated indifference at best and at worst opposition to “all” Canadians having access to timely, necessary and affordable health care services. Instead of strengthening the system the Conservatives download on the provinces with resulting increased privatization of essential services. The thrust towards a federal minimalist position on health care is unacceptable. The question remains. Which party will step up to the plate to provide national leadership and save our health care system?
Baldwin Reichwein is a retired social worker with a career background in social and health programs.