The fall session of the Nova Scotia legislature wrapped up Thursday – not with a whimper but a crack – as the government ignored opposition and expert advice and whipped through its flawed cyber bullying and adult capacity legislation. Those bills, along with a gormless cap-and-trade bill that will leave everything to cabinet regulation, were the dubious legislative highlights of the session. Question period and a lot of the budget debate were dominated by health care and its mismanagement.

Given that health care also monopolized the recent Nova Scotia election, one might have expected more attention directed to the diminished federal health transfers that are contributing to the problems. Some insist that money (or lack of it) isn’t the issue. That may be true, but we are having trouble finding family doctors and the ones we have are, on average, the lowest paid in the country. So there is at least a correlation between the issues everyone’s talking about (finding a family doc) and the one rarely mentioned (the tight-fisted approach of the Harper-Trudeau government to health transfers).

Thanks to the Nova Scotia Health Coalition, the subject of health transfers finally arose during question period a week ago Friday. The Coalition had put out a release pointing out that the health deal accepted by the McNeil government around Christmas time last year would cost Nova Scotia something like $1 billion over the next ten years.

The $1 billion figure was a little lower than the $1.2 billion I calculated in a piece last March using a slightly lower annual escalator. However, give or take a couple of hundred million, unless the national economy booms it is very likely that there will be a costly (to Nova Scotia) gap between what the provinces settled for and what we could justly demand. When NDP Leader Gary Burrill, citing the Health Coalition’s report, asked the Premier to admit he signed a bad deal, the ensuing exchange elicited from McNeil a response typical for the session just past. Every time the NDP asked a question, McNeil responded by distorting the NDP’s record in office and throwing it back at them.

What follows is an edited version of the exchange from Hansard for Oct. 20, starting with Gary Burrill questioning the Premier.

Burrill: A new report from the Nova Scotia Health Coalition finds that the Health Accord negotiated with the federal government last December will end up costing Nova Scotia close to $1 billion over the next 10 years because the Premier agreed to an escalator clause that falls so far short of the 5.2 per cent required to ensure the federal government pays its proper share. Mr. Speaker, the Premier was adamant at the time that this was a fine and fair deal for our province. Will he now admit that there is mounting evidence that he was wrong?

McNeil: Mr. Speaker, the honourable member…would know that when he was in government last, that escalator clause was negotiated with his Premier and the federal government, the former Conservative federal government….We went to negotiate it to ensure that there were hundreds of millions of dollars added, to ensure that we dealt with the escalating costs of home care…there’s also additional funding in that Health Accord to adolescent mental health. (Interruption)

The Speaker : Order, please.

McNeil: Thank you, Mr. Speaker. Again, I think it’s sensitive to them, the fact that the deal that they are referring to is one that was negotiated by their former Leader with the former Conservative Party…We’re going to continue to stand up and work with Nova Scotians to ensure they have access to primary health care.

Burrill: We have communities holding Chase the Ace events so they can buy lifts for their hospitals; we have nursing homes making cuts in diet and programming. Just this weekend, we have six emergency rooms across the province that are closed. The Health Coalition reports that the money Nova Scotia failed to negotiate in the Health Accord would have paid for 396 physicians. I want to ask the Premier, why did he negotiate a deal that put us so far behind the eight ball for dealing with the health care crisis?

McNeil: Mr. Speaker, the deal he is referring to, the base of that deal was committed to by that government. Thank God Nova Scotians booted them out…We negotiated on behalf of the people of Nova Scotia to have hundreds of millions of dollars added to that deal for home care, which is a priority for our government, which continues to reduce the home care wait-list, to provide supports at home for seniors where they want it…

Burrill: Mr. Speaker, I do hope that the Premier will not be looking to us to provide him with a reference as a history teacher. Now few, if any, government decisions will have negative consequences as long-lasting in our communities as the Premier’s negotiation of a health deal that does not account in its fundamentals for the realities of our older and our rural population…

Let’s look at the actual history, instead of McNeil’s version.

  • The health deal in place when the Liberals took office was not “negotiated” by the previous government. The Harper Conservatives imposed the deal on the previous government (and all provincial governments), decreeing in December 2011 that a 6% annual increase would end in 2017, to be replaced by smaller increases tied to the rise in the GDP.
  • As the 2012 Chair of the Council of the Federation, McNeil’s predecessor, Darrell Dexter, responded to the edict by working with the other provincial and territorial governments to seek negotiations with Ottawa for  a better health deal. When Stephen Harper refused to negotiate, the Dexter government joined the other Atlantic provinces as well as British Columbia and Quebec to press for a funding formula that would give a top-up to provinces like Nova Scotia with older populations.
  • During the 2015 federal election campaign, the federal NDP committed to retaining the 6% escalator. The Trudeau Liberals accepted the Harper government’s escalator and promised only to spend an extra $3 billion over four years for home care – worth about $7 billion less to the provinces than keeping the 6% escalator over the same period. The Liberals  made no commitment for a needs-based top-up.
  • McNeil and other Liberal Premiers in the region said little or nothing about health funding during the federal campaign helping to keep the issue – and the stark difference in party platforms – off the campaign radar.
  • Post election, there is no evidence that the McNeil Liberals vigorously pressed the Trudeau government for a demographic top-up, an idea that had support from both the Canadian Medical Association and the Conference Board of Canada.
  • Nova Scotia was one of the first provinces to abandon the provincial common front demand for a 5.2% annual increase to settle for a GDP-determined escalator, some targeted per-capita funding for mental health and home care, with no demographic top-up.
  • According to budget documents, as of next March 31, two and a half years into the Trudeau government mandate, Nova Scotia will have received a mere $8.8 million of new money for home care and mental health, the first modest instalment of the heavily back loaded “hundreds of millions of dollars” McNeil claims to have “negotiated.”

Instead of looking in the rearview mirror for someone else to blame for the federal and provincial Liberals’ health funding duplicity McNeil should spend more time thinking about the future of health care. A good place to start would be the latest annual sustainability report from the Parliamentary Budget Office. The PBO finds that the federal-provincial fiscal imbalance that began under the Harper government is continuing. Despite current deficits, the Office’s long term growth and demographic projections show the feds completely eliminating  their debt over the next 40 years. Meanwhile, provincial debt will increase more than three-fold without some combination of spending cuts or tax increases.

The principal cause of this potential debt down loading is increased health costs from an aging population, and federal contributions that do not keep pace with those cost increases. As a result, the PBO projects the federal share of health spending will drop by from 20-30% in the Atlantic Provinces over the next 25 years. In Nova Scotia, the federal share of health spending is projected to drop from 23% in 2016 to 18.1% by 2041. In the worst case, Newfoundland and Labrador, the federal share based on current trends is 13%, down from 18.6%. To preserve any semblance of a national system where the quality of health care is not determined by postal code, those percentages need to be going up, not down. The McNeil Liberals need to drop the partisanship, admit the flaws of the current health deal and work to fix them.