Health transfers | What is Ottawa getting involved in?

Do you know what year it’s been since Ottawa managed a hospital?

Answer: 2016. It was the veterans’ hospital in Sainte-Anne-de-Bellevue, west of Montreal, the very last establishment in the country under the leadership of Ottawa, which began to cede its hospitals to the provinces since the 1960s, with the establishment of the health insurance system.

Suffice to say that the federal government has no expertise in the management of health establishments. However, Ottawa persists in wanting to tell the provinces what to do and imposing its conditions on them before transferring to them the money revealed with great fanfare last year.

On February 7, 2023, the Trudeau government announced an increase of $46 billion over 10 years in health transfers. The provinces, which demanded six times more, were presented with a fait accompli. But time was running out. They wanted to integrate this windfall into their spring budgets, which they did.

Quebec’s share rises to 4.7 billion within five years.

Except that 11 months later, the money is still in Ottawa’s bank account. Oops ! Quebec has budgeted an addition of 1.08 billion for the 2023-2024 fiscal year which ends very soon, on March 31. But the money is still not there.

It is time for this to be resolved, because we will not pay doctors and nurses with promises.

Last week, Nova Scotia signed a final agreement with Ottawa, following in the footsteps of British Columbia, Alberta and Prince Edward Island.

But with Quebec, negotiations are at an impasse. It’s a matter of principle. We cannot let Ottawa trample our autonomy in health care, as the members of the National Assembly reminded us last fall in a motion adopted unanimously.

Quebec is a good player. He agrees to share health data, several of which already appear in Minister Christian Dubé’s famous dashboard, which will allow better national comparisons to be made.

But there is no question of agreeing to submit to a federal action plan, with objectives to be achieved within three years.

What measures would Ottawa take if the objectives were not fully achieved after these three years? Would it reduce funds for subsequent years? Would he put the provinces under supervision? It all doesn’t make sense.

Okay, we all have the impression that nothing is improving in our health. Emergencies are overflowing like never before. Family doctors are as rare as a four-leaf clover. And the waiting lists for a specialist or an operation are endless.

It is not for nothing that Canadians’ dissatisfaction has soared over the past four years. At the start of the pandemic, one in two Canadians said they were satisfied with the government’s management of health matters. Today, only one in four Canadians hold this opinion. And Quebecers are no exception^⁠1.

Health is now the biggest concern for citizens, just behind inflation and the cost of living.

We agree on the fact that it is not just by injecting more and more money that we will solve health problems. We also need to thoroughly review the organization of work.

But adding a layer of bureaucracy to Ottawa will not improve health services.

Already, the federal government is having difficulty delivering the services that fall under its control – just think of the chaos in the passport offices. So, we definitely don’t want to see him get involved in health, which is under provincial jurisdiction. During other rounds of health transfer negotiations, Quebec did not accept any conditions. There is no reason for him to do it today.

Action plan ? Quebec already has one: the Dubé reform which was adopted just before Christmas. And the minister already has watchdogs who hold him to account: the Auditor General, the National Assembly and, above all, all citizens.

No offense to the federal government, its role in health is to ensure adequate funding, not to lecture the provinces and make inroads into an area that is not its own.

The last example? The launch of a Canadian dental insurance plan which will come into force gradually, starting in 2024.

Here again, Ottawa has not managed to come to an agreement with Quebec, which already offers its own coverage. The province does not want to take the risk of managing the system for Ottawa… and finding itself assuming costs which may be higher than expected.

Then, the two systems risk living in parallel and the lack of harmonization could result in duplicate reimbursements. Anything but sound management.

Everyone has their own job, health will be well managed.