Ottawa’s Provincial Health-Care Deal: What Kind of Fix?

Canadian premiers hold a press conference following a meeting on health care in Ottawa on Feb. 7, 2023. (The Canadian Press/Sean Kilpatrick)

Commentary

The current Liberal government might achieve a windfall in popularity from concluding agreements on health care with each of the provinces. Perhaps the agreements will be used as the trigger for an early election. It is impossible to evaluate the deals without seeing and studying the details. In the meantime, there are some questions and concerns.

More transfers from Canada to the provinces is not an unconditional good for the provincial taxpayers. They pay both federal as well as provincial taxes, and they pay when inflation is caused by government spending. Is the deal-making  process here guided by any rational standard that ensures fair treatment for all provincial governments and taxpayers? Or will the federal government be able to reward or punish on political grounds—where their seats or potential voters are—which provincial government proves to be the most pliant on health care or other federal government priorities?

Taxing and borrowing in one area can be at the expense of others, such as education.     Taxation, or inflation from government spending, can damage the overall economy or burden taxpayers to an extent that is actually unhealthy for many Canadians. How do we know that the new deals will produce good value in relation to all the costs?

Many Canadians, likely most, believe that the health-care system really is broken, and would be willing to pay more, in taxes or personally, for real improvements. But will this new seat of deals actually translate into better health outcomes?

The federal government is looking for more metrics. They could, if properly defined and applied, be a positive. But another way to register and observe effectiveness is often more effective: observing the decisions that providers and patients make when they are free to choose. Will the latest health-care deals simply maintain or increase the extent to which politicians and bureaucrats control the system and crowd out individual initiative and autonomy?

What metrics will be actually used? We should be keeping in mind that particular procedures and services are a means to an end—such as including healthier citizens.    The number of procedures performed is not the ultimate metric of success. You would have to know if the procedure is working for patients, including how effective it is compared to alternatives. Surgery is sometimes the best option, sometimes it may be medication, a change in lifestyle, therapies provided by physiotherapists or psychologists, or acceptance of a condition in light of the risks of treatment.     Moreover, if a system of metric focuses on certain kind of surgery, will the system provide them at the undue expense of other kinds of surgeries or other interventions?

These apparently will be 10-year deals. Will they effectively lock in some of the features of the current system that need a bold and creative re-think?

My recent op-ed in these pages proposed a specific approach whereby we might have more room for private-pay options—not just private-provider options, which were never contrary to the Canada Health Act. The proposal  is actually quite conservative; the federal government would allow private-pay options where provincial authorities consider them useful and when there is sound evidence and analysis that the private-pay option will help, or at least not hurt, the publicly funded system. But will even that modest reform be ruled out for another 10 years? Even if it might make the public system work better, and even if it might save the life or health of some patients who cannot cope with the delays in the publicly funded system or its outright inability to offer a needed service?

More broadly, even if there is a bit more flexibility in some respects—less federal government scolding of private-provider options, even though they are publicly funded—will this set of deals in practice preclude the kind of open debate, fresh thinking, and real reforms that we need?

The Romanow Royal Commission on the Future of Health Care in Canada had that effect. The system was under strain then, and after many words heard and discharged, we were simply told we need to expand and spend more on the same system. Little or no fresh thinking, no increased room for provider and patient choice, no reduction of bureaucratic control, and no increased room for innovation and experimentation at the provincial level.

This new set of deals might prove to be similarly uninspired and ineffective. Talk about more metrics and spending a modest amount of more public money each year may turn out to be a dangerous placebo. We will feel better for a little while, but reality will overtake us. And then we will be less, not more able, as a society and through our governments, to think the thoughts and take the actions needed.

Views expressed in this article are opinions of the author and do not necessarily reflect the views of The Epoch Times.