The song is well known, and the premiers of the provinces and territories have come together to sing it together once again. Ottawa must repeatedly and unconditionally increase federal health transfers from 22% to 35% of costs, they claim.
“We’ve been short of money across the country for a very, very long time because we can’t count on a stable partner,” British Columbia Premier John Horgan, who presides, said Monday at a press briefing. the first Council of the Federation to be held in person since 2019.
His Quebec counterpart, François Legault, who also spoke, said this “unanimous priority” was “necessary [et] within reason “. “It is important to have these 28 billion recurring, because the priority is to hire nurses, staff, and that, we cannot do it with the non-recurring money that we have received. from the federal government,” added Mr. Legault.
Rather, Ottawa considers that it is already doing its part considering the value of the tax points ceded to the provinces some forty years ago, when part of the federal transfer was replaced. According to calculations prepared by its officials – and revealed on Sunday by The Canadian Press – the federal government estimates that it has contributed in some way to 37.8% of public health spending in 2019-2020, to 44.7% in 2020-2021 and 39.8% in 2021-2022.
This data made Prime Minister Horgan jump. “When Canadians hear us having an accounting debate… […] God, people expect us to sit down and sort out how they’re going to get their hip replacement when they need it,” he said.
In turn, Mr. Legault held up his title of “chartered accountant, CPA” and pointed out that “despite the transfer of tax points, in Quebec, for example, 40% of taxes go to Ottawa, 60 % in Quebec, then there well, they pay only 22% of health expenses”.
This is without taking into account that the growth in health care spending is 5% to 6% per year, he argued, so much so that, according to data from the Quebec Ministry of Finance transmitted by his cabinet, the share of the federal government in health has fallen, including the transfer of tax points, from 43.3% to 33.4% in 40 years.
Conditional priorities?
The office of the federal Minister of Health, Jean-Yves Duclos, has made it known that Canadians do not want a “sterile tax debate”, but rather “care”. He notes in passing that Ottawa has invested more than $72 billion in the fight against the COVID-19 pandemic.
The Trudeau government says it wants to discuss targeted investments for the future. Minister Duclos had also presented a series of five “priorities” during a speech at the end of March, stubbornly refusing to qualify them as “conditions”, a toxic word in the face of provinces that jealously defend their areas of jurisdiction.
Those priorities that seem to have consensus are delays in treatment, diagnosis and surgery and healthcare workers; access to primary care; long-term care and home care; mental health and addiction; as well as health data and virtual care.
“It makes me think of the siren song that wants to deflect the boat towards the magic island by saying: “We are waiting for you with what you want”, illustrated the Quebec Minister of Intergovernmental Affairs, Sonia LeBel, in an interview. While she recognizes that these are current issues, these may change. Out of the question “to be trapped in a kind of path where we will say: ‘Come this way, come this way, these are the priorities of the hour.’ »
“It’s the responsibility of the provinces, and each province has different issues, different health priorities, and it’s up to us to take care of them. The federal government’s responsibility is to be an adequate financial partner. “And by the way, “these are conditions”, supports Mme LeBel.
Settle it once and for all
In a study published last year, the Center for Productivity and Prosperity of HEC Montréal concluded that the solution to this eternal federal-provincial bickering was the outright abolition of health transfers — and that, in return, the federal government gives up the tax points needed to fund health care.
“These transfers were born because the federal government did not retrocede the tax points that it took to finance the war effort in the early 1940s”, explains in an interview one of the authors, Jonathan Deslauriers.
According to him, the question will never be resolved as long as Ottawa makes transfers to the provinces, since they will continue to be subject to the goodwill of the federal government. “There is nothing that guarantees them that, in 10 years, the government will agree to maintain these transfers and will continue to improve them,” added Mr. Deslauriers.
In Ottawa, however, it is felt that this is not a realistic scenario because the federal government has obligations under the Canada Health Act with respect to universality, accessibility, funding and administration. care.
The Summer Premiers Meeting will continue for a second and final day on Tuesday. The theme of the rising cost of living and economic recovery is also on the agenda.