Health-Care Funding

Spring 2003 CSANews Issue 46  |  Posted date : Apr 15, 2007.Back to list

Several members and even a Director of the Canadian Snowbird Association have shared their personal experiences with us describing how the provincial governments of Canada have been applying their residency requirements "by the book" to the personal detriment of these otherwise respectable citizens of Canada.

In this and future issues of CSANews we will explore the funding and functions of the various levels of Canadian government that have the power to aid or alienate us in our quest to exist as we desire and so richly deserve.

Our first excerpt explores the trickle down funding process that ultimately leads to the short sighted application of residential status and the restriction of health care benefits to citizens while at home in Canada.

Health care is probably the most common subject covered in today's popular Canadian press. Rarely does a day go by that some aspect of our health-care system, or lack thereof, is exposed in daily print, radio or television news. In addition, health-care stories are always covered in the front section of the newspaper; this reinforces the subject's broad relevance as opposed to subjects covered in the more specialized sections that follow. Why does the subject consistently carry such a high profile? The immediate answer, which Canadian snowbirds know all too well, is that we all require reassurances that we will be taken care of when it's our turn to rely on the system to take care of our loved ones and/or ourselves.

The second answer is that health care is a mega-industry in which we are commonly invested like no other. The health-care basket carries a huge collection of our national eggs and, as a result, will always be a source of major interest to Canadians everywhere. The Canadian Institute for Health Information (CIHI) recently reported that in the 2002/2003 fiscal year, provincial/territorial governments will spend close to $68 billion on health care. This is up from $66 billion in the previous year. CIHI also reports that in the past five years, provincial and territorial governments have been investing in health care at an increasing rate that is, on average, higher than in any other five-year period since 1975.

Canadian governments and their leaders are well aware of how much press health care receives, and why. As a result, they are constantly trying to move stories and headlines in their favour. This has been particularly noticeable with efforts of current provincial premiers and health ministers to secure more federal funding for health care.

Public health care, like many endeavours funded by Canadian governments, is managed through constitutional arrangements that give the highest taxation powers to the federal government but responsibilities for service delivery, or spending powers, to provincial governments. This causes provinces to be heavily reliant on federal funding transfers when delivering the services for which they are responsible, including health care. Naturally, this also causes constant negotiation and struggle for reaching agreement on how much money the federal government must give to enable the provinces to fulfil their responsibilities. Many of these negotiations are carried on publicly through the popular press.

At the beginning of this year, Canada's provincial premiers formed The Premiers Council on Canadian Health Awareness. This well-funded organization has become an important contributor in the effort to secure favourable public support for the provinces' efforts to gain more federal money to cover the heavy burden of their health-care responsibilities. Recently, the organization launched a national ad campaign arguing that, for years, the provinces have been forced to manage their health-care systems with less and less federal funding.

The campaign begins with a bold and frank statement from provincial leaders telling Canadians that, "We're not looking to spend less on health care, we're just looking for the federal government to spend more."The provinces emphasize that the initial deal for covering public health care was a 50/50 cost-sharing agreement between the federal and provincial/territorial governments, and that this has eroded to a situation in which, today, the federal government pays only 14 cents of every dollar that is spent provincially. A further concern is that this reduced commitment from the federal government has come at a time when public health care must address the realities of an aging population, increased demands for medical technology, home care and hospital availability.

The response from the federal government has been that the provinces aren't telling the complete story. The feds argue, on their finance Web site, that the provinces are comparing only the cash portion of the Canadian Health and Social Transfer (CHST) to all of their social spending, including social services and education. They also argue that the provinces haven't considered other contributions, such as $16 billion worth of tax points (tax dollars that were previously collected exclusively by the federal government but may now be directly collected by the provinces) and more than $10 billion given through an equalization program designed to reduce the difference between wealthy provinces and those with fewer resources.

Further, the federal government claims that the provinces don't consider $5 billion in direct contributions to health made through federal activities. These include First Nations' health, health of veterans, national health promotion and protection, innovation and research, health information and health-related tax credits for medical expenses, disability, caregivers and infirm dependants.

What's clear in this mess is that, since its birth in the1960s, public health care in Canada was unintentionally allowed to evolve into a situation in which health dollars are collected, prioritized and distributed at all levels of government in a far too murky and confusing environment. A big part of the problem is that federal funding for health care is currently part of a global block of funds that the provinces may use for a wide range of programs within their mandate. Unfortunately for all of us, this has made it unnecessarily easy for governments to pass the buck and point the blaming finger in other directions when confronted with growing public concern.

What all levels of government must remember is that Canadians expect them to work together to meet the demands of good health care and we don't really care about intergovernmental funding squabbles. Instead, we are still waiting for the answers to real questions such as what services should be covered publicly, and to what extent? Publicizing arguments about funding transfers may be part of the process, but has little to do with our real concerns. It is true that Canadians have more than one government, but they have only one wallet. What's really needed is the reassurance that our collective investment will pay off when the time comes.