patient room

Wither Medicare?

Health Policy

This is largely completely in response to a CBC article from a few days back, ‘End of medicare’: Maude Barlow raises alarm on health spending.*

In it, Ms. Barlow (speaking for the ever-vexing “Council of Canadians”) argues that health transfers from the federal government are being cut and that such cuts are to prompt partial or full privatization of services, and that this poses a significant threat to the health of Canadians.

The article struck a chord with me because it’s extremely wrong.  Not just a little wrong, entirely wrong. The cuts Barlow accuses the Government of making don’t exist.  Furthermore, even if they were making cuts that lead to partial privatization it wouldn’t be the most dangerous thing for our health.

First things first, to get the basic facts of the case out of the way:  the Government of Canada is not cutting health transfers to provinces.  The agreement currently in force guaranteed the provinces an annual increase of 6% in the Canada Health Transfer through FY 2016-2017.  Once it expires, its proposed replacement would link it to economic growth, which means the Parliamentary Budget Office figures that the average annual increase will be 3.9% between FY 2017-2018 and 2024-2025.  The current program isn’t being cancelled (i.e. cut), it’s expiring and being replaced with something that continues to guarantee an increase in funding (i.e. that funding won’t go down).  Yes, this is well below the estimated growth in state health expenditures 2007-2016 (6.1% according to the PBO).  So was the old strategy, which means that the federal portion of health spending will decline relative to provincial spending a bit faster than it otherwise would have. (Source for all:  Parliamentary Budget Office)

So there are no cuts, but the provincial share of health spending will increase.  Is this a bad thing?  No.

Provinces have almost the exact same revenue capabilities as the federal government.  As the Harper Government has lowered taxes at the federal level, room has increased to raise provincial taxes to fill the gap should it strike their fancy.  Provinces are generally reluctant to talk about raising their own revenues when it comes to health.  Their insistence that the feds should supply the money to fulfill their constitutional obligations can be chalked up to simply not being seen to raise taxes.  They can sell their voters on the myth that the new money comes from “Ottawa” instead of their own taxpayers through a different path.

It’s not the specter of federal cuts or privatization that threatens the health of Canadians:  it’s people like Ms. Barlow.  I mean this both in the ideological and demographic sense.  In the demographic sense, those who are currently north of 45 are expected to incur massive health care costs over their lifespan.  They’re living longer than ever before and working for a smaller portion of their life. The system has appeared sustainable because younger workers put in the taxes to keep the system going.  It’s unlikely that the system can survive unreformed in the medium term as the population ages.

One can’t fault Ms. Barlow for being a net burden on the healthcare system.  That’s the result of many choices made by Canada’s politicians, policymakers, and voters.  We can, however, fault her for perpetuating one of Canada’s less savory collective personality traits: a strong aversion to long-term thinking on health.  In its status as a national religion, Canada’s system is being left to falter because no one is willing to be the health system’s Martin Luther and say what needs saying.  Ms. Barlow and her generation, and perhaps even my parents’ generation, may get the care they want but my generation will be left out in the cold under the burden of excessive taxes to pay for services we can never benefit from.  It’s time to think about reform while we can, instead of when we have to.

*A quick shout out to the CBC: printing what is essentially a press release without any fact-checking is inappropriate.  A good place to start is trying to get a counterpoint.  Almost any health or budget policy analyst would have pointed out that those cuts do not actually exist and the CBC would have been saved the embarrassment of having to write a retraction on what is such an easy thing to check.

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