By Michel Martin
I’m writing you because of your involvement and interest in health care services. The current pandemic, unfortunately, has both demonstrated and amplified the weaknesses in the organization and delivery of health care services throughout Canada. Quite simply, there are not enough resources devoted to the public health care system: hospital beds, doctors, nurses and other elements as well as the dollars necessary to adequately fund the health care system.
Furthermore, the health care system as conceived by its initiators and legislators has been overtaken by newer needs and developments in mental health, public health, prescription medications, prosthetics, dental services, and home care and long term care for the elderly and the handicapped, which were not included in the initial planning of public health care services. Moreover, the well-known fact of an aging population in Canada that requires more and more health care leads to an observation that our health care system would benefit from an upgrading and modernisation.
Beginning in the last century, public deficit preoccupations, even a mania for austerity, have meant a persistent chipping away and reductions in public services including health care services. While the provinces have indeed demonstrated their share of responsibility for creating this situation, the federal government has also failed to maintain its share of health care financing. Originally conceived as half of provincial and territorial health care budgets, the federal share of financing now represents only 22% of public expenditures on health care. We must address federal financing such that it can reach 50%.
In the current state of federal financing, it has been difficult for the federal government to insist upon the conditions for its financing of provincial health care expenditures, no matter how desirable, as they are contained in the Canada Health Act: universality, comprehensiveness, portability, accessibility, and public administration. Facing this lack of federal funding and a continuing increase in public demand and needs, provinces have had recourse to privatisation of services by various means, often hidden, or not even recognizable to the public.
The provinces and territories via the Council of the Federation have argued for an immediate re-instatement of a federal contribution of 35% of provincial and territorial health care expenditures. The Trudeau government has responded to this request by promising to study it after the pandemic is over, if indeed the pandemic can be forecast to actually end. This response manages to be vague, incomprehensible and pointless, all at once. The recent Freeland budget did not address the problem of the shortcomings in permanent federal financing of the public health care system, only that federal-provincial meetings would be needed to address the question. The country needs a gradual, year-over-year increase of federal financing over five years until it reaches 50% of provincial/territorial health care budgets, with these amounts to be indexed thereafter for inflation. This financing framework should be included in new federal legislation.
Often at the federal level or within civil society, discussions of improved federal financing are accompanied by suggestions of conditions that should be applied to the provinces to meet national standards or cross-Canada needs. As far as Quebec is concerned, and indeed with some provinces in English Canada, such conditions would interfere with provincial jurisdiction. Thus, they are prima facie non-starters that will produce no positive results in federal-provincial discussions. Even if arrangements can be struck that reflect Quebec’s special situation and needs, one still is faced with the question of how public servants in Ottawa can understand the different health care realities across Anglophone Canada. For instance, can they understand the different realities of La Ronge, in northern Saskatchewan, as compared to St. John’s, Newfoundland; or Chinatown in downtown Toronto, as compared to the suburbs of Vancouver in southern British Columbia? Thus, the provincial/territorial role is essential for determining health care needs and organization that reflect the local and regional realities of our vast country. Moreover, these determinations and decisions are more readily and immediately subject to the democratic control of provincial/territorial voters.
How to increase democratic control over health care services should be the question to be posed to best respond to the needs of Canadians, rather than federal controls that would be administered by bureaucrats in Ottawa. In this document, we propose several means of making our health care system more democratic and responsive to public needs. Among others, these include the following.
- The new federal law would include provisions for a parliamentary servant, similar to the position of the federal Auditor-general, who will report annually on the state of health care in the country, or might undertake special studies she or he might deem necessary at any other time; these provisions would be supported by budgets appropriate for this work; provinces/territories might wish to imitate these provisions within their own jurisdictions and legislatures.
- Health Canada will undertake program evaluations at intervals of two years for a provisional assessment, and five years after adoption of the new law for a more complete evaluation; these would be presented by the federal ministers of Health and Finance to Parliament for debate and action.
- The committees relevant to health care and its financing in both the House of Commons and the Senate will study the legislation and its effectiveness as they deem fit, and shall receive budgets appropriate for this study and review.
- Health Canada would be given the job of financing civil society enquiry and study of health care systems throughout the country, supported by adequate budgets, at the local, regional, provincial/territorial, or national levels. This funding would include civil society in all its manifestations — business groups, professional associations, organized labour, community groups, social planning organizations, think tanks, health care groups — or other organizations that wish to study health care, thus contributing to democratic debate about health care. This funding would be covered in the legislation proposed herein, and would be subject to the same processes of review and reporting to Parliament as other parts of the law.
By no means are the above ideas comprehensive; they represent only the tip of the iceberg of ideas to democratize the health care system, and to make it more responsive to the needs of patients, the broad public, and communities, and less bureaucratic and hierarchical. Other ideas abound at local and regional levels among health care patients, workers, and communities. They await promulgation and promotion as part of the effort to improve the health care system across Canada; they should form part of Health Canada’s work.
Michel (Michael) Martin is a freelance writer and social historian. His books include: CITY OF THE SUN: Development and Popular Resistance in the Pre-modern West; Working Class Culture and the Development of Hull Quebec 1800-1929; and The Red Patch, A story of political imprisonment in Hull, Quebec during WWII.