There were no high fives or attaboys at the recent meeting between the prime minister and Canada’s premiers regarding healthcare funding and related conditions. It was a sombre group that received the proposed Canada Health Transfer, amounting to 22% of the budgeted $204 billion for health care, versus the requested 35% for this fiscal year and beyond..It has been a long and mostly troubling journey as Canada's once perceived world-leading healthcare system has floundered. Long gone is the old fallacy that our healthcare system defines us as a country. Worse, several generations of Canadians now believe that healthcare is free, and should be. Of course, it isn't as almost half of provincial government budgets are now dedicated to this entrenched entitlement. Our country is stuck with a financial challenge without obvious solutions. The question is how long we can keep up the status quo..A little history. It was in 1959 that Tommy Douglas, the socialist premier of Saskatchewan, promised “a comprehensive health insurance program that will cover all our people and will ensure a high standard of medical care to every citizen of Saskatchewan.” While this has proven to be a hollow statement, he was correct in also prophesying that eventually other provinces would follow Saskatchewan's lead to a national health insurance program..The Canada Health Act was indeed approved by the unanimous vote of the House of Commons and received Royal Assent on April 17, 1984. It tightened previous legislation, prevented “extra billing” and private delivery, and famously promulgated five principles: In Canada, healthcare should be publicly administered, comprehensive, universal, accessible and portable. Politicians from all parties basked in the limelight of imposing this monopoly legislation on Canadians, and its promise of ensuring “a high standard of medical care.”.The province of Alberta expressed its satisfaction with its existing private insurance plan. The federal government made it difficult (some might call it bullying) for Alberta to turn down the 50% federal share of funding. But over the years the federal share has fallen to almost 20%, ergo the demands of the premiers for a 35% federal share of current and future costs..The early naive expectations of Canadians and our political leaders have evolved into today's inadequacies. The Fraser Institute regularly measures costs versus a range of outcomes compared to 30 high income countries. The most recent found that Canada ranks “highest for expenditures on healthcare as a percentage of GDP, eighth highest per capita.” Across 39 indicators representing four broad categories — availability, use of, and access to resources, and quality and clinical performance — the study concluded that “although Canada is the most expensive universal access healthcare system in the OECD, its performance is modest to poor.”.After inception it appeared that our federal government monopoly mandated system was working — patient needs were met, doctors were getting paid, funding was adequate and Canadians were proud. But after a couple of decades, costs and wait times escalated while federal transfers fell to just over two percent of GDP, half previous levels. This led to a series of reports and further unsuccessful attempts to add accountability, only further politicising this failing project. Luminaries such as Senator Michael Kirby, Deputy Prime Minister Don Mazankowski, and Premier Roy Romanow were charged with finding solutions..Well known and popular with deep political experience, Saskatchewan’s Romanow successfully, and at some political cost, undertook the courageous task of rightsizing Saskatchewan’s bloated balance sheet. But later, after traveling the world examining other healthcare systems, he returned home and declared the only solution is more money..Next was Paul Martin who “fixed healthcare for a generation” by committing six percent annual federal transfer increases. I recall at the time knowledgeable physicians pointing out a dichotomy — as part of his responsible reduction of government spending, the number of spaces at medical schools were reduced, contributing to our shortfall today. Such are the perils of managing from the top down..The history of our country features the serial incompetence of federal governments as a manager. Examples include our once globally respected military, likewise the RCMP; Via Rail and transportation generally; immigration; dysfunctional payroll systems; clean water for aboriginal communities; our slow, cumbersome, and ineffective justice system, etc.,etc..A recent National Post column by Terry Corcoran quotes Parliamentary Budget Officer, Yves Giroux, describing the management of passports and unemployment insurance “as a system that is broken.” This management inadequacy applies to every federal government in the modern era regardless of political brand. The geography and breadth of our country with distinctive regions, cultures, and values make top down, one-size-fits-all policies inevitably ineffective, often dysfunctional, and increasingly divisive. No amount of money, even if it were available, will cure the problems of an unaccountable monopoly, driven by entrenched entitlements, with little individual responsibility, no awareness of real costs, and absent