CUPE Health Care

What if the Prime Minister linked a climate deal to a health deal? That could be politically explosive. But McGill economist Chris Ragan thinks it's a good idea. One reason is that Mr. Ragan thinks the federal government will end transferring more money to the provinces anyway. Although the growth in provincial health spending has actually slowed in recent years, there are forecasts that it will grow by 3 per cent of GDP - by 2040. Mr. Ragan figures Ottawa will eventually give in, and might one day pay a third, that would be about $30-billion in 2027. The feds might as well admit it now and get a climate-change deal out of it, he argues. In other words, mix talks on health and climate together. "The more things you choose to put on the table, of course it becomes more complicated, but it also becomes a lot easier," Mr. Ragan said. "Because one of the things you bring to the table is a bunch of money."

There are a few problems. One is that Mr. Trudeau's government already wants something else from the provinces, a deal on home care. Ottawa is offering $3-billion and wants provinces to agree to meet targets for home-care services. Another is that Ottawa might not be ready to concede that it's going to have to transfer more to provinces. The recent years of slower growth in provincial health-care costs is an argument that the provinces don't really need the extra money. But that doesn't mean it will stay that way: Many economists believe those costs will rise sharply again in the near future. Then there is politics. Health transfers are to help the sick. Linking it to something else is likely to be seen as crass. But in the end, health-care transfers are dollars, and no one can really identify which dollar is spent on what. Mr. Ragan suggests they could be spent both on health and a climate deal.

Mr. Ragan is also chair of the Ecofiscal Commission, an organization of economists studying climate policy, which argues pricing carbon is the most efficient way of reducing greenhouse-gas emissions, because it will cost the economy less. The Ecofiscal Commission's models indicate that as long as the revenues are pumped back into the economy in the right ways, the costs of carbon pricing will be modest. In other words, if you are going to reduce emissions, a carbon price is the least costly way. In fact, the premiers, including Mr. Wall, agreed last spring to work on carbon-pricing options. Ms. McKenna is now brandishing a federal carbon tax as a stick to demand they seal a deal. But money is the traditional carrot. Mr. Trudeau might find it too politically dangerous to link health transfers to a climate deal. But it would allow him to offer what it usually takes to make a deal: money.

The provincial government has only exercised the right to appoint a supervisor to Ontario hospitals 21 times since 1981. But CUPE, which represents more than 300 BGH front line staff, called the move "an optics exercise to distract from the significant provincial funding shortfall." The union said it relied on the latest figures from the Canadian Institute for Health Information (CIHI), to conclude the Ontario government's funding for hospitals is $1,395.73 per capita. The rest of Canada, excluding Ontario, spends $1,749.69 per capita, the union added. CUPE's own research shows that average Ontario hospital funding for a population the size of Brockville in 2005-06 would have been about $1.04 million less than average funding for the same population outside of Ontario. By 2015-16, the union adds, the funding difference would have reached $7.74 million.

That much more money every year would put an end to BGH's financial distress, added Hurley. "We're advocating for the hospital to receive an infusion of funding," he said. Leeds-Grenville MPP Steve Clark has also pointed to the provincial funding model as a "primary factor" behind BGH's fiscal woes. Staffat the Ministry of Health and Long-Term Care did not immediately respond on Friday to a question about CUPE's funding figures, but defended the appointment of a supervisor.

In an email to The Recorder and Times, spokesman David Jensen said the supervisor's appointment is based on a recommendation by the South East LHIN, which cited "ongoing concerns about the hospital's financial situation and organizational challenges." Jensen cited local media coverage "regarding the organization's financial challenges as well as other organizational issues facing BGH. "The appointment of a supervisor will help to move the hospital forward to achieve its goals and foster the development of more positive relationships," wrote Jensen. At this stage, added Jensen, the supervisor appointment is still a recommendation to be made by Health Minister Dr. Eric Hoskins.

"If appointed, a hospital supervisor would work with the hospital and government to support robust governance and management at the facility," wrote Jensen. The minister has notified BGH of his intention to recommend to the Lieutenant Governor in Council that a hospital supervisor be appointed, added Jensen. The Public Hospitals Act provides for a 14-day notice period, after which the supervisor can be appointed.

However, until now no federal government has had the nerve to take on serial offender Quebec. Quebec has been allowing its doctors and clinics to charge extra user fees since 1979. The province's current health minister, Gaetan Barrette, freely acknowledges this. In some cases, these fees were truly exorbitant. The Montreal Gazette reported last year that some colonoscopy clinics were charging patients an extra $600 for medications - on top of the publicly paid medicare fee. Many Quebecers were outraged. The provincial Liberal government's somewhat peculiar response was to pass a bill codifying the practice of extra-billing but giving itself the authority to regulate it. In March 2015, the then-Conservative government in Ottawa formally notified Quebec that it would be looking into the issue. This March, Liberal Philpott sat down with Barrette to discuss the practice. On Sept. 6, she sent her provincial counterpart a letter threatening cutbacks to Quebec's health transfer. A few days later, Barrette announced that extra billing will end as of next January.

It is hard to gauge the importance of Philpott's threat. User fees have become widely unpopular in Quebec. That alone may have been enough to drive the provincial government to disavow them. Still, it was bracing to see a federal health minister publicly standing up for the principles of medicare. It is not an everyday occurrence. It is particularly interesting that she targeted a province that is notoriously touchy about what it sees as federal interference. Perhaps she will do more. Certainly, more needs to be done. The latest annual report on the Canada Health Act filed with Parliament notes that private MRI clinics in British Columbia, Alberta, Quebec, New Brunswick and Nova Scotia are charging user fees to patients. It says some hospitals are avoiding the ban on charging for drugs by routing the sick through outpatient clinics - which do charge. It also notes that the portability requirement of medicare, which allows Canadians to receive care outside their home provinces, is routinely ignored.

Quebec routinely refuses to fully reimburse other provinces that provide health services to Quebec residents. Yet it has never been penalized by Ottawa for this. Nor have an unspecified number of other provinces that, at one time or another, did the same. Except for Prince Edward Island, the report says, no province appropriately reimburses residents who obtain medical care outside Canada. Such patients aren't necessarily entitled to the full cost of their out-of-country care. But they are entitled to be reimbursed for the amount it would have cost them to be treated in their home province. To work as a national program, Canadian medicare needs two things. First, the federal government must put up enough money to give it a real financial role in the system. The 2002 Romanow royal commission suggested that Ottawa provide at least 25 per cent of medicare funding. That figure still makes sense. Second, Ottawa has to use its financial clout to enforce those few national standards that do exist. A former Liberal health minister, Diane Marleau, tried to do this back in the 1990s. She was sandbagged by Jean Chrétien, the prime minister of the day. Let's hope Philpott has better luck.

It was bracing to see a federal health minister stand up for medicare principles, writes Thomas Walkom.