Justin Trudeau’s conditions and the demands of François Legault and his provincial counterparts eventually gave way to compromise. The federal offer is less generous than claimed, but it will only come with little or no accountability. While the political impasse has been resolved, on the ground, overflowing emergency rooms, endless waiting lists and the search for a family doctor by six million Canadians are likely to continue. A missed opportunity, deplores Jane Philpott, former Minister of Health in the Trudeau government.
On both the federal and provincial sides, the lines drawn in the sand over the past two years have suddenly faded in recent weeks.
Justin Trudeau repeated before Christmas that “it would not be the right thing to do to simply invest more money” and “watch the problem go without solving it” by not imposing results obligations on the provinces in exchange for funds for their health systems. The offer of 46.2 billion new money that he made to them on Tuesday did not count, however, so to speak, no conditions.
The provinces refused outright, for their part, to discuss with Ottawa as long as the federal government would not offer them at least 28 billion more as of next year. Finally, they seem resigned to settling for six times less per year, on average, for the next five years.
The provincial premiers will take stock Friday, during a virtual meeting. But already, Ontario Health Minister Sylvia Jones said Wednesday that “there is no doubt that we will accept any new expenditure or any new investment in health”.
The pandemic has changed that. The crises that have afflicted health systems, out of breath for three years, have meant that citizens no longer have the patience to watch their governments persist in wars of numbers for months on end. The budget schedule also certainly forced the hand of the federal government and the provinces, which wanted to close these negotiations before finalizing their financial statements. “These are not winning negotiations, in terms of public image. The population wants to know the outcome of the negotiations, but does not want to spend weeks hearing about the negotiations,” says Maude Laberge, professor of health economics at Laval University.
The offices of the Prime Minister of two provinces confided, this week, that they felt this impatience of their citizens. As well as a “sense of urgency”, recognized one of these sources, and a desire “to settle the file”, explained another.
And for good reason: 86% of Canadians admitted to being worried about the state of their province’s health care system, in a recent Léger poll. The highest proportions were observed in the Atlantic provinces (96%), Quebec (89%) and Ontario (85%). However, it was precisely the premiers of the Maritimes and the Ontarian Doug Ford who quickly underlined that the new investments, even below expectations, were “certainly not negligible”.
A lack of ambition
The post-pandemic context therefore led to “a more conciliatory conversation”, but which did not match the “ambition that would have been necessary” to fill the gaping holes in the system, according to Jane Philpott, who served as minister of Health from 2015 to 2017 and who had overseen the last difficult round of negotiations in this eternally contentious file.
Mme Philpott judges that the offer of his former government lacked “imagination” to rethink funding and relieve health systems. Justin Trudeau should have insisted, for example, on demanding tangible results from the provinces in terms of access to a family doctor or primary care.
Prime Minister Trudeau underlined Tuesday, praising his proposal, that it was precisely “time to rise to the occasion”. “This moment was in front of them, and it makes me sad that it was not seized for the bringing of real in-depth changes”, laments in an interview the DD Philpott, who now heads the Faculty of Health Sciences at Queen’s University.
These are not winning negotiations, in terms of public image. The population wants to know the outcome of the negotiation, but does not want to spend weeks hearing about the negotiations.
The federal envelope will also be insufficient to really relieve health systems. “It’s an amount that may not change much, in fact,” launches Maude Laberge. Justin Trudeau may speak of a “major” investment, “it is a relatively marginal increase”, nuances the professor.
Federal Finance Minister Chrystia Freeland had indicated – even repeated – in recent days that the government should exercise budgetary restraint. “But if you want to show restraint, I would argue that health care is not the place to do it right now,” countered Jane Philpott.
François Legault now seems to be pinning his hopes on a future Conservative government, which Pierre Poilievre would form if elected in the next few years. Mr. Poilievre has indeed pledged to respect the agreements that Justin Trudeau intends to quickly conclude with the provinces. But he didn’t go so far as to promise them more money either.
Mr. Legault and his counterparts already promised on Tuesday to return to the charge to demand for the umpteenth time that the federal government improve its share of health funding. But workers in the sector and their patients watched their leaders on TV worrying that in the meantime nothing would change.