A New Health Accord

The Liberal government’s adherence to its campaign promises has been rather selective. Sometimes the substance of their positions is much like the Conservatives. Is that also true for health care?

Some examples so far:

  1. “We are committed to ensuring that 2015 will be the last federal election conducted under the first-past-the-post voting system.” The Prime Minister has been sending progressively stronger signals that no significant change will happen. Why, he asks, would people want change now that they have the government they want?
  2. “We will … partner with provincial and territorial leaders to develop real climate change solutions.” Nova Scotia certainly does not feel that the unilaterally announced carbon tax was a result of a partnership discussion. Ditto Saskatchewan. On the other hand, the Liberal platform explicitly committed to pricing carbon, so they should not have been surprised.
  3. “We will work alongside provinces and territories, and with First Nations, the Métis Nation, and Inuit, to enact the recommendations of the Truth and Reconciliation Commission, starting with the implementation of the United Nations Declaration on the Rights of Indigenous Peoples.” In July, Justice Minister Jody Wilson-Raybould called the adoption of the Declaration into Canadian law unworkable.
  4. “We will end Canada’s combat mission in Iraq.” The fighter jets were recalled, but they were replaced by up to 210 Canadian special forces troops on the ground near Mosul, supporting Kurdish Peshmerga fighters. This is probably more useful than planes. It is certainly more dangerous.
  5. “We will run modest deficits for three years … and credibly offer a plan to balance the budget in 2019.” The platform projected a current year deficit of $10 billion. The first budget speech raised that to $30 billion.

Which brings us to the Liberal promise on health care: “We will restart that important conversation and provide the collaborative federal leadership that has been missing during the Harper decade. We will negotiate a new Health Accord with provinces and territories, including a long-term agreement on funding.”

The background to this begins in 2004, when Paul Martin promised the provinces funding increases of 6% per annum for a decade. Stephen Harper honoured that promise and extended it to 2017, after which increases would be not less than 3%.

Many critics dishonestly characterized this as reductions in spending. “The federal Conservatives are cutting $36 billion from health care over the next decade,” said one. The Liberal Party website featured a similar comment, although it was removed before the election campaign commenced.

It has come as a bit of a shock to provincial health ministers that the Liberal funding offer is the same as the Conservatives. Federal Health Minister Jane Philpott points out that provincial spending on health has been growing much more slowly than the federal contribution.

She wants more evidence from the provinces that the money is going to health, including any new money that might be offered for home care—for which the platform promises $3 billion over four years.

It would be pretentious to suggest that this is a matter of “negotiation”. It implies that the provinces have something to offer to the federal government in exchange for the money, which they do not.

Assuming Ottawa sticks to its position, it will be difficult to characterize whatever emerges from the process as an “agreement”—and certainly not something that has resulted from a “collaborative”” conversation.

If there is anything new in the Health Accord, it will be a requirement for more accountability from the provinces. Not exactly what provincial ministers were hoping for.

It must be said that many of the Trudeau government’s decisions to differ from their platform have been good ones. The way we vote does not need changing. They are giving the provinces lots of flexibility on carbon tax. The UN Declaration is hopeless as a text for legislation. We should be supporting the attacks on ISIL in Iraq.

There is no amount of money that Ottawa can give the provinces for health care that will leave them satisfied. They should also skip the bit about accountability—it just means more irritable conversations and pointless friction.

The Liberals are much less concerned than the Conservatives were about balancing the books, and more active on climate change. But in a remarkably broad range of other policies, they find themselves choosing the Conservatives’ positions over their campaign promises. Not many pundits predicted that.

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