LETTER TO THE EDITOR: Health care suffering from dysfunctional federal-provincial relationship

Opinion

Hey there, time traveller!
This article was published 16/12/2022 (738 days ago), so information in it may no longer be current.

To understand the debate regarding health care in Canada between the federal and provincial governments, reference must be made to the Canadian Constitution.

The Canadian Constitution gives sole jurisdiction (with a few exceptions) for health care to each of the provinces limited to their respective physical boundaries.

A formula further confounded by the taxation/revenue powers that favoured the federal government thus requiring federal government monies to support the provinces in developing their respective health-care systems.

A formula that demands co-operation and mutual respect between and among the federal government and the provinces for any successful efforts to establish equitable health-care systems in all provinces in Canada for Canadians.

Several different but unsatisfactory funding arrangements were initiated by the federal government post-1930s and the Second World War eventually led to the 1957 health-care agreement. It was an agreement between the federal and provincial governments to establish a pan-Canadian health-care system while respecting the separation of powers as prescribed by the Constitution and to provide federal funding support to the provinces.

Per the agreement, the federal government agreed to fund, through cash transfers, 50 per cent of the provincial costs of delivering specified health-care programs and services with the condition that they be universal, affordable, portable, accessible to all Canadians across all provinces.

In the 1970s, all parties agreed to a new funding arrangement. Federal government funding would be in two forms. One form was an annual cash payment to the provinces at approximately half of its previous commitment. An amount roughly equated with 23 per cent of health-care costs currently covered by the federal government.

The second form was (and continues): 1. to reduce its tax rates and revenues by an amount equal to the other half of its commitment and; 2. for the provinces to increase their respective tax revenues equivalent to levels vacated by the federal government. Additionally, the federal government agreed to give more funding flexibility to the provinces/territories in terms of designing and implementing their respective health-care systems.

Not surprisingly, the current agreement has proven to be unsatisfactory to all parties. The provinces do not recognize or accept the tax “transfer” as “real” cash/revenue. Their position is that the only contribution made by the federal government is its cash transfer covering only 23 per cent of health-care costs. Additionally, they are adamant that the federal government has no right to specify how federal health-care funds can be used.

The federal government’s concerns are manifold. It wants to know whether and how their cash transfers and the revenue from the “tax room” are being used with respect to health-care programs and services as specified in the agreement and whether they are being used efficiently and effectively. These are questions that have been raised and with recommendations made by health policy professionals and by a Senate committee inquiry.

The undisputed current health-care crisis has made federal funding of national health care, the dimensions of a comprehensive health-care system, and the use of performance measures to evaluate health-care systems of paramount importance to the federal government. In the absence of an agreement between the federal government and all provinces, the federal government has negotiated bilateral funding agreements with some individual provinces to fund expanded health-care programs and services — with agreements on methodology to measure the performance of these individual provinces with respect to these expanded programs and services.

These bilateral arrangements are less than satisfactory in terms of the original federal (and presumably provincial) government objectives of a universal health-care system. Nor are they welcome by provincial governments. They want funding without any conditions with respect to defining what health-care programs and services will be jointly funded, their reporting on the use of federal and provincial health-care monies, performance measures with respect to jointly defined objectives.

While our governments are quarrelling over jurisdiction, funding, reporting and co-operation, taxpayers are witness to a dysfunctional relationship between the federal and provincial governments and a health-care system in disarray, which is not meeting the promises of a pan-Canadian health-care system.

They are victims of a health-care system in crisis, victims of a system that does not address the vital, entangled and comprehensive aspects of health care — including but not limited to — training, recruiting, certifying, long-term care, emergency care, respite care, home care, preventive care, health education, mental health and mandates.

ROSEMARIE AND CHESTER LETKEMAN

Brandon