Most of the Canadian political class will acknowledge, at least in private, that the current one-tier health-care status quo cannot be sustained indefinitely. So long as health-care spending continues to grow faster than the combined rate of inflation and population growth, it will consume more and more of the budgetary pie. In fact, some statistical models suggest that in coming generations, as our population ages, health care will eat up virtually the entirety of some provincial budgets.
What is the solution to the problem? There are two real schools of thought.
The first is that we need to implement innovative, imaginative and tough-minded modifications to the way that one-tier service is delivered — for instance, through the creation of team-based health providers that can identify and prevent diseases before they require expensive interventions by surgeons and other specialists.
The second, even better, approach (which already is creating facts on the ground through the spread of private clinics in Montreal, Toronto and elsewhere) would be to move Canada to a European-style blended structure that combines private-insurance options for core health needs (which are nominally banned under the Canada Health Act) with the current universal-coverage system.
Then there is a third school of thought — which dictates that the current unsustainable system should be propped up indefinitely at Ottawa’s expense. But this isn’t really an economically legitimate option. It’s more accurately regarded as a populist pass-the-buck inter-provincial Ponzi scheme. Its only real benefit is to politicians: It allows premiers to avoid any real policy change, while shifting blame for any future problems to the Ottawa bogeyman.
And who knows more about that kind of posturing than premiers from the Atlantic provinces? This week, the leaders of Newfoundland and Labrador, Nova Scotia, New Brunswick and Prince Edward Island met in St. John’s to prepare for forthcoming talks with Ottawa over future funding formulas. Their bizarre conclusion: The unsustainable status quo must not only be maintained, but enhanced.
The answer to the health-care crunch, they agree, is for Ottawa to give them more money. Not just the annual 6% increases already approved to 2014. That’s not nearly enough. They want to keep that, of course, as well as additional funding for province-specific priorities. Further, they want the federal government to commit to a flat 25% contribution: However much the provinces spend, Ottawa should kick in a quarter.
“People hear about a 6% escalator and they assume that the provinces are continuing to get more money,” Nova Scotia Premier Darrell Dexter complained, before elaborating that annual rates of increase in provincial health-care spending often exceed the annual funding boost from Ottawa.
Of course, that is precisely the problem. Until the provinces can manage their health-care spending within existing means, why would the federal government agree to an open-ended commitment to pay ever more?
Not that Ottawa doesn’t have a role to play in health reform. But that role should be played through legislative initiatives, not writing bigger and bigger cheques. In particular, the Harper government should make it clear that it will not be enforcing the universality requirement in the Canada Health Act in such a way as to preclude “two-tier” health reforms.
Ultimately, Canada’s health system will be saved not through bigger and bigger federal subsidies, but by giving Canadians the same private health options enjoyed by citizens of every other developed nation on Earth.