The Battle of Healthcare Reform
A classic Canadian showdown is currently occurring between the federal and provincial governments. Both governments are duelling it off to reform healthcare through increased transfers. Unfortunately for Canadians, neither the federal nor provincial governments are budging in their demands. While the provinces have put up a united front demanding the federal government increase their share of healthcare spending from 22% to 35%, the federal government has other priorities.
The federal government is arguing that giving provincial governments more money will only improve Canadians' healthcare outcomes. So the government is only willing to provide money to the provinces if they agree to certain conditions on how they should spend the money. Essentially, the federal government wants "results" from any money they are committing to the provinces for healthcare. The federal government wants to ensure that any money isn't put towards other provincial initiatives like infrastructure projects, giving blank cheques to citizens, housing, or anything that would see the money going out of healthcare.
The provinces contend that any funding they want will come without any conditions. They want money "unconditionally" without any conditions or accountability. Furthermore, the provinces argue that any money sent will be under the preview of local expertise, claiming that they know how to spend money more effectively than the federal government. Therefore no such strings from the feds are required.
At this point, the federal and principal governments are playing the waiting game to determine who will give in to those demands. Will the federal government give in to pressure from healthcare associations and the provinces? Or will the provincial governments be forced to accept the federal government's conditions under their collapsing healthcare systems?
What Does the Federal Government Want?
The Federal Minster of Health, Jean-Yves Duclos, has specifically stated his intention on how he wants to improve healthcare in Canada using his "results" based approach. He outlines 5 key priorities:
1. Reducing backlogs and investing in better conditions for healthcare workers.
2. Improving access to family health services by reducing waiting lists for family doctors.
3. Investing and improving long-term care and home care in an aging population.
4. Providing adequate mental health services and combat substance abuse.
5. Developing a national health data sharing system on health outcomes to monitor healthcare performance.
Health ministers from every province have differing views on the federal government's intentions. According to minister Duclos, the premiers of each province have silenced the provincial health minister's in any intention to negotiate with the federal government's conditions. Minister Duclos also stated that although provinces "were in total agreement… in private… The problem is that the premiers don't want us to speak about those outcomes and those results." It effectively makes healthcare a political issue between politicians rather than negotiations between health experts.
And indeed, the federal government's position is favorable, considering the provinces have jurisdiction over healthcare, and their negligence over decades has caused this collapse. The question is, how long can each side hold out? And are the provinces willing to hold out in the future as the situation worsens?
However, whoever gives in at the end of the day. There will eventually be some healthcare reform in Canada through raw increased funding or conditional funding. Both the federal and provincial governments understand that healthcare needs some reform at the end of the day. It's just a matter of who wins the battle.
What's The Likely Outcome? (Divide and Conquer)
The most likely outcome for any agreement to fall through is that the federal government divides and conquers each province. Rather than negotiate with all provinces at once, the federal government will likely convince each province one by one through focused bilateral agreements with each province, starting with the maritime provinces of Newfoundland, New Brunswick, Prince Edward Island, and Nova Scotia. However, British Columbia may be the wildcard in breaking the provincial united front. Just as BC did with the federal child-care program, BC may be the first to agree on healthcare with the federal government. In addition, the province of Quebec is also open to negotiating for more funds since the province's finances are in a worse position to fund healthcare than other provinces. The rest of the provinces will likely follow through after some of them reach their independent agreements.
In a recent interview with CBC News, The Prime Minister of Canada, Justin Trudeau, hints that he is likely to take this divide-and-conquer approach. Specifically stating that if picking off provinces one by one was the answer to improving healthcare, then he would do it. The Prime Minister consistently uses the term "results" numerous times to precondition any new federal government funding.
The Prime Minister's goal is to get a healthcare deal done with the provinces no matter what. The divide-and-conquer strategy is likely the best method to accomplish his ambitions. Knowing the polls indicate that healthcare is one of the top issues in Canada, along with inflation and the cost of living, the Prime Minister is in a position to fix Canada's healthcare on his terms and take credit for it.
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