Can Ottawa take a yes for an answer on health care? Stay tuned
In the spring of 1940, in the face of rapidly darkening clouds of war, Winston Churchill quietly contacted Clement Attlee, a longtime opponent, to join a new unity government with some of his senior colleagues. The Attlee Agreement helped Britain win the war.
Four decades later, Pierre Trudeau, faced with a worsening recession, soaring energy prices and growing tensions with Quebec and the West, contacted Ed Broadbent and asked if he and some of his colleagues are said to be considering joining a government. Broadbent objected, knowing that the enmity towards Trudeau Sr. over issues like wage and price controls was too deep to fly. Trudeau then stumbled upon the disastrous National Energy Program on his own.
Four decades later, Canada faces a pandemic, a climate crisis and looming battles with the provinces – most often, perhaps, in health care. We have a new minority government – never good at inter-party dialogue, let alone federal / provincial – strutting once again as a majority government.
They face an interesting opportunity and test in the coming months, to show that they now also understand the importance of alliances and agreements across the aisle and country, especially in times of crisis.
The Council of the Federation (COF), the club of provinces and territories, has signaled in Ottawa that they are increasingly united and more willing to reach a deal on health care funding. As always, the negotiation will focus on the two thorniest questions: how much and for what?
If Quebec was less vocal in its perennial demand to “simply sign the bloody check and be silent”, this would give the premiers the chance to find bridges to agree on “conditionality” and on the amount, putting Ottawa in a difficult position. Justin Trudeau’s government demand for âconditionalâ health care funding is a bit insulting. Insisting on specific guarantees, like funding mental health care only for programs they approve, means that prime ministers are a collection of irresponsible spendthrift teenagers.
If Ottawa said “we would like to tell Canadians what you think you need funding the most for,” the Premiers’ response might sound more like “we have these six issues at the top of our list of needs, and together we will prioritize to any new money owed to them. Instead, Ottawa’s arrogance naturally gets a finger up.
Many premiers may be considering some form of performance evaluation of how they deliver health care. There have been discussions among experts about an existing national health studies institution, such as the Canadian Institute for Health Information, or a new one created for this purpose, carrying out annual evaluations of the goals. and targets achieved. If accepted by the COF, it would be a gift for Ottawa to seize. But it would take a counterpart.
The biggest noise is always made about the cost, but this is the problem much easier to solve. The federal Liberals have always governed as if spending had never been a real concern for their favorite projects. After those 20 spendthrift months, how could they credibly mourn for the future of healthcare? It would do the reputation of a somewhat weakened prime minister good for bringing about transformational change in federal / provincial health care management.
It has as a direct partner the Premier of British Columbia, John Horgan, President of the COF this year. Despite battles for his own health – as well as catastrophic flooding – Horgan has made it clear he will work hard to get health care results. He has had a good working relationship with the federal government, most recently in managing the disastrous year of fires and floods in British Columbia.
Trudeau may want to think seriously about the cost of being the Scrooge who blocked a great Christmas present for all Canadians – the prospect of reviving and renewing our crumbling healthcare system. More details on how that might play out – and what it might predict on a less resentful 2022 for our shaken federation – should arrive next week.