“Where did the love go?” : Premiers say Ottawa is turning its back on a health care system in crisis

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It’s not the first relationship to struggle under the health and financial pressures of the pandemic, but the dysfunction-prone Canadian federation seemed to need a skilled mediator or two this week.

Like aggrieved partners who now speak only through lawyers, Premiers gathered in Victoria, British Columbia, on July 11-12 to renew their call for an urgent First Ministers meeting to negotiate an increase in the Canada Health Transfer (CHT). As the premiers made their case to the assembled reporters, senior federal ministers appeared in the media to make their demands.

“Where did the love go?” John Horgan, the soon-to-retire premier of British Columbia, said in his last press conference as chairman of the Federation Council. “Everything was going so well. And then it wasn’t.”

For reporters who covered the several dozen prime ministers’ meetings held during the COVID rush, it seems a bit revisionist to say the relationship was “good” during the pandemic.

Of course, the prime ministers talked a lot (virtually). But it took a lot of talking to hold together all that was falling apart in this emergency and to continue border restrictions and vaccination policies.

Patience is fraying now because Prime Minister Justin Trudeau has not met with the premiers in person. Health Minister Jean-Yves Duclos announced one-time funding for specific things like surgical backlogs in March, but Finance Minister Chrystia Freeland’s spring budget offered nothing longer term.

“Ghosted,” is how Horgan described — “with sadness, not anger” — what he sees as a lack of federal commitment.

Horgan said Federal Intergovernmental Affairs Minister Dominic LeBlanc only had time to call him to register before last Sunday morning’s meeting, when the premiers were already heading to Victoria.

“Is there anything else on his log besides us 13?” said the prime minister. “I don’t think so, but here we are.”

The day after the Prime Ministers returned home, The Freeland office issued a press release confirming that it had just transferred the additional 2 billion dollars to the CHT promised by Duclos. He gave reporters a chart outlining the breakdown of transfers by jurisdiction. And then Freeland left for the G20 finance ministers meeting in Bali, Indonesia.

Practitioners and patients agree: the health system is collapsing. But responsible governments seem to be at an impasse, relying on each other’s inaction to distract from their own ineffectiveness.

“False” numbers and “triple R”

The shots fired this week were aimed at two things: calculations and accountability metrics.

LeBlanc called the premiers’ figures on the federal contribution to health care “fake”.

Premiers are still using the same favorable calculus they have used for months to argue that Ottawa is no longer paying its share.

Was the CHT ever intended to pay for half of rising healthcare costs? Not really. But did LeBlanc really need to use a provocative term like “false”?

Both parties agree that new investments are needed. Trudeau maintained on Wednesday that they would still come.

“The federal government will be there to invest in health care,” he said, “but we’re going to make sure those investments benefit Canadians.”

In one of his last major events as premier of British Columbia, John Horgan chaired meetings of the Council of the Federation in Victoria earlier this week. His efforts to negotiate an increase in the Canada Health Transfer with the federal government during his term as president failed. (Chad Hipolito/The Canadian Press)

And this is where the responsibility fights begin.

The federal instinct to tie strings and guarantees is understandable. Ask Stephen Harper what it’s like to reform equalization payments at the behest of lobbying premiers – only to see one use the new money to implement a major provincial tax cut. More recently, provincial watchdogs have concluded that billions of dollars in federal COVID support for the provinces have not been spent as planned by Ottawa.

But federal ministers trying to tell the provinces how to spend in an explicitly provincial jurisdiction like health can expect some pushback. This may explain why Duclos, in a recent interview with CBC News, sounded like a management consultant giving a Ted Talk – framing his arguments around what he called a “triple R rule”: respect for competence, shared responsibility and focus on results.

“The federal government is unable and will never attempt to micromanage the health care system in Canada,” he said.

Negotiations must be “sequential”, Duclos said. Health ministers must first meet to define the ‘results’ they want to achieve – a process which apparently is not yet complete – before anyone can talk money, he added .

‘Ragging the puck’

Premiers have strongly pushed back against the suggestion that they cannot be trusted to spend health transfers on health. Their books are public, they told reporters in Victoria, and they should be graded by the voters who elect them, not according to a checklist on Duclos’ desk.

