At every meeting of provincial premiers in recent memory, the demand has always been the same: more funding from the federal government for health care.
But the call coming from year’s instalment of the evergreen story of federal-provincial relations, held this week in Victoria, B.C., was more insistent, with health-care systems across the country still reeling from the pandemic.
The provinces are dealing with burnout among front-line health workers, the reduction of hours at urgent care centres and lingering backlogs in diagnostic testing and surgeries, despite a special, one-time $2 billion federal transfer intended to help resolve such issues.
The problem, the premiers and territorial leaders say, is not just the effects of the COVID crisis, but a systemic underfunding of health care they insist gets worse every year as Canada’s population ages and the cost of new therapies rise.
The premiers reduce the complexity of funding shortfalls to a simple number: 22 per cent, that’s the share they calculate the federal government spends towards the costs of health care for every Canadian — a figure that was closer to 50 per cent in the early days of Canada’s publicly-funded health system.
In Victoria, the premiers re-iterated their call for the Trudeau government to bump the number to 35 per cent, an increase that would add an estimated $28 billion in annual spending. They also demanded Trudeau urgently convene a first ministers meeting to hammer out a deal.
The federal government was not represented at the Victoria meetings, but at the end of the first day, Intergovernmental Affairs Minister Dominic LeBlanc shot back from Ottawa, accusing the premiers of pushing a fake number by failing to include tax points Ottawa transferred to the provinces in their calculations on health care.
LeBlanc also raised an on-going irritant to the federal side: provinces spending money after receiving federal help intended for health. LeBlanc referred to the $500 per person rebate cheques sent out by Francois Legault’s Quebec government and the refund of vehicle licence plate fees by Ontario Premier Doug Ford, not long before a provincial election.
How can provinces cry poor on one hand, the thinking goes, and then reduce their own revenues with refunds and rebates?
“What’s not fake is the fact that the Canadian health-care system is in crisis. We see it in every province,” responded Newfoundland and Labrador Premier Andrew Furey, who is also a practicing physician.
“It’s not fake when I have to go in and tell a patient they can’t have surgery, that’s not fake.”
British Columbia Premier John Horgan, the host of this year’s premiers meeting, appeared particularly annoyed by LeBlanc’s remarks. For Horgan, the stress on provincial systems is both political and personal. He often cites his own experience going through treatment for throat cancer, and his province is experiencing a serious shortage of primary care physicians as more than 900,000 residents report being without a family doctor.
“It’s not about coming with our begging bowl and saying ‘Please, sir, give us some more’,” Horgan said, evoking “Oliver Twist.”
Horgan also suggested two key programs the Liberal government is pushing could be held until the issue of health transfers is resolved.
“We’re happy to talk about renewed programs, like pharmacare or new programs like dental care, but we shouldn’t be doing that until we have a firm foundation for our entire program,” he said.
While progress on a national drug program has been slow, the Liberals need to begin implementing dental care as a condition of an agreement with the federal NDP to retain power until 2025. Both programs require negotiations with the provinces to set up.
The two days in Victoria were the first in-person meetings of premiers and territorial leaders since 2019. During the pandemic, they regularly met virtually with the prime minister to co-ordinate their COVID-19 response. But as the premiers return home, there is no plan for a sit-down with Trudeau or his ministers, and no specific commitments to increase transfers.
The cooperative spirit that prevailed during COVID now appears to be fading as the health system still struggles to recover from the greatest crisis it has faced in generations.