Health Care Delivery Is Best Managed By The Provinces

Providing health care is a provincial responsibility. The COVID pandemic has shown why that is a good thing.

At the outset, public health officials had little science to inform them. It took months to understand the means of transmission, who might be the most vulnerable populations, and what restrictions to impose. Remember the unfortunate officials urging people not to touch their faces, while unconsciously doing so?

The learning continued, with lockdowns being imposed of varying duration and severity. New variants have arisen requiring shifts in tactics. As the period of restrictions grinds on, people experience mental health issues, especially those living in cramped quarters or financial distress.

Each province’s response has been led by a team headed by its chief public health officer and premier. As the pandemic ebbed and then resurged, they adopted different strategies, some more successful than others. Provinces learned from each other.

Closing schools for in-person learning was felt to help reduce transmission. Doing so causes significant stress for both students and their parents. As this became more evident, provinces have become reluctant to close them. British Columbia schools did not close at all in the spring of 2020.

Some provinces have been willing to have closing strategies that differ by region. Nova Scotia belatedly joined that group, initially keeping schools in Halifax and Sydney closed when letting the rest of the province reopen.

This kind of granularity in decision-making has been very important. If restrictions are always province-wide, they will either be too strict for some parts or too loose for others.

Provinces have also been able to prescribe restrictions on travel across and within their borders.

Likewise, distinctions have been made by the economic sector and formulated in consultation with each. Thus the construction sector in Nova Scotia has been able to remain open since the beginning of the pandemic. Arts and sports organizations, faith leaders, retailers, personal service businesses, offices, and not-for-profits have all received restrictions based on their operating environments.

The public health leaders who consult the various sectors are the ones that announce their decisions at press conferences. The premiers play an important but secondary role, mostly in dealing with the broader consequences of public health measures that disrupt travel, schooling, and many businesses.

Imagine what it might be like if instead the operation was being directed out of Ottawa. Would a federal government choose to isolate individual provinces, let alone form an Atlantic bubble? And if they did would there be much greater resentment from outside those bubbles?

How would a federal government explain that construction could continue in Nova Scotia but not in Ontario? How would fine distinctions be made between Sydney and the rest of Cape Breton Regional Municipality? How would there be learning between different provinces?

Yes of course there would be people on the ground in each province, but they would always be constrained by a national policy context. Would Bonnie Henry in British Columbia or Nova Scotia’s Robert Strang be as credible if they were reporting their orders from Theresa Tam in Ottawa?

Yet there is a steady drumbeat of experts arguing for a federal role in delivering health care, on the grounds that it will deliver better results.

Thus on April 6th, Carolyn Hughes Tuohy of the University of Toronto argued in the Globe and Mail that because the federal government provides funding toward long-term care, they should have a role in managing it.

In support of her argument, she points to the Canada Pension Plan which is entirely managed by the federal government except for joint decision making on the infrequent occasions that benefits or contributions are being adjusted.

She points out that “Ontario’s COVID-19 fatality rate per 100 long-term care residents was about four times that of British Columbia”, with the implication that federal guidance would have resulted in BC’s better experience.

Ottawa is responsible for ensuring adequate resources for pandemics, rather than having each province struggling to find them on global markets. Yet the arrival of the COVID pandemic found us woefully short of many personal protective items such as N95 masks. The government was also slow to purchase vaccines. That we are doing well now is because the United States no longer needs its full output.

What is to say that federal oversight of long-term care would have produced BC’s experience instead of Ontario’s?

Other advocates insist that Ottawa should be dictating national standards on all Medicare services in exchange for their funding, in the hope that it would equalize quality across the country. When Medicare began, the federal government paid half of the cost, a proportion that they later reduced.

Hence the skeptical reaction to the Trudeau government’s proposals for child-care programs or pharmacare.

Under Janet Knox, the Nova Scotia Health Authority centralized decision-making. This constrained the ability of hospital care leaders to make sensible choices based on local conditions. How much worse that would become if management came from Ottawa in a vain effort to achieve equivalent outcomes across the country.

Health care delivery is a top political issue and will always have challenges. Federal management would not make it better.


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