It’s not unusual for health care to be selected by the Canadian public as a top election campaign issue. What is new this go around is the willingness of the Liberals and Conservatives to talk about it. Unlike the vague generalities characterizing their health care commitments in the last two federal elections, the two parties most likely to form government have been quick with some big-ticket commitments. We can probably thank the pandemic for that. It revealed the deficiencies in the health care system and shattered the over-riding obsession with spending restraint.
The main plank in the Conservative platform, released a couple of days into the campaign, is a promise to restore the six per cent a year accelerator to health transfers to the provinces. That’s the level that existed for a dozen years before the Trudeau Liberals followed through on the Harper government’s earlier plan and reduced the accelerator to the greater of nominal growth in the economy or three per cent.
The Conservatives claim that restoring the six per cent accelerator will cost the federal treasury $60 billion over ten years. The party’s platform – yet to be costed by the Parliamentary Budget Office (PBO) – also discusses long-term care and mental health. But aside from an extra $1 billion for indigenous mental health and drug treatment, it looks like the funding for other mental health and long-term care initiatives will come out of the increased provincial transfers.
The Liberal platform released this week looks to outbid the Conservatives, at least in the short run. The dollars start rolling in right away, with $6 billion this year for “eliminating backlog of surgeries and procedures” and $1 billion for a “COVID-19 Proof of Vaccination Fund.” There are additional smaller amounts this year to get things moving on these items to be rolled out over five years:
- $3.2 billion five-year to expand access to family doctors and primary care teams;
- $4.5 billion mental health transfer;
- $4.3 billion on top of $3 billion long term care money announced in the spring budget;
- $2.2 billion to ensure personal support workers are paid at least $25 an hour;
- $1.1 billion for virtual care and “expanding access to care in rural areas.
All together, the health care promises in the Liberal platform add up to $25 billion over five years. The increase to six per cent in provincial transfers promised by the Conservatives would, by rough calculation, cost no more than $18 billion over five years. The NDP has yet to release costing for its platform beyond its commitment for national pharmacare. The PBO has estimated the cost of the NDP plan at $38.5 billion over four years, putting the NDP in top spot in the health spending race on that promise alone.
The politics of it
Party platform commitments on federal health spending are only the beginning of the political machinations. Although the Liberals and Conservatives have abandoned their penny-pinching pasts, they are nowhere close to meeting the demands of the provinces, reiterated in a letter to all party leaders at the outset of the campaign. The provinces want an immediate increase of $28 billion to bring the federal share of health spending to 35 from the 22 per cent pre-pandemic share.(COVID-related spending, much of it coming from Ottawa, would produce a higher federal share for 2020 and 2021).
According to a analysis for the website Finances of the Nation, the Conservative proposal could raise the post-pandemic federal share to, at most, 27 per cent and that wouldn’t happen for some years. That percentage, if it comes about, would be a far cry from an earlier suggestion, reported here, that the Conservatives would increase federal funding to 50 per cent.
Despite the about face, the current Conservative promise is likely to be preferred by most provinces over the richer Liberal or NDP offerings. That’s because the Conservatives are content to transfer funds with no strings attached. For its part the NDP wants to spend big on a national drug plan – towards which most provinces are lukewarm – and the Liberals tend to pursue “national standards” by targeting increased spending to specific areas through federal-provincial agreements.
A factor that could blur the lines between the two approaches is the always-volatile vote in Quebec where the popular Francois Legault has been leading the Premiers’ campaign for an unconditional increase to 35 per cent. Going into the campaign the Conservatives with 10 seats and the Bloc Quebecois with 32 were all in with Legault’s no strings approach. If the Liberals and NDP want to add to their seat count, or even keep what they have, they may end up fudging the strings-attached issue. As for the Conservatives, they could suddenly decide that the six per cent increase is negotiable – upward toward something more closely resembling provincial demands.
Whatever happens, pledges by all of the major parties to increase health spending is good news for the Nova Scotia government. An influx of new federal money will make the Houston government’s health care “fix” more affordable. On the political downside, if a satisfactory fix doesn’t happen despite the windfall from the feds, the Nova Scotia PCs will have no one to blame but themselves.