competition..A second significant problem is the intrusion of the federal government with ever more conditions on funding. Other than a few specific exceptions laid out in Section 91, Section 92 of Canada’s Constitution gives provincial legislatures exclusive powers over health care..One solution that Prime Minister Harper wrote about when he was an academic but failed to implement when he could have, is to transfer the tax points to the provinces. This would also remove conditions that accompany the tax dollars and lead to better accountability at the provincial level where services are delivered. This would also foster innovation and experimentation with different models that at least could be tailored to provincial and local challenges.Another partial solution is allowing additional private services as each province so decides. Often overlooked, much critical technology enhancement is already funded by private donors — most hospitals have foundations raising money to supplant government financial limitations..According to an informative National Post interview with academic Dr. Jon Meddings, Canada’s private sector, including “prescription drugs, home care, seniors care, physiotherapy, lots of mental health care” comprises 37 cents of every health care dollar. He recommends fewer government regulations and limitations, including more private delivery. But, this sensible direction may be problematic as Trudeau at the recent meetings with the premiers added even more conditions and a requirement to honour the 1984 Canada Health Act Principles. Hence, more limits on choices for Canadians..One of the important takeaways from the above saga is the long term risk of creating entitlements that are ultimately impossible to unwind. In that regard it is hard to understand the provinces accepting more “free money” to initiate childcare and dental plans. Are the provinces themselves now captured by their own entitlement thinking, forever subject to federal conditions and inevitable funding reductions?.These additional programs are NDP conditions for supporting the Trudeau government. Policy determined by the minority partner of a minority government. Really?.The unfortunate saga amounts to a betrayal of the early promises to citizens who paid higher taxes to fund healthcare and are now denied access when most needed. Will this be a lesson for our politicians to be more cautious about creating additional entitlements?.They stand on the shoulders of previous promises, now impossible to uphold, while Canadians suffer. Meaningful reform continues to be stifled by the federal government’s ongoing breach of our much abused Constitution.
There were no high fives or attaboys at the recent meeting between the prime minister and Canada’s premiers regarding healthcare funding and related conditions. It was a sombre group that received the proposed Canada Health Transfer, amounting to 22% of the budgeted $204 billion for health care, versus the requested 35% for this fiscal year and beyond..It has been a long and mostly troubling journey as Canada's once perceived world-leading healthcare system has floundered. Long gone is the old fallacy that our healthcare system defines us as a country. Worse, several generations of Canadians now believe that healthcare is free, and should be. Of course, it isn't as almost half of provincial government budgets are now dedicated to this entrenched entitlement. Our country is stuck with a financial challenge without obvious solutions. The question is how long we can keep up the status quo..A little history. It was in 1959 that Tommy Douglas, the socialist premier of Saskatchewan, promised “a comprehensive health insurance program that will cover all our people and will ensure a high standard of medical care to every citizen of Saskatchewan.” While this has proven to be a hollow statement, he was correct in also prophesying that eventually other provinces would follow Saskatchewan's lead to a national health insurance program..The Canada Health Act was indeed approved by the unanimous vote of the House of Commons and received Royal Assent on April 17, 1984. It tightened previous legislation, prevented “extra billing” and private delivery, and famously promulgated five principles: In Canada, healthcare should be publicly administered, comprehensive, universal, accessible and portable. Politicians from all parties basked in the limelight of imposing this monopoly legislation on Canadians, and its promise of ensuring “a high standard of medical care.”.The province of Alberta expressed its satisfaction with its existing private insurance plan. The federal government made it difficult (some might call it bullying) for Alberta to turn down the 50% federal share of funding. But over the years the federal share has fallen to almost 20%, ergo the demands of the premiers for a 35% federal share of current and future costs..The early naive expectations of Canadians and our political leaders have evolved into today's inadequacies. The Fraser Institute regularly measures costs versus a range of outcomes compared to 30 high income countries. The most recent found that Canada ranks “highest for expenditures on healthcare as a percentage of GDP, eighth highest per capita.” Across 39 indicators representing four broad categories — availability, use of, and access to resources, and quality and clinical performance — the study concluded that “although Canada is the most expensive universal access healthcare system in the OECD, its performance is modest to poor.”