Did we need to see our ministers of health rolling around while our health systems threaten to implode? By inviting himself to a meeting in Vancouver empty-handed, but animated by his “good faith”, the federal Minister of Health, Jean-Yves Duclos, did the opposite of what he had announced. His determination not to get caught up in the business of money will have overcome the spirit of “collaboration” that he had sold to his counterparts in the provinces and territories. They gave him an impeccably united front in return. With zero gain for patients.
“The chicanery is bad,” lamented Minister Duclos at the end of these two days of lost negotiations, which he nevertheless left without asking for his rest. He even allowed himself a swipe at the premiers of the provinces and territories. In his opinion, if the meeting failed, it was because it turned into a “battle of cocks” between the premiers and the federal government. But Mr. Duclos seems to forget that his own leader has not deprived himself of blowing on the embers. Until getting Prime Minister François Legault out of his hinges.
Justin Trudeau took a frontal attack on his anti-inflation shield, proof according to him that the provinces have more financial room for maneuver than they want to admit. The distribution of checks to taxpayers will cost the Quebec treasury $3.5 billion. However, the provinces want the federal government to assume a larger share of health funding than the current 22% (it was 50% originally) and are now aiming for an increase to 35%. For Quebec, that would mean $6 billion more per year.
The calculation of Mr. Trudeau, who cavalierly invited Quebec to review its priorities, is demagogic. The anti-inflation shield is a one-off measure born of an exceptional situation. What is at the heart of the debates here, the Canada Health Transfer (CHT), is recurring and predictable. And no one, not even the federal government, denies that it is somewhat behind, not to say definitely behind. Especially after the ordeal of a pandemic that has had devastating effects on our already ailing health systems, and as the aging of the population accelerates.
Prime Minister Trudeau is right about one thing: for patients, healthcare is less about money “than results”; we all need “a health system that works”. But now, the results (and the means to achieve them) are not its business, they are strictly the business of the provinces, as the Constitution clearly states.
The stubbornness of the federal Liberals in regimenting the TCS by assigning it five priorities (all of which are excellent, by the way) brings out the worst of their centralizing reflexes. The unconditional bonus has already been brandished by the Trudeau government in exchange for better accountability processes and data sharing that all players have graciously agreed to set in motion, including Quebec, which has since multiplied initiatives in this direction.
That Minister Duclos is acting today as if that is no longer enough serves his government’s spirit of quibbling with regard to the division of powers. Above all, this feeds the bureaucracy with a nameless gluttony that wreaks havoc in our ossified health networks. The provinces and territories do not have the luxury of wasting time on a reform that would come on top of their already Herculean projects.
It is to be hoped that the provinces and territories will hold their own. United fronts, as we know, are hard to maintain, even more so with provincial governments with interests as disparate as ours. Divide and conquer is a proven method. The risk that the common front will break up as soon as Mr. Trudeau begins to table his offers is great. If necessary, Quebec knows the song, he who has benefited from asymmetrical agreements in the past. But do we still need to go through these cross roads? Now where we are, it would be time to conclude that patients have too much to lose to bother with such procedural federalism.