Justin Trudeau has finally confirmed that he will meet with the provincial premiers to discuss federal health funding on February 7. A working meeting, he said, with a view to concluding, in a few weeks, a ten-year agreement, before the tabling of the next Freeland budget.
On the side of the Legault government, we are delighted that Ottawa no longer speaks of “conditions”, but rather of “data sharing”. However, it is clear that with data, we can check whether the objectives set are achieved, whether the conditions are met. “What can be measured can be improved”, has already said Christian Dubé.
This is a real breakthrough, it was observed. Just a few weeks ago, the Canadian Prime Minister and his Minister of Health, Jean-Yves Duclos, repeated that the federal government would never agree to increase its share of health funding without the additional sums being linked to conditions and the achievement of results. It would probably be wrong to believe that this determination has vanished as if by magic.
What Justin Trudeau is proposing to his counterparts is a comprehensive agreement that would be accompanied by 13 bilateral agreements signed by as many provinces and territories. These bilateral agreements would be used to meet the specific needs of each of the provinces and each of the territories, which could allocate the amounts according to their priorities, such as front-line care, including home care, the reduction of waiting lists for surgeries and mental health.
The question that arises is whether these bilateral agreements will include specific envelopes for each of the priorities, associated with the achievement of measurable results and corresponding accountability, all reviewed periodically. Clearly, it could be funding with conditions through which the Trudeau government would assume responsibility for controlling health systems and practicing a form of supervisory federalism. There are also many voices, especially in English Canada, who see this as a desirable development. It is true that the Trudeau government is hounded by the New Democratic Party and by a good part of public opinion, which does not care about provincial jurisdictions when it comes to health.
Premier François Legault welcomes these à la carte agreements that would allow Quebec to sign its own “asymmetrical” agreement under which his government would only commit to providing the data it already collects or that he intends to collect once the computer integration of the network has been enhanced. The federal government seems to find inspiration in the collection of health data as it has been done in Quebec since Christian Dubé took over the reins of the Ministry of Health and implemented his “dashboard”.
Of course, everyone agrees on the importance of improving health care in Canada. Before the pandemic, the health networks in the rest of Canada were considered to be much better than the underfunded Quebec network. But reality has somehow caught up with these provinces: respiratory infections in children have caused a crisis in their children’s hospitals, like here, for that matter, and the shortage of nurses and other health professionals is hitting them as well.
In this sense, the major priorities set out by the federal government are shared by all the provinces: remedying the labor shortage, improving primary care, home and long-term care, investing in mental health and in telemedicine. It is also obvious that the Legault government wants to obtain results. Everyone is for virtue.
A stumbling block remains, and not the least: the global sum that Ottawa must put on the table on February 7. It will certainly not be the $28 billion, or a 35% share of health care expenditures compared to 22% at the present time, that the provinces are demanding. But it goes without saying that if the federal government wants to increase its share of health funding, its transfers will have to grow at a higher rate than provincial health spending, a growth that was in the order of 4% to 5 % before the pandemic.
With these bilateral agreements, the illusory common front of the provinces has just evaporated without even being mentioned. We will see how the Trudeau government will shape its conditions and how it intends to use data to exercise its control.