Recipients of Finance Minister
Jim Flaherty's largesse are still feeling a little giddy.
Most working in the health field aren't particularly
interested in whether the Conservatives' 2007 federal
budget was an attempt to bring on an election —
to them it looked like a very competent attempt to disarm
and win over potential opponents. And a generous one
at that.
CH-CHING!
By far the biggest news in this budget is the $1.2 billion
increase in the Canada Health Transfer to the provinces.
This was actually a planned installment of the 10-year
Plan to Strengthen Health Care, an agreement reached
between Ottawa and the territories in 2004. This agreement
called on provinces to reduce wait times, or at least
"work towards" patient guarantees of minimum wait times
in five key categories: cancer treatment, heart procedures,
joint replacement, sight restoration and diagnostic
imaging. The provinces were dragging their feet on this,
to put it mildly, with none having produced a guarantee
or even a plan for one by the beginning of this year.
So Minister Flaherty threw in an
extra $612 million as a sweetener, to be split between
provinces on a per capita basis — but provinces
are only eligible if they publicly present a draft plan
for a wait time guarantee in at least one of the five
areas by March 31. Only Quebec already qualified, earning
$127 million over three years for its plan, announced
in February, to guarantee maximum wait times in cataract,
hip and knee surgeries.
Mental health advocates are also
high on this budget. Not only did they get the Mental
Health Commission so long needed (Canada's the only
G8 country without a national mental health strategy),
they got one of mental health's strongest advocates,
former Senator Michael Kirby, as its chairman.
The CMA has a few gripes, pointing
out there's still no national strategy for ensuring
an adequate supply of doctors and nurses. The CMA also
believes that the Canada Health Infoway, the grand plan
to introduce electronic medical records for all, is
being shortchanged. The promised $400 million is not
much for a project that's ultimately expected to cost
$10 billion.
DON'T
WAIT!
At press time, Nova Scotia, Newfoundland and Ontario
had all squeaked in with wait time guarantee announcements
before the deadline and received big money in return
(Quebec already had guarantees thanks to the Chaoulli
decision). Federal Health Minister Tony Clement was
confident the rest would soon follow suit.
This part of the budget is, at
the very least, great politics. It's also pretty sharp
financial practice: Ottawa is seen to be attacking the
wait times problem, but is liable only for short-term
payments.
The money Ottawa's offering, while
more than enough to justify coming up with a plan, will
never pay for the wait times guarantees themselves,
because real guarantees like Nova Scotia's cancer radiation
plan require the province to fund treatment in other
jurisdictions if it can't meet its goals. Ten years
from now, Minister Flaherty's millions will be a distant
memory, but the provinces will still be bound to pay
for their guarantees.
A similar sleight of hand lurks
behind the headlines about the budget announcement of
a $300 million nationwide HPV vaccination program targeting
girls and women aged 9 to 26. It sounds great, but at
$435 per vaccination, $300 million is actually only
enough to vaccinate all girls aged 9 to 12. When asked
who's expected to pay for the bulk of this program,
Ottawa concedes it's the provinces.
TROJAN
HORSE?
The provincial governments aren't completely dim, of
course, and know the sums don't add up. But they don't
get to vote on the budget. The only province that has
dedicated representatives in the federal parliament,
Quebec, was singled out for especially generous treatment
in the great fiscal imbalance settlement (although that
didn't help Jean Charest win a majority in Quebec's
recent provincial election).
The fiscal imbalance debate is
all about healthcare, because what really forces the
provinces to constantly lobby Ottawa for money is health
spending. Almost all healthcare expenditure comes from
provincial treasuries, yet these represent only 60%
of the country's tax revenue. The remaining 40% goes
to Ottawa, whose healthcare responsibilities are minimal
by comparison.
That's why Ottawa consistently
turns in bigger and bigger surpluses, while the provinces
sink into debt. Before the fiscal imbalance was apparently
addressed by Minister Flaherty, it was estimated that
by 2020, the combined provincial spending deficit would
be about $12 billion, while the federal surplus would
be a phenomenal $86 billion.
Mr Flaherty's budget will transfer
$3.5 billion to the provinces annually. That's enough
to make a big difference now, when most provinces still
keep their accounts in or near the black, but it will
seem small indeed by 2020. Mr Flaherty has called it
a "once and for all" solution to the fiscal imbalance.
We haven't seen one of those since September 2004.
The opinions expressed are those
of the author and are not necessarily the views of the
National Review of Medicine.
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