“This is the number one issue for every Canadian province. This is our single biggest line item, delivering health care to our citizens.”
That’s from Nova Scotia Premier Stephen McNeil, who has been one of the most outspoken critics of the federal decision to offer only a three per cent annual increase for the 2017-18 health care transfer, rather than the six per cent the provinces have received since 2004. That’s a difference of about a billion dollars a year nationally.
Last week, federal Health Minister Jane Philpott and her provincial counterparts met to continue negotiations. Not that there is much to “negotiate.” The dynamic is as even as that between Oliver Twist asking for more gruel and the workhouse cook guarding the slop pot.
Provincial complaints that their health care bowl is empty would be more convincing if premiers had not come to rely on the six per cent lagniappe to underwrite general budgets — why one of Philpott’s conditions for more funding is an assurance the money will be spent on health.
Her other condition is that provinces reform their health-care systems to make existing and any new spending go further. Philpott cited a 2014 study by the non-partisan Commonwealth Fund, which ranked Canada tenth out of eleven national systems. On waiting times, Canada placed dead last.
Unfortunately, the real lesson of this report is one Philpott doesn’t seem willing to learn. Every country ranked above Canada integrates private care and private insurance into delivery of universal health care. Canada is the stubborn anomaly, and Canadians are paying the price while being consigned to suffer months or years on waiting lists for necessary surgeries.
Much of the solution is within provincial control, but Philpott is not making it easy. In Vancouver, four patient plaintiffs and a private clinic are now in court challenging provincial restrictions on access to private care. Their central claim is that, if a province does provide timely medical treatment to all residents, and no one is seriously arguing they do, it violates the charter rights of suffering patients to legally prevent them from taking control of their own care and arranging private treatment.
Although the case is directed at provincial restrictions and does not implicate the federal Canada Health Act, Philpott and the federal government have intervened against the patient plaintiffs. The effect is to chill healthcare innovation and make it less likely provinces will undertake reforms that have made European systems more efficient than ours.
About eight million Canadians have disability insurance provided through work, but statutes in most provinces prevent them from accessing that coverage for injuries that do not occur on the job. Most provinces also prevent doctors who work in the public sector from moonlighting in private clinics, either outright or through limits on fees they can charge.
Lifting these prohibitions would allow Canadians to spend more of their own money on their own care, if they wanted to, without taking a penny from the public system. It would free up billions of dollars more in new health funds than what provinces are asking for, all from private, voluntary sources. It would introduce healthy competition into the overall system to encourage reform.
A new source of health funds that spurs innovation and does not require raising taxes? It sounds too good to be true. It isn’t. Provinces only have to take the federal call for health care reform seriously. Ottawa should to get out of the way and let them.
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