No Health Deal. Now What?

Well, I just finished watching the federal health and finance ministers discuss the failed federal transfer health deal on the news.  I suppose coming just a few days before Christmas, a dispute over federal health transfers can become a new sort of Canadian holiday tradition given it has happened before with the December 2011 unilateral transfer decision announced by the federal government.  

The provinces are walking away from a deal that would have provided a 3.5 percent annual increase in the Canada Health Transfer as well as additional billions (11.5 billion over ten years) targeted for mental health and home care.  The provinces are upset with the amount of the increase - less than what they say they need as well as the intrusion into provincial affairs by the money being pointed at mental health and home care.

I suppose this type of operatic performance by assorted provincial health ministers must make Prime Minister Justin Trudeau pine for the days of Harper approach to federal provincial relations.  What is a federal government to do?  I think given the failure of reaching a deal, the federal government should simply revert to what was supposed to kick in starting in 2017.  That is, increases tied to the increase in nominal GDP subject to a floor increase of 3 percent.  Indeed, the CBC reported Finance Minister Morneau has said just that- 3 percent as of April 1st 2017.  This has been what the provinces have been expecting since 2011 and should not come as a surprise.

A more cynical observer of federal provincial relations might argue that this has turned out just like the federal government would have liked.  Having the provinces walk away has allowed the federal government to say that they tried to give the provinces more while reverting to the smaller increases set under the Harper government.

Comments

[Tim]

I have an interesting historical and constitutional question. What happened to the old "marine hospital" system that was/is constitutionally a federal program? In particular it is my understanding that the Federal government was/is supposed to provide a marine hospital system in certain provinces such as BC and Newfoundland as part of those areas acceding to confederation. How would the SCOC interpret the Marine Hospitals clause in the present day. Could Ottawa use this to bypass the provinces in terms of Health care delivery? What would be the response of Quebec? I assume that once long long ago there was a "Marine Hospital" in Montreal given its importance as a port.

[Jacques René Giguère]

There was one in Montréal
https://archivesdemontreal.ica-atom.org/marine-hospital-18
and one in Québec City,though it seems that responsibility was unclear and may have varied from time to time
http://www.banq.qc.ca/ressources_en_ligne/intruments_rech_archivistique/hopitaux/marine.html

[Jacques René Giguère]

There were federal hospitals for veterans in Québec City and Sainte-Anne-de-Bellevue in western Montréal (there may have been others).
The one in QCity was transfered to the province somwhere in the early '70's to become an hospital for the Université Laval (not to be confused with the Hôpital Laval a few kms away.
The one in Montréal was recently transfered and became a CHSLD, specialising in chronic care as this what is has been transformed by the passage of time.

[Livio Di Matteo]

The point about marine hospitals is quite interesting. Along with that, I believe there was also federal power over quarantine.

[Tim]

Jacques,

I knew the veterans hospital in Montreal had only been transferred quite recently and long ago there had been other veterans hospitals in other provinces along with DND military hospitals too. I believe some "regular" hospitals such as Montfort in Ottawa have specialized military medical departments nowadays in place of having standalone military hospitals such as the Americans have.

One of the general problems in healthcare worldwide is politicians really don't like closing hospitals even when they are largely empty.

[Shangwen]

Tim, the marine hospitals (new term to me, I assume you mean DND-run and veterans' facilities) are possible because the constitution exempts the military (and other groups) from provincial coverage. The Veterans' facilities fall under the fed mandate to provide supplementary benefits to Veterans. There is no longer even a DND "hospital", just a floor at the Montfort Hospital in Ottawa. Now it's all farmed out to the provinces, private clinics, and some out-of-country care. The federal government can't use this to bypass this and create hospitals for its own policy priorities for the general public, which is what I assume you're saying.

I am glad the ministers walked away. There is no real indication that the problems in mental health care are related to lack of funding, and a low growth rate in general is better.