It’s time to renew Canada’s public health-care partnership

By Don Davies, MP 

Published in The Hill Times 

It is now a truism that while COVID-19 caused many problems, it exposed others already there. One of the latter is the dangerous erosion of capacity in our public health-care system which began long before the pandemic struck.

Decades of underfunding and neglect have impeded access to care and undermined our ability to respond to an emergency like COVID-19. This has placed tremendous strain on our health-care system, resulted in millions of delayed surgeries and diagnostic procedures, and pushed frontline workers to the edge of their capacities.

Yet, clear warnings were ignored for years prior to the outbreak of this virus. A review of Canada’s critical care capacity conducted following H1N1 found that intensive care unit resources vary widely across Canadian provinces, and cautioned that during times of crisis this could result in geographic differences in the ability to care for critically ill patients.

Canada has just 1.95 acute care hospital beds per 1,000 people, fourth worst among the 27 OECD countries. The number of hospital beds in Canada is similarly near the OECD bottom, and has dropped dramatically from 6.9 beds per 1,000 in 1976 to 2.5 beds today. As a result, our country’s pre-pandemic acute care bed occupancy rate of 91.6 per cent ranked far higher than the OECD average of 75.7 per cent. The internationally accepted standard for safe hospital capacity is 85 per cent.

Canada ranks 21st of 27 in the per capita number of MRI and CT scanners and 10th out of 10 among similar countries in wait times for surgeries and procedures. While general health outcomes are still fairly good in Canada, that is due more to the skills and talents of Canada’s health-care workforce than to the resources we provide them.

Our health-care fiscal framework is a foundational part of the problem.

When medicare was first established in Canada, the federal government agreed to assume half the costs incurred by provinces and territories. However, at a first ministers meeting in 1976, prime minister Pierre Trudeau put forward a plan to replace the 50-50 cost sharing agreement with a new regime of block grants that exposed the provinces and territories to unilateral federal cuts over the subsequent decades.

Today, the federal share of overall health-care spending in Canada has plummeted from the original 50 per cent to 21.7 per cent. Without immediate action, the federal contribution to provincial and territorial health expenditures is projected to decline even further over the coming years.

When seeking re-election in 2011, Stephen Harper pledged to negotiate a Health Accord with the provinces and territories—but no discussions ensued. Instead, then-finance minister Jim Flaherty simply announced that the Canada Health Transfer escalator effectively would be cut from six per cent to three per cent.

In its 2015 election platform, the Liberal Party pledged to negotiate a new Health Accord with the provinces and territories—but instead adopted the Harper cuts. This decision has deprived our health-care system of an estimated $36-billion over a decade.

The long-term impact of the Harper/Trudeau funding formula is clear. Because health-care costs across the country are rising at an average of five per cent per year, if the federal government is only increasing spending at three per cent, that is a recipe for fiscal imbalance and cuts. In addition, the Conference Board of Canada estimates that the impacts of the COVID-19 pandemic will result in a further $80-billion to $161-billion in health-care expenditures over the next ten years.

Instead of deferring discussions on health transfers to an unspecified date in the future, the federal government should step up now with the long-term funding needed to protect our health-care system. Federal-provincial-territorial negotiations should begin without further delay so that an agreement can be finalized early this year, ahead of federal, provincial and territorial budgets.

And there is a historic consensus. Canada’s premiers are united in calling for the federal government to increase its share of health funding through the Canada Health Transfer to 35 per cent and maintain this share of funding. This is aspirational and will no doubt take time, but an important starting point for negotiations. The proposed “25 per cent by 2025” federal contribution pitch by Canada’s major health-care stakeholders is a realistic and achievable short-term goal. What is clear is the federal government must re-commit itself as a full funding partner to renew Canada’s public health-care system for the 21st century.

Through federal leadership and collaboration, we can ensure the sustainability of our existing public health-care system, while expanding it to provide desperately needed services and treatments such as better long-term care, pharmacare, dental care, and mental health care.

In doing so, we can emerge from the COVID-19 pandemic with a stronger and more equitable public healthcare system for all Canadians.

NDP MP Don Davies represents Vancouver Kingsway, B.C. He was first elected in 2008, and re-elected in 2011, 2015, 2019 and 2021. He serves as the NDP critic for health and deputy critic for global affairs and international development. Prior to that, he served as official opposition critic for international trade, citizenship and immigration and multiculturalism, and public safety and national security.

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