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A Canada with no health accord?

Jan. 8, Ottawa, Ont. - The provinces are grappling with the real possibility that they may soon be delivering health services without the guidance of a formal, national health care accord.


January 9, 2012
By Massage Therapy Canada


They are
scrambling to figure out how to move forward after Finance Minister Jim
Flaherty took them by surprise last month when he handed them a 10-year
funding package for health care with no policy strings attached.

Health
Minister Leona Aglukkaq is now touring the country to see how her
provincial counterparts want to proceed, with the official aim of
stitching together a new accord that would set national standards and hold
provincial governments to account for their spending.

And
provincial premiers are preparing to hash out a some sort of plan when
they meet in Victoria on Jan. 15 to 17.

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But a
no-accord approach is a distinct possibility, say provincial and federal
officials.

"It’s
a possibility that we have no codified accord,” said one federal source,
who spoke on the condition of anonymity.

That’s
because the new funding arrangements for 2014 to 2024 were presented
without negotiation, pleasing some of the Western provinces but upsetting
the rest of the country. Now the federal government has signalled that it
will be taking a back seat in setting health care policy.

Prime
Minister Stephen Harper was asked this past week in a radio interview
whether Ottawa is, in effect, telling the provinces to take full
responsibility for health care.

"Well,
that’s partly what we’re saying,” Harper said during an appearance on the
Rutherford Show, an Alberta-wide radio call-in program.

"Look,
most provinces are already projecting reductions in their own growth rates
and health-care spending. But the provinces themselves, I think, are going
to have to look seriously at what needs to be done to make the system more
cost effective.”

Flaherty’s
fiat cements financing until 2024. It gives provinces some fiscal
certainty about their levels of funding. But it also comes with no
mechanism to ensure national standards or service improvements.

At the
same time, the new 10-year funding arrangement will be allocated to the
provinces based purely on a per-capita basis, eliminating any
consideration for poorer provinces, fragile tax bases or higher costs in
remote areas.

That
means the distribution of the funding will swing heavily in favour of
richer provinces west of Manitoba, to the detriment of Manitoba and
east. 

The
equalization formula is also up for negotiation soon, so there is no
guarantee poorer provinces will see additional federal cash to make up for
the health redistribution.

The
concern is that without national standards, have-not provinces will see
their health care systems deteriorate, as the health services in richer
provinces flourish.

"Is
it appropriate that the federal government just washes its hands of the
country’s most important social program?” asked one provincial official,
who was not authorized to speak publicly.

Some of
those have-not provinces are contemplating a co-ordinated push back
against the unilateralist nature of Flaherty’s funding.

They
would argue that Harper promised a collaborative approach to health care
during the last federal election campaign, and has also committed to
reducing wait times and improving accountability and health care services
more generally.

But they
are far from united heading into their meeting in Victoria. And it’s not
clear Harper would have any obligation or incentive to listen to them
anyway.

There’s
not a hell of a lot the provinces can do about it,” said University of
Regina professor Greg Marchildon, who was the executive director of Roy
Romanow’s royal commission to reform health care a decade ago.

"They
can complain publicly but they cannot force the federal government to come
to the table and negotiate.”

"The
provinces will have a difficult time forging a national accord as long as
one of the key players -the federal government –  is absent from those
discussions," Marchildon said. And Harper has shown little
inclination to join in.

"There
can’t be an accord unless there’s an agreement to have a meeting,” he
said. "The federal government does not want a meeting so there can’t
be an accord.”

The
provinces could decide to take matters into their own hands and all go
their separate ways on health care. Or they could decide to work together
in some areas without the federal government, using the Council of the
Federation as a secretariat.

Health care has not always been directed through
a federal-provincial accord. That practice started in about 1999
with social-union talks that morphed into the more formal 10-year
accord of 2004.

 

 

 


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