Federal and provincial health and finance ministers are set to meet in Ottawa on Dec. 19 to try to come to terms on a multibillion-dollar deal on how health care is funded. At issue is the federal Liberal government’s plan to cut the increase in its main health transfer payment to provinces from six per cent a year to about three per cent a year.
Not surprisingly, the provincial governments don’t like the sound of that. Some premiers are pushing hard for a higher annual “escalator.” But Justin Trudeau’s government wants any additional money, beyond the reduced annual hike, to be earmarked for federal priorities, notably home care and mental health.
Health Minister Jane Philpott, who is herself a family doctor and was chief of family medicine at Markham Stouffville Hospital from 2008 to 2014, spoke with Maclean’s to frame next week’s discussions. The interview has been edited and condensed here; you can hear the full conversation on this week’s Maclean’s on the Hill politics podcast. Subscribe on iTunes here, or wherever you listen to podcasts.
Q: It seems like the provinces would like to talk about how much Ottawa gives them overall for health care, but you would rather discuss targeting certain priorities. So what will be on the table when you meet with provincial ministers on Monday?
A: It would be my goal to have the discussion focused on health and how we can improve health in the country, and how we can support our provincial and territorial counterparts to give better access to care in some of our priority areas, like home care and mental health.
Q: What if your provincial counterparts just want to bargain about the escalator? Will you be leaving that for the finance ministers to discuss, since they will be gathering in Ottawa at the same time?
A: We’re working side by side, the finance minister and myself, from the federal level, and I suspect the same thing is happening at the level of the provinces and territories.
The reality is we were quite clear in terms of what we were prepared to do on health care. There have been significant increases in the investments in health from the federal level in recent years. In fact, the transfer is slated to continue to increase at an appropriate level.
But where we are interested in making further investments, beyond the transfer, is in areas where we believe that the system is not adequately serving Canadians, and where we believe that investment can actually be transformative.
Q: You say we need to do more in home care, in mental health services, and that sounds right to me. But, if those needs are so obvious, why is it not adequate to just increase overall transfers to the provinces, and trust them to spend appropriately in those areas?
A: Certainly, as we make further investments, it’s entirely appropriate for us to work with them to identify priorities. Areas like mental health and home care, we agreed upon, when I first met with [provincial] health ministers in January, as priority areas. We have lessons that can be learned from history. In the previous 2004 health accord, there were significant new investments in the transfer, but there was, I think arguably, less success in terms of actually transforming systems.
Q: So what went wrong? Why didn’t big, guaranteed annual increases in transfer payments translate into the right sort of health service improvements?
A: I think we can do much better at laying out ahead of time the particular areas where we believe that the that the investments should go, and what Canadians can expect, and then we can do better on measuring those so that we can see how well we’re doing over time.
On something like mental health care delivery, it would actually be relatively easy to make measurements, in terms of wait times for access to mental health, the amount of mental health services that are delivered to Canadians. It’s an area where I hear from Canadians every single day that they are struggling to access care. Provinces and territories have not had the opportunity to be able to invest in the delivery of, for example, psychotherapy for youth in distress.
Q: Do you think mental health has been neglected because it has never received the sustained lobbying for funds that’s been brought to bear on politicians over, say, wait times for heart surgery or joint replacements?
A: You can look back historically to when publicly funded health services were first being established in the 1950s and ’60s. There was a commitment made to deliver medically necessary care that was that took place in hospital or by physicians. And so by definition a lot of that mental health care doesn’t necessarily get delivered in hospitals and it isn’t. And it can often be effectively done by providers other than physicians. So it’s kind of fallen out of the basket of services that were covered under the Canada Health Act.
I also would say that, in fact, those who are suffering from mental illness are often by the very nature of their illness less able to advocate for themselves.
Q: We tend to talk about meetings of federal and provincial health ministers as though they are bargaining sessions. They’re not really, though, are they? I know you don’t talk in terms of ultimatums, but in the end, the provinces have no choice but to accept your policy direction, in order to get federal money, don’t they?
A: I think we’ve tried to indicate over many months now that we’re very open to hearing from provinces about how we can best support them. We’ve been quite sincere in our negotiations. I’ve asked my the counterparts to indicate to me what their plans are on improving mental health and what we might be able to provide them that would go toward that.
So I think there’s been good opportunity for them of input and we have certainly been making every effort to negotiate in good faith and say that we want to be a good partner and to do our part.