Speech: Responsible Funding for Health Care
Ottawa, October 17, 2016
Provincial and territorial Health Ministers are meeting today in Toronto to discuss a new health transfer accord with Ottawa. They will be joined by their federal counterpart tomorrow.
The topic is of utmost importance: Poll after poll has shown that Canadians consider access to health care their top priority.
Yet, I can make one prediction: This meeting is not going to solve anything. What we are going to see is a bunch of bickering politicians failing their primary responsibility, which is to find more efficient ways to offer first-class health care services to all Canadians. And at the same time deal with the fact that health care costs are increasing at an unsustainable rate and putting more and more financial pressures on the budgets of all governments.
We already know the scenario. The provinces will beg Ottawa for more money. And the federal government will try to impose its priorities over how and where the money is spent. All this, despite the fact that health care is an exclusive constitutional responsibility of the provinces.
Whatever happens, more and more money will be spent. But Canadians will not get better services. And they won’t know who is really responsible for this.
Why are we in this situation? It cannot be because Ottawa is not contributing enough to health care funding. The amounts transferred to the provinces have increased by 80% between 2006-07 and this year, from $20 billion to $36 billion. Meanwhile, all other federal program spending only increased by 50%.
The 6% increases that our Conservative government provided, year after year, were way above what should have been a normal rate of increase, given economic and population growth.
We might have expected this increased funding to help solve the access problems plaguing our health care system. But that did not happen. Canada has the dubious distinction of having the worst wait times among developed countries.
According to studies conducted by the Commonwealth Fund, Canada is dead last in international rankings of developed countries when it comes to wait times in the emergency room, to see a doctor or to undergo treatment.
The problem is not money. Canada is among the OECD countries that spend the most on health care when we adjust for age.
The fundamental problem is that we are the only developed country where the government has a monopoly on medically required care.
It’s time we break the taboo surrounding the role of the private sector in health care. I agree that we should not be following the American model, which costs a lot more than ours and excludes too many people without insurance. But that’s not the only model available.
Apart from the U.S., all other OECD countries have mixed universal health care systems, without a public monopoly like in Canada. They all provide more hospital services through the private sector than Canada. Yet, they are also all universal systems where everybody is covered by public and private insurance.
Patients in these countries have a lot more choice than Canadians. They can be treated in public or private hospitals, with the government paying for the treatment. In Germany, Australia, Spain, France and Italy, more than one third of hospitals are private and for profit. In Canada, the proportion is zero.
These countries all perform better than Canada. Nobody is left aside because of low income. Wait times are non-existent or very short. Nobody is denied care while waiting months or years to receive treatment.
Why can’t we do the same? Why can’t we reform our health care system to make it more flexible, less bureaucratic, and more responsive to the needs of patients?
Those who believe in big government, big bureaucracies and big unions don’t want Canadians to know about this. Every time someone raises the issue of the role of the private sector in health care, they cry “Americanization” or “two-tier health care.” These irrational fears prevent us from having a meaningful debate and consider the pragmatic solutions implemented in every other developed country, in Europe, in Japan, in Australia.
I’m giving my opinion here not as a politician who proposes to do these reforms, but as a citizen. I would like my parents, my two daughters, and all Canadians to benefit from the same efficient health care system. But it’s up to the provinces to implement these reforms. Ottawa can only set up the right conditions to encourage them to do so.
You may remember that when our government was elected in 2006, one of the five priorities in our election platform was the establishment of wait times guarantees. Hundreds of millions of dollars were distributed in various programs and to the provinces to implement that promise. Ten years later, wait times are as bad or worse.
Throwing more federal money at the problem is not going to make any difference. On the contrary, it is part of the problem. Why would provincial governments make tough decisions if they can always blame Ottawa for not sending enough money?
So, what should be done? We should get rid of today’s dysfunctional system for funding health care. And replace it with another that will give the right incentives to provincial governments to adopt the necessary reforms.
That is why I propose to replace the Canada Health Transfers by tax points of equivalent value that will be given to the provinces, under a model already used for several programs since the 1960s. There will be no more transfer of cash from Ottawa. Provinces will raise the money themselves and decide what to do with it.
This proposal is in no way original of course. It was defended by successive Quebec governments for decades, regardless of the political status they favoured for Quebec.
Several years ago, Preston Manning and Mike Harris made a similar proposal in their series Canada Strong and Free, published by the Fraser Institute and the Montreal Economic Institute. Respected economists such as Jack Mintz have also argued for this type of reform.
If elected Leader of the Conservative Party and Prime Minister, I will implement a Responsible Federalism for Canada’s health care funding. My campaign is based on four themes: Freedom, responsibility, fairness and respect.
The Liberals have been trying for decades to centralize the management of health care, using Ottawa’s so-called spending power. The federal government should instead RESPECT our Constitution. Ottawa’s meddling has only brought confusion over who does what and who is responsible for what, without any positive results in terms of reduced wait times.
At the same time, provincial governments need to take full RESPONSIBILITY for managing health care. They should be held accountable before their own electorate for their successes or failures to solve problems.
With this reform, the provinces will no longer have excuses, but they will be empowered to fix the system. They will stop constantly begging for more money and won’t be able to blame Ottawa for their failure to tackle wait times. It will force them to be more innovative and to take the tough decisions that are necessary to achieve concrete results.
Canadians have been waiting for too long, both when they want to see a doctor and for a real reform of our health care system. I’m asking them to support me so that we can finally apply the right treatment after having made the right diagnosis.