While Ottawa and the provinces play ping-pong with health funding, we lose sight of the essentials.
However, it is not rocket science: the growth of health care spending in the long term (5%) will be greater than the growth of the economy (4%) and of government revenues that are used to pay the bill. To close this structural gap of 1 percentage point, more taxes will therefore be needed… unless cuts are made elsewhere, which would atrophy the other missions of the State. Lets forget that.
In this context, the Coalition avenir Québec (CAQ) could not have chosen a worse time to hang up its election signs for the by-election in Saint-Henri–Sainte-Anne. All smiles, François Legault appears with the slogan: “Tax cuts from 2023”.
Basically, this gift that we cannot afford is a form of denial of the needs of the health network.
And strategically, it undermines Quebec’s bargaining power against Ottawa, which just this week offered an increase in health transfers of $46 billion over 10 years to the provinces and territories, when they were asking for six times more.
It is true that their demands were unreasonable, but the money promised by Ottawa is far from sufficient.
In the long term, the federal government has more leeway than the provinces, whose public finances are undermined by the aging of the population, which is driving up health care spending, for which they bear 78% of the bill.
If nothing changes, Quebec will be chronically in deficit, which is unsustainable in the long term, according to a study by the Chair in Taxation and Public Finance at the University of Sherbrooke1.
Ottawa must do more. But in the short term, the federal government is broke, because of the costs of the pandemic which have caused its debts to explode from 30% to 50% of GDP. In addition, Justin Trudeau did not hesitate to increase expenses (childcare services, dental insurance, etc.).
If the provinces have accepted the federal government’s unattractive offer without much hesitation, it is because they know that the debate on health transfers has only just begun.
We are only in the first round…
But it is not by returning the ball that we will solve the problem. And in the end, the money will always come from the same pocket: that of the taxpayer, who has little to wax about the debates of figures and the federal-provincial quarrels.
What he wants is a family doctor available, a hip operation within a reasonable time, emergencies that don’t look like the jungle…
To put an end to the eternal debate on health transfers, Ottawa could simply transfer tax points to the provinces, as in 1977.
Clearly, the federal government would lower its taxes to leave the provinces with new tax room for funding health care. Equalization would be adjusted to benefit the less well-off provinces in order to ensure uniform services across Canada.
In this way, the provinces would become fully responsible for health management, which is within their jurisdiction. Logic itself! But this idea may not please many Canadians, for whom universal health care is the icon of national unity.
Yes, an icon. But you still have to finance it adequately if you don’t want your varnish to crack even more.
Should we introduce a special tax as recommended in 2002 by Senator Michael Kirby, at the head of a cross-party committee that traveled across Canada and collected some 400 comments? Twenty years later, the question remains topical.
But money is not a miracle cure either.
Already, Canada is the second largest country spending on health as a proportion of GDP (12.9%), well above the OECD average (9.7%).
Unfortunately we don’t get what we pay for as Canada ranks 10e out of 11 countries for the performance of its network, according to a comparison carried out by the renowned Commonwealth Fund2.
Here is the proof that money does not cure everything, in particular the shortage of manpower which is behind many evils. Even with higher salaries, health care workers cannot be cloned.
We therefore have no choice but to act otherwise. Examples ?
– Decentralize the network to stimulate the innovation that will come from people in the field if we give them the means to change things, by measuring the results.
– Invest in technology to improve productivity, in particular by reducing the paperwork that takes up a quarter of doctors’ time3.
– Defeat the corporatism that prevents the decompartmentalization of tasks and limits the recognition of foreign workers.
– Enable the private sector to provide more care, covered by the public, in areas where it can lead to efficiency gains4.
With political courage, it can be done. And the Minister of Health Christian Dubé has some. Let’s support it.
All of these modernization efforts can mitigate the rise in costs, without necessarily curbing it entirely. So please, let’s stop lowering taxes, limit new spending and focus on the essentials: health.