This is the non-news of the summer: meeting within the framework of the Council of the Federation, the provincial premiers once again demanded that Ottawa increase the Canada Health Transfer (CHT) from 22 % to 35% the federal contribution to the costs of health systems, i.e. a sum of 28 billion. “Without conditions”, repeated in chorus François Legault and his new friend, the premier of Ontario, Doug Ford.
Playing his role well as Premier of a province like the others, François Legault only pursued a modest objective, which he believes he has achieved: that at the end of the meeting, no province will question this requirement. , at least not before Justin Trudeau meets with his counterparts to discuss this issue. But in Quebec, there are hardly any illusions for the future. We know that some provinces will not be choosy and will agree to be accountable in exchange for cold hard cash. This is what happened in 2017 when the Trudeau government shattered the illusory common front and negotiated with the provinces one after the other, starting with the smallest, the most vulnerable.
As the meeting of the Council of the Federation began on Monday, the federal Minister of Health, Jean-Yves Duclos, not without a certain nerve, made public the calculations of his officials on the federal share in the financing of health. . It was 44.7% in 2020-2021 and 39.8% in 2021-2022, sudden increases that include the billions granted to the provinces to deal with the pandemic. The minister went back to Methuselah, which is 1979, to say that in the end, even before the pandemic, Ottawa had contributed 37.8% of the funding, taking into account the points of tax that had been devolved to the provinces at the time. As far as going back in time, one can argue that there was a time when the federal government assumed 50% of the costs of public health care systems in Canada.
The question is not there and these calculations are futile. The fact is that the provinces face health care expenditures that are increasing faster than their incomes, a trend that is not about to be reversed, given the aging of the population and the rising cost of advanced treatments and new drugs. In 20 years, the Quebec government has doubled its health expenditures, and their share of the overall state budget has continued to grow, rising from 39% to 45% of program expenditures. For all the provinces, year after year, health costs increase by 5% to 6% annually. And that’s where the shoe pinches: the federal government has capped the increase in the TCS at 3% per year, a ceiling from which it can however derogate arbitrarily.
According to a Conference Board study, provincial deficits are set to climb over the next few years due to rising health care costs, while federal public finances are heading towards surpluses. It’s a bit like the return of the fiscal imbalance of the 2000s.
Ottawa simply cannot ignore this financial reality. But Justin Trudeau says it’s not just a matter of “pitching” money to the provinces, implying that he intends to insist on setting conditions and dictating priorities. The pandemic has revealed major shortcomings in health systems, particularly in Quebec, and the population is well aware of this. It is to be feared that the Trudeau government will take advantage of the opportunity to extend a federalism of supervision that pays little heed to the jurisdictions and prerogatives of the provinces. In a speech at the end of March, Minister Duclos presented the five priorities that the provinces in health should adopt, namely delays in surgical procedures, treatments and diagnoses, access to the first line, long-term care and home care, mental health as well as virtual care and computerization of data.
Nothing to say about these priorities, which cannot be said to shine by their novelty. However, beyond platitudes and apple pie, it is a serious reform of the health system that we must tackle in Quebec. We do not see what the federal government and its civil servants, who are already struggling to manage even simpler things, such as the issuance of passports and visas, airports, the granting of permanent residence to newcomers and the payroll service for federal employees, could teach the Quebec government about health management and what their expertise is in this area. Because this federalism of supervision can turn out to be a federalism of dilettantes, vain and bothersome.