Talks are about to begin on drawing up a new national health accord. By all accounts, we鈥檙e in for a slugfest. The current accord, which expires this year, was introduced by prime minister Paul Martin in 2004. Over its lifetime, it delivered $345 billion in federal transfers to the provinces.
In annual terms, that means Ottawa pays for about 25 per cent of public-sector health costs. The provinces are responsible for the remainder.
The original deal was a win for both sides. The provinces gained multi-year funding stability. And Ottawa extracted a commitment.
The premiers agreed, in exchange for the money, to improve wait times in five priority areas 鈥� coronary-artery bypass surgery, hip and knee replacements (counted separately), radiation therapy for cancer and cataract surgery.
So why are the two levels of government at daggers drawn this time around? First, although the provinces did reduce wait times initially, the trend has largely stalled in recent years, and in some cases reversed.
Between 2011 and 2015, there was no significant improvement in radiation therapy and knee replacement. Wait times for hip replacement and cataract surgery grew longer, and the provinces never did agree on appropriate wait times for coronary-bypass surgery.
Equally concerning, wait times are defined here as the interval between seeing a specialist and receiving treatment. But that doesn鈥檛 count the growing delay most patients face before they meet a specialist. Ottawa isn鈥檛 impressed.
Second, there are indications the federal government wants to strike out on its own. Prime Minister Justin Trudeau鈥檚 health minister, Jane Philpott, has said she鈥檚 鈥渘ot convinced鈥� that putting more cash into the accord is the right way to go.
She believes federal funds should be used instead to boost home care, mental-health services and palliative care.
And that has infuriated the premiers. Constitutionally speaking, they are responsible for health-care delivery. Yet here we have a federal minister suggesting she wants to steer the ship.
The provinces have already signalled this means war. Quebec Premier Philippe Couillard and sa国际传媒 Health Minister Terry Lake, will lead a spirited defence against further intrusions into provincial jurisdiction.
And they have a case to make. When universal health care was first introduced in Parliament, the provinces feared that any such commitment would ruin them. The federal government met that concern by pledging to fund half the costs.
But that isn鈥檛 what happened. Today, Ottawa pays only a quarter of the bill, and that bill is rapidly rising.
In 1975, health expenditures, countrywide, were less than $50 billion. Today, they鈥檝e reached $230 billion, and these are constant dollars, adjusted for inflation.
The result is that, as federal cost-sharing declines, the provinces are struggling to make up the shortfall.
In 2013, more than 12,000 jobs in health care and social assistance were eliminated in sa国际传媒 That is one symptom of the emerging crisis. There are many more: Too few GPs, unacceptable wait times to see a specialist, crowded hospital emergency departments.
If Philpott chooses to redirect the remaining federal cash to new priorities that will create additional strains on the system, fur will fly.
The minister鈥檚 desire to steer funding into neglected areas of care is admirable. But first, she needs to get the ship off the rocks. Adding more ballast to a foundering vessel is no solution.
Certainly Philpott is in a stronger position than Paul Martin, whose minority government hung by a thread when the first accord was negotiated.
But the need for federal assistance is growing clearer, and more urgent. Our health-care program was a uniquely Canadian creation. The government of sa国际传媒 has an obligation to step up and save it.