.After inception it appeared that our federal government monopoly mandated system was working — patient needs were met, doctors were getting paid, funding was adequate and Canadians were proud. But after a couple of decades, costs and wait times escalated while federal transfers fell to just over two percent of GDP, half previous levels. This led to a series of reports and further unsuccessful attempts to add accountability, only further politicising this failing project. Luminaries such as Senator Michael Kirby, Deputy Prime Minister Don Mazankowski, and Premier Roy Romanow were charged with finding solutions..Well known and popular with deep political experience, Saskatchewan’s Romanow successfully, and at some political cost, undertook the courageous task of rightsizing Saskatchewan’s bloated balance sheet. But later, after traveling the world examining other healthcare systems, he returned home and declared the only solution is more money..Next was Paul Martin who “fixed healthcare for a generation” by committing six percent annual federal transfer increases. I recall at the time knowledgeable physicians pointing out a dichotomy — as part of his responsible reduction of government spending, the number of spaces at medical schools were reduced, contributing to our shortfall today. Such are the perils of managing from the top down..The history of our country features the serial incompetence of federal governments as a manager. Examples include our once globally respected military, likewise the RCMP; Via Rail and transportation generally; immigration; dysfunctional payroll systems; clean water for aboriginal communities; our slow, cumbersome, and ineffective justice system, etc.,etc..A recent National Post column by Terry Corcoran quotes Parliamentary Budget Officer, Yves Giroux, describing the management of passports and unemployment insurance “as a system that is broken.” This management inadequacy applies to every federal government in the modern era regardless of political brand. The geography and breadth of our country with distinctive regions, cultures, and values make top down, one-size-fits-all policies inevitably ineffective, often dysfunctional, and increasingly divisive. No amount of money, even if it were available, will cure the problems of an unaccountable monopoly, driven by entrenched entitlements, with little individual responsibility, no awareness of real costs, and absent competition..A second significant problem is the intrusion of the federal government with ever more conditions on funding. Other than a few specific exceptions laid out in Section 91, Section 92 of Canada’s Constitution gives provincial legislatures exclusive powers over health care..One solution that Prime Minister Harper wrote about when he was an academic but failed to implement when he could have, is to transfer the tax points to the provinces. This would also remove conditions that accompany the tax dollars and lead to better accountability at the provincial level where services are delivered. This would also foster innovation and experimentation with different models that at least could be tailored to provincial and local challenges.Another partial solution is allowing additional private services as each province so decides. Often overlooked, much critical technology enhancement is already funded by private donors — most hospitals have foundations raising money to supplant government financial limitations..According to an informative National Post interview with academic Dr. Jon Meddings, Canada’s private sector, including “prescription drugs, home care, seniors care, physiotherapy, lots of mental health care” comprises 37 cents of every health care dollar. He recommends fewer government regulations and limitations, including more private delivery. But, this sensible direction may be problematic as Trudeau at the recent meetings with the premiers added even more conditions and a requirement to honour the 1984 Canada Health Act Principles. Hence, more limits on choices for Canadians..One of the important takeaways from the above saga is the long term risk of creating entitlements that are ultimately impossible to unwind. In that regard it is hard to understand the provinces accepting more “free money” to initiate childcare and dental plans. Are the provinces themselves now captured by their own entitlement thinking, forever subject to federal conditions and inevitable funding reductions?.These additional programs are NDP conditions for supporting the Trudeau government. Policy determined by the minority partner of a minority government. Really?.The unfortunate saga amounts to a betrayal of the early promises to citizens who paid higher taxes to fund healthcare and are now denied access when most needed. Will this be a lesson for our politicians to be more cautious about creating additional entitlements?.They stand on the shoulders of previous promises, now impossible to uphold, while Canadians suffer. Meaningful reform continues to be stifled by the federal government’s ongoing breach of our much abused Constitution.
