OTTAWA — Health care is a provincial responsibility in Canada but you’d never know it from the way federal party leaders are bitterly tussling over who can and can’t be trusted to improve it, put money into it, or altogether trash the universal public system Canadians hold dear.
All parties pledge to pour billions of dollars into health care. Where they differ is in their philosophies about how best to spend and target that money, and whether the provinces should get more health-care dollars with no strings attached.
Canadians often cite health care as a main concern but don’t base their vote on it. A pandemic election may be different, says Prof. Kathy Brock of Queen’s University’s school of policy studies, as people weigh concerns about their economic security and personal, physical security.
So week two of the federal campaign has begun with a promise by Liberal Leader Justin Trudeau to spend an additional $9 billion to press provinces into hiring 7,500 more family doctors, nurses and nurse practitioners, and to reduce wait times while improving access to primary care — promises that echoed pledges made in 2019. That’s in addition to $9 billion Trudeau promised Friday to hire more personal support workers and improve long-term care. Both promises fall squarely on provincial turf.
Trudeau’s proposals came with a pointed attack on Conservative Leader Erin O’Toole, whom Trudeau accused of supporting two-tier health care — the so-called “third rail” of Canadian politics, where a misstep can zap and fry electoral hopes.
Trudeau doubled down Monday on an edited video clip which the Liberals had used to claim that O’Toole would undermine Canada’s universal, publicly funded health care system — and which Twitter red-flagged as “manipulated media.”
In it, O’Toole said “yes” when asked if he would allow provinces to experiment with allowing private and not-for-profit services, and that he would leverage innovation in the private sector to address a public system that was becoming “inefficient.”
“If we want to see that innovation, we have to find public-private synergies and make sure universal access remains paramount.” O’Toole said. “Everyone’s wait times will go down.”
Twitter issued a warning about the O’Toole video because the Liberals had edited out the part where the Conservative leader said he supported universal access to health care. That didn’t stop Trudeau from doubling down, charging in a Halifax appearance that O’Toole “came out unequivocally in support of private health care, in terms of for-profit health care.”
In Ottawa, O’Toole flatly denied Trudeau’s assertion — “I one-hundred-per-cent support our public and universal system,” he said — but he did not answer when asked what kinds of privatized services he would allow provinces to expand under the Canada Health Act.
He cited the Conservative platform pledge to increase the annual transfer of health-care money Ottawa sends to provinces, and said he would provide it in a “predictable, stable and unconditional” manner.
Steve Staples, national director of policy for the Canadian Health Coalition, a group of organizations and unions that advocates for public health care, said the parties have to address the pandemic’s toll in long-term-care homes, and said unconditional transfer payments for health care are “a poison pill” to many.
“How could anybody with a straight face say that we should continue with a more privatized health care system?” he asked in an interview.
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“Clearly, the failure of private, for-profit, long-term-care facilities as exposed during the pandemic has to be corrected. And the NDP is addressing it by phasing out long-term care in favour of the other two (kinds): public or non-profit. Conservatives seem to want to go in the opposite direction. And the Liberals don’t seem to be addressing the elephant in the room, which is the for-profit providers.”
The Liberals say they are running on their 2021 “budget, plus” agenda. The budget laid out more than $9 billion in new spending over five years on health measures. Trudeau has not yet released a full platform with a price tag on what “budget, plus” would cost.
Yet he is contrasting his party with the Conservatives on health-care issues like mandatory vaccinations for federal public servants and air and rail passengers, and their candidates — which the Liberals and NDP support, but the Conservatives do not.
O’Toole would increase yearly transfer payments to the provinces for health care by three per cent from the level where Stephen Harper’s Conservative government first set it, and Trudeau’s retained it, doubling the cap on increases to six per cent a year. That would cost, the Conservatives say, nearly $60 billion over 10 years — money that would be tied in part to the Conservatives’ priorities of mental health and addressing the opioid crisis.
But he also left open the possibility of increasing Ottawa’s annual contribution by more than six per cent as the economy recovers.
Trudeau says the Liberals would increase the transfer payments as well, but only after sitting down with provinces. He has not specified how much.
Speaking in Trudeau’s home riding of Papineau in Montreal, NDP Leader Jagmeet Singh said neither the Liberals nor the Conservatives can be trusted on health care.
The NDP wants to expand the public health care system to cover pharmacare, eye care and dental care, and would eliminate for-profit services in long-term care; in other words, it would have conditions attached to an increase in Ottawa’s health-care spending. But the NDP has not costed its package and is waiting on the Parliamentary Budget Officer’s tally.
The provinces and territories want an immediate injection of $28 billion, which would raise Ottawa’s share of health funding to 35 per cent from the current 22 per cent — and they want it with no strings attached. Plus, they want the annual increase boosted to more than five per cent a year.
Brock, at Queen’s University, said the reality is Canada has a “largely public system, but with a lot of private aspects.” Doctors have private practices and bill government for their services; workplace benefit programs provide additional health insurance for coverage of things like medications, or private hospital rooms. Worker compensation plans allow for private MRIs to be covered. Executive health services offer a bypass of emergency waiting rooms to clients who pay.
At a time when COVID-19 test kits were scarce and provinces gave priority to high risk or vulnerable individuals or those who had symptoms, private health clinics offered COVID-19 tests at between $50 and $250 for those who could afford to pay. Federal MPs had access to private testing, and O’Toole — who used the service — used it as a political talking point to criticize the lack of available tests in the public system at the time.
Brock said some Canadians may support diversifying suppliers of medical services “but with clear government regulations, clear government rules” while others will say “No, we want publicly funded made-in-Canada provisions to the maximum possible degree.”
She added Twitter’s label about the Liberals’ tweet is a warning to all parties early on in the campaign: “You have to be careful. In Canada, we expect more reasoned debate. So let’s engage in it.”
Tonda MacCharles is an Ottawa-based reporter covering federal politics for the Star. Follow her on Twitter: @tondamacc
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