Spring 2023 // Canadian Government Executive / 7 CANADIAN POLITICS Q: What did you think of the health care deal that the federal government announced on February 7? So this has been long-awaited. This has been something that the provinces and the federal government have talking about a long time and the provinces have been indicating they don’t have enough resources to be able to offer the quality of health care and to fix the kind of gaps that have been clear in the system for a long time and have been made worse by COVID. This has been a point of contention for a long time now and the deal that that was announced by Ottawa yesterday does not come close, financially, to what the provinces were asking for. Now, that shouldn’t be a surprise to anybody in the sense that this is a back and forth between the federal government and the provincial governments and provinces are always going to ask big and hope they get something close to that and the federal government’s never going match it entirely but we’re watching to see where they land. What’s the midpoint between them or what’s the agreement point between them? And we can see that, financially, this deal, at this point, falls quite short of what the provinces have been asking for. I kind of wondered whether, at this point in Trudeau’s career, because he is a third term Prime Minister, he’s been there for almost eight years, he’s been leader of the party for almost 10 years, he’s got to be thinking about how he’s going to bring his political career to a close. This is a moment where he might want to do something transformative. But this deal is not something that really shakes the terrain of how we do health care in Canada. So, it’s interesting in the sense that they’re saying they’re going to bump up the Canada health transfer by five points if the provinces meet the requirements on data collection. And then they are also going to do bilateral agreements with the different provinces so that provinces can take a chunk of money and use it for things that they have deemed to be priorities in their own jurisdiction. There is some opportunity here for politics in a good way on the part of premiers to push the Prime Minister to say, “this is what we need.” But I think, at this point, there’s no slam dunk to this. There is no sense that, okay, we’ve got a deal, everyone’s signed, everybody’s happy or even everybody’s not happy. There’s no closure at this point. There’re just more questions about what forms the bilateral agreements will take. Q: You’re saying there’s a leadership opportunity, there may be an opportunity for a swan song, but right now, it’s not fixing health care. What needs to happen? What could be done to make this a good package? Is more money the answer? We’ve been throwing money at health care, arguably not anywhere near enough, for a long time. But the fact of the Constitution, which is that the federal government has, overwhelmingly, the greater fiscal capacity and then the provinces have jurisdiction over health care, which is the most expensive program we have buy a lot - if we continue down that road without any sort of change in responsibilities or fiscal capacity, it means that we’re always going to have this scenario where the provinces are responsible for this huge program, but they don’t have the money to deliver it and they need to go to the feds for that. And even if they decided they were going to somehow go it alone, it would be wildly different what one province could offer as opposed to another, because we have different physical capacities in different populations and different strains on our health care systems. It was always the case when it came to health care that even though we don’t have a national system, we have provincial systems, we wanted a national standard. We wanted nobody to be without just because of where they lived. I think that we’re seeing the strain on that system now. Maybe we’re thinking differently about what sort of role the federal government could play but as long again as we have It was always the case when it came to health care that even though we don’t have a national system, we have provincial systems, we wanted a national standard. We wanted nobody to be without just because of where they lived.
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