Health Care – Why Bilateral Deals are a Problem
From March 31, 2004 to 2014, Canada had a cohesive, nationwide Health Accord that provided federal health care funding to the provinces (called the Canada Health Transfer, or CHT), with committed funding increases of six per cent per year. The Health Accord also supported the principles of the Canada Health Act that make Canadians proud: universality, comprehensiveness, portability, accessibility, and public administration. In 2011, the Harper government announced that it would cut the annual increase to a minimum of three per cent. Seeing this as an opportunity in the 2015 election, the Liberals promised Canadians a new Health Accord with predictable, long-term and growing funding – fuelling the hope and expectation that the Harper-proposed cutbacks might be averted Health care funding: Canadians need Trudeau to be more than Harper-lite. Sadly, the Trudeau government broke its promise in 2016 by starting the process of signing separate bilateral agreements with each province. As of today, Manitoba is the only province not to have signed such an agreement. These deals set forth funding increases at a minimum three per cent per year, with additional monies for home care and mental health. So – what’s the difference for Canadians?
Less Money for Health Care
The Liberals project that federal health care funding will grow at little more than three per cent per year. However, multiple calculations have shown that funding must increase by 5.2 per cent per year just to maintain the current level of existing health care services. Reading between the lines, this raises some concerning questions: what health care services will the provinces need to cut if they are not getting enough from the federal government? How will we be able to support an aging population with increasing health care needs? If the system is underfunded now, how much more will have to be invested in the future to ‘fix’ the system?
The Liberal government says that the bilateral agreements provide extra money for home care and mental health amounting to $11 billion over 10 years for home care and mental health starting in 2017. This, undoubtedly, is a welcome investment. However, the funds are allocated for programs outside the existing public health care system, meaning that the decreased Canada Health Transfer funding offered in the bilateral deals will still leave provinces and territories struggling to maintain current health care services.
Opens the Door to For-Profit Services
It is a fundamental Canadian value that our health care system is funded by the public, for the public – regardless of one’s ability to pay. It was not put in place for anyone to profit from.
The new bilateral funding deals between the federal and individual provincial governments fail to protect our public system. The deal with Saskatchewan, for instance, allows for private MRI clinics to continue operating – so if you have money, you can pay to jump the queue CUPE stands firmly opposed to privatization in health care. This is in direct violation of the Canada Health Act and our right to universal access – a violation that a new Health Accord, if properly implemented, would have better enabled the federal government to crack down on.
Moreover, there is nothing in the bilateral deals to compel the provincial governments to put federal transfer monies into public, rather than private, services for home care or mental health. This allows public funds to be spent on private profits, rather than on universally accessible health services.
No Oversight of National Health Standards
The Health Accord gave the federal government a cohesive framework to uphold the Canada Health Act, enabling it to enact financial penalties for violations. With bilateral deals, the federal government has not invested any money towards the enforcement of the Canada Health Act, and offers no common framework with which to uphold an equitable national vision. Without the enforcement of national health standards, Canada runs the risk of moving towards a system of privatization, extra billing by doctors, and two-tiered structures that cater to the rich while harming the everyday Canadian.
Despite the Liberals’ promise of transparency and accountability, the bilateral deals were not negotiated in public, and details of the agreements are still not available, months after provinces and the federal government reached agreement with each other. This lack of open public discourse threatens our collective ability to engage and safeguard our public health system.
As of today, Manitoba remains the only province without a bilateral agreement, and the Trudeau government has become increasingly aggressive in its negotiation tactics, threatening to pull $60 million from a manufacturing research facility if the province doesn’t sign.
The Liberal switcheroo from its promise of a coherent and comprehensive Health Accord to fragmented bilateral deals is a major disappointment. It’s time now to step up to the plate and defend our public health care system more than ever. CUPE continues to advocate for public solutions in health care, adequate funding to strengthen and expand public health care services, adequate staffing levels, a national public drug plan, and a continuing care strategy for our seniors.
 Federal Budget 2017, http://www.budget.gc.ca/2017/docs/plan/budget-2017-en.pdf (p. 155).
 The 5.2% escalator was calculated by the Department of Finance of Canada 2016/2017, Parliamentary Budget Office, Conference Board of Canada, and the Financial Accountability Office of Ontario.