Toronto Star
By: Robert Benzie, Tonda Maccharles
Date: Dec 13, 2016
Ontario
hopes to end the national logjam over health-care spending with a proposal for
a new 10-year federal health spending plan, the Star has learned.
Under the plan, Ottawa would agree to increase federal health transfers by 5.2
per cent every year in exchange for provincial commitments to spend on
"mutually agreed-upon priority areas," such as mental health and
home-care services - areas the federal Liberals campaigned on.
The proposal says as part of the new long-term health accord, each province and
territory would decide for itself how to report on the use of the federal
funds.
What it would effectively do is take the $3 billion over three years that the
Liberals say they want to spend on those services and roll it into the federal
transfer, then extend the spending over a decade, giving provinces the ability
to plan properly instead of seeing money dry up after a few years.
The yearly hikes Ontario proposes are a lot more than the 3 per cent provinces
are soon to receive under changes put in place by the previous Conservative
government. But it would be less than the 6-per-cent annual increases provinces
had been receiving since 2004 that premiers had hoped to reinstate.
According to a two-page document obtained by the Star that was circulated
Friday to provincial, territorial and federal officials on Friday, Ontario
warns the imminent reduction in federal transfers will slash more than $1
billion out of the health system in 2017-18 alone.
Prime Minister Justin Trudeau, who was directly and actively engaged in
horse-trading with premiers on climate change Friday, sat down afterwards for a
private dinner with all 13 to talk about their views on health-care funding.
But substantive discussions were punted to next week's meeting of finance
ministers from across the country, multiple sources said. Health ministers are
invited to attend Monday's meeting.
Ontario's analysis is based on the Conference Board of Canada's estimate that
future health costs will grow at an average rate of 5.2 per cent annually from
2015 to 2035 - a conclusion Ontario says is supported by other experts
including the Parliamentary Budget Office.
It's not clear how much traction Ontario's proposal will have among provinces.
For now, the provinces have asked that the 6-per-cent "escalator"
remain in place for one more year while Ottawa and the premiers negotiate an
acceptable new deal.
At Queen's Park, officials refused to comment on the proposal other than to
confirm that Ontario did table one.
Health Minister Eric Hoskins broached Ontario's proposed formula with his
colleagues across the country and sources say the premiers concluded Friday
morning - before they sat down with Trudeau - that it could be workable.
Sources say the increases would "make health care sustainable and also
allow for new investments in shared priority areas such as home care and mental
health."
For some, money that is committed to direct spending on services would allow
premiers to ensure it goes to front-line services as opposed to collective
agreements for health-care workers, said one senior provincial source from
Eastern Canada. Another provincial source from Western Canada said if there is
a guaranteed federal increase in the range of what Ontario proposes for another
decade, then a deal could be likely.
A senior federal source has suggested to the Star that the billions the federal
Liberals want spent on home care and mental health services could be rolled
into the federal health transfer but discounted increased funding hikes along
the lines of 6 per cent.
Quebec, for one, has insisted on a 6-per-cent increase. And for Quebec, money
that comes with strings attached is a non-starter. The other provinces have
long recognized that federalism can make room for "asymmetrical" agreements
that accommodate Quebec.
Quebec Premier Philippe Couillard told reporters Friday he would never agree to
any deal that requires the province to spend on federal priorities in health.
In fact, Couillard said, he had extracted a promise from Trudeau that it would
never be the case.
"We want to have the same clause that was adopted in 2004 recognizing that
Quebec will choose its own priorities," said Couillard, referring to the
health accord struck by former Liberal prime minister Paul Martin.
"Monsieur Trudeau privately has told me this would not be an issue so
that's fine," said Couillard, adding that any federal funding formula that
would see money dry up in a short time frame is a "poisoned pill."
At a news conference Monday, Trudeau was asked if he is willing to prolong the
6-per-cent health "escalator" until a new health accord is signed. He
replied only by pointing to next Monday's meeting of finance ministers where
health ministers are invited to work out an agreement.
"I think people expect us to act in a measured way but also in an
immediate way on the health file," he said.