Horgan accused Ottawa of claiming a problem that does not exist. Withholding federal money until certain conditions are met would be a “cop,” he said, and attaching conditions to new health care funding makes it seem like the two levels of government have a master-slave relationship. (He’s not wrong. Constitutionally, the provinces are not subordinate to the federal government, even though the federal government obviously has more fiscal capacity.)

Alberta Premier Jason Kenney, a lame premier now free to talk because he will never have to negotiate with the federal government again, put it bluntly.

“If they have something to tell us about the conditions, come sit down and say it,” Kenney said. “But so far it looks like they are dragging the puck because they have no intention of paying their share.”

Bottom line: the feds say they won’t negotiate the money until they set the terms, while the provinces are wary of any strings attached and say they can’t proceed without more silver.

Trudeau’s vague explanation for not meeting with the premiers to discuss the CHT is based on bandwidth: a pandemic, he said, is not the time.

But when the federal government wanted a national child care program amid the pandemic, it first invested the money, then found the time and energy to negotiate a custom slice for each province.

Freeland’s current fiscal framework has no CHT hike and she warned that greater restraint is needed to counter high inflation. What message does this send about his intentions?

The federal government has also pointed to the timing of the election as one of the reasons for the lack of engagement between the prime minister and premiers on health spending. The Liberals say they fought off a deadly federal election last fall and didn’t want to meddle in Ontario and Quebec’s election campaigns this year.

Will Trudeau’s calendar suddenly free up after Quebecers vote in October? Or was it just an excuse to kick the pot?

Rejection and return on investment

Two signs emerged this week that the provinces want to increase the political cost of federal inaction. One was a public relations ploy, while the other threatened to hold certain Liberal political priorities hostage.

CBC News has reported that the premiers are planning to launch a national ad campaign to impress on Canadians that their health care system will suffer if the federal government doesn’t spend more money on it.

A new “blame Ottawa” offensive could redirect anger from provinces responsible for backlogs and bad health care experiences. But he ignores a point raised by health care advocacy groups — that some reforms, such as interprovincial recognition of professional licenses and credentials, can happen without a fight with Ottawa over money.

Protesters greeted the Prime Ministers on the second day of their Council of the Federation talks in Victoria. Public health advocates regularly meet with leaders at their summer meetings, but the current funding dispute has added urgency to those conversations. (Chad Hipolito/The Canadian Press)

Potential hostages are Liberal promises to implement national drug and dental coverage – two conditions set by the federal NDP earlier this year in return for backing confidence votes in the House of Commons .

Adding drug and dental coverage, Horgan said, is not possible without a “solid foundation” of funding for the services already covered.

“You can’t access one without the other,” he told reporters.

Given that federal officials need the cooperation of the provinces to implement national programs outside of federal jurisdiction, could these programs slow down or stagnate until the CHT increases?

That could test the patience of federal New Democrats who are currently shielding Trudeau from threats of a snap election.

Event without announcement

The first major victory for the Council of the Federation (COF) in 2004 was an agreement with the Liberal government of Paul Martin on health funding.

When it was created, the COF was supposed to be a leader in its own right, not to wait for Ottawa to solve national problems. And Canada’s premiers have shown themselves able to do more than pressure the federal government by reaching a deal on bulk drug purchases and the imperfectly implemented interprovincial trade agreement.

But there has been no action or announcement approaching the importance of these measures in this year’s COF press release. Instead, he piled on more demands for Ottawa beyond health care, on things like infrastructure and immigration.

Has the loss of a few years of face-to-face meetings made it difficult to move forward on other files? Maybe.

Victoria’s Empress Hotel was filled with civil servants reuniting with their colleagues in the 13 jurisdictions. The media have been denied access not only to their meetings, but also to their social and networking events, so reporters may simply not be able to get a line on other work going on behind the scenes. .

The serious rhetoric in Victoria has underscored the collective resolve of premiers to prevail in a 2022 rematch of the fight against health transfer payments. But it’s possible they focused on the federal demands because they had no progress to report on other things under their control.

A first ministers meeting will not solve this.

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