Many Canadians believe that the Canada Health Act is the bulwark that is supposed to be protecting public health care and that it should ensure comparable levels of coverage across the country. Yet, if one examines per capita provincial government health spending, the evidence shows that there are major differences.
Let us move now to the Canadian Constitution Act, 1982, specifically Section 36, which reads:
36. (1) Without altering the legislative authority of Parliament or of the provincial legislatures, or the rights of any of them with respect to the exercise of their legislative authority, Parliament and the legislatures, together with the government of Canada and the provincial governments, are committed to
(a) promoting equal opportunities for the well-being of Canadians;
(b) furthering the economic development to reduce disparity in opportunities; and
(c) providing essential public services of reasonable quality to all Canadians.
(2) Parliament and the government of Canada are committed to the principle of making equalization payments to ensure that provincial governments have sufficient revenues to provide reasonably comparable levels of public services at reasonably comparable levels of taxation.
My point is as follows. There seem to be major differences across the provinces in terms of what is being spent per capita on public health care. How wide a difference in per capita public health spending is consistent with reasonably comparable levels of public services? Income and consumption tax rates are not that divergent across the provinces – indeed, net of natural resource revenues, the differences in per capita own source revenues do not seem as stark.
I realize that Section 36 is a statement of broad principles and principles are not exactly judiciable but at the same time, what’s a good lawyer for if not to press the boundaries of the law? I guess what I’m wondering is why Ontario in particular but also Quebec and British Columbia have not taken the federal government to court and argued that based on per capita public health expenditures they are not able to provide reasonably comparable levels of public health services and clamour for additional payments to boost their health spending closer to the national average. Can the federal government argue that the differences are not due to fiscal capacity but simply represent a provincial choice over resource allocation? Can they argue that health is a provincial responsibility and jurisdiction over health means that they can diverge in per capita spending and that the federal government has already ensured equity by making equal per capita health transfers? What should the standard be when it comes to health care spending? Should it be per capita spending? The share of provincial budgets devoted to health? Am I missing something?