For the second time in as many months, Prime Minister Justin Trudeau has surprised me on the national health-care file, and in a positive way. The health-care system has been well-established as a sacred cow in Canadian politics. Many politicians will decry the state of health care in the nation, but few will dare to muse about changing the system itself. Trudeau hasn't exactly been an advocate for systemic health-care reform, yet he has been signalling that he is receptive to supporting it.
It was a bold statement from a prime minister who is not typically inclined to give frank, clear statements on policy issues. Trudeau didn’t try to walk back his statement and it’s clear he didn’t misspeak. Not only did he admit the system is broken, but his statement could also be interpreted as an invitation for provinces to start changing the system.
The delivery of health care is a provincial jurisdiction and premiers don’t need the prime minister’s permission to expand delivery options, even if they are private. Singh’s posturing and demands run contrary to the Constitution, but that is of little concern for an opposition leader who wants to paint himself as a defender of public health care.
The health systems in every province are severely stressed right now. Surgical backlogs and staffing shortages are common, and premiers are forced to examine changes to the system. The Canada Health Act only prohibits extra billing for insured services, it doesn’t prohibit private delivery of care. Every province has all sorts of private provision options, from diagnostic services to walk-in clinics. Whether expanding the scope of private surgical facilities will take pressure from the system remains to be seen, but it isn’t in contravention of Canadian health-care legislation.
Now for the politics of it all.
Why would Trudeau wade into an issue that may threaten his governance deal with Singh and could lead to interprovincial battles over health-care provision?
Ford was very supportive of the Trudeau government during the COVID-19 pandemic while federal restrictions were put in place. Is Ford now calling in favours from Trudeau?
It’s an odd alliance, but Trudeau could feel obligated to have Ford’s back now, and perhaps is hoping for support from Ford when the next federal election comes. It was interesting hearing Trudeau referring to Ford informally as "Doug" rather than "Premier Ford." It does imply they have developed a close relationship.
Perhaps Trudeau is trying to end his coalition with the NDP. He will need a deal-breaker to do that, and supporting the expansion of private health-care options in provinces could lead to that. How can Singh keep supporting the Liberal government when it departs so far from NDP principles?
Whatever the reasons may be, Prime Minister Trudeau has become an unlikely champion for provincial health-care initiatives, including expanding private care options. Canada needs to allow provinces to innovate, and let’s hope Trudeau’s uncharacteristic pragmatism on the issue continues.