Justin Trudeau’s imminent departure has led to an outpouring of commentary on his legacy, both pro and con. Although the latter has been dominant, his detractors have not paid much attention to his record on health care funding, a record that deserves a prominent place amongst the cons.

I’ve written many times the last nine years about how Trudeau and his succession of  Ministers of Health have dangled various strings-attached bilateral health deals in front of the provinces while steadfastly refusing provincial demands to restore health transfers to the annual six percent escalator in place between 2004 and 2017.

After avoiding them for years, Trudeau finally agreed to talk health funding with the provincial premiers two years ago. The meeting resulted in a deal providing unconditional five percent annual increases in the Canada Health Transfer from 2023 to 2028, up from the three percent growth guarantee in effect between 2017 and 2023. Reached in February, 2023, the agreement also promised $25 billion over ten years for bilateral deals, strings attached. 

As discussed here the five percent annual growth and the potential side deals left funding well short of what the provinces claimed was needed to sustain a robust publicly-funded system. The provinces went into the meeting seeking $300 billion from the feds, but left with less than $50 billion in new funding. 

As I wrote at the time:

The premiers’ failure to get what they were asking for is no surprise, given their ineffectual campaign and the damaging optics of arguing about money amidst a crumbling health system. But the scale of their setback is shocking and bodes poorly for the future of universal health care in this country…. 

In the immediate future  nobody knows how the limited amount of new federal spending will improve the situation. By international standards we don’t have enough family doctors, hospital or nursing home beds. We may have enough nurses, but too many of them are exiting the public system because of dire working conditions. Wait times for elective surgeries are far too long, too much of prescription drug costs are borne by individuals and families, and mental health services are inadequate. 

Some, if not most, of the Premiers who accepted the crumbs on offer this week, would have no ideological objection to embracing more privatization as one response to the crisis. That would not solve anything, but by limiting its fiscal commitment, the federal government has left that door open wider. 

On privatization, there has been an increase in for-profit delivery of publicly-funded health care going back several years, and more recently private operators such as Telus have been caught charging fees to facilitate access to publicly-funded health care providers. However, recent estimates from the Canadian Institute for Health Information (CIHI) show no significant change in the ratio of public-to-private health spending – 71 cents of every dollar spent on health care in Canada still comes from public sources which has been the case for years.

As for the 2023 deal’s impact on the health care crisis, the federal-provincial agreement includes monitoring progress in five priority areas but it’s too soon to draw any conclusions. However, as reported here one early finding from the CIHI-led process is that access to primary care is significantly poorer in the Atlantic Provinces than in the rest of the country and appears to have become worse in 2023. 

Furthermore, with recent population growth, the inadequacy of the federal transfers under the 2023 health deal is being exposed. In 2023, thanks to the new growth escalator and a one-time top up, the CHT increased by 9.3 percent. But population went up by almost three percent in 2023, reducing the per capita increase to 6.2 percent. And in 2024, without the top up, the CHT increased by 5.4 percent but with another three percent increase in population the per capita increase was only 2.3 percent – barely above the rate of inflation. Per capita increases were even lower for Nova Scotia – going from a rise of 6.4 percent per capita in 2023 to 2.3 percent in 2024 and projected to drop to 1.9 percent this year.  

Population growth is expected to slow down over the next couple of years which will likely mean a reversal in the downward trend in CHT per capita. However, that relief will be short-lived, as the five percent escalator negotiated in 2023 is set to expire in 2028, to be followed by a return to the three percent growth guarantee that prevailed from 2017 to 2022.

What all of this means is that despite the bandaid applied through the 2023 agreement, federal health transfers should be put back on the agenda. 

The Premiers, through the Council of the Federation, could re-open discussions about the billions foregone in 2023. The rotating chair of the premiers’ group  has come around to Ontario’s Doug Ford. Currently occupied in fighting possible Trump tariffs, Ford and the premiers should soon turn their attention to the future of health transfers and how a possible Pierre Poilievre government would deal with the issue in light of Conservative promises of “fix the budget” and guarantee more “powerful paycheques.” 

According to a report in The Walrus magazine, Poilievre has committed to maintaining the 2023 health deal – no big surprise given that should the Conservatives win the next election the five-percent-a-year increase guarantee would be just two budgets away from dropping to only three percent, with likely dire consequences for the less-wealthy provinces.

By promising to maintain Trudeau’s 2023 agreement Poilievre may succeed in taking health funding off the table during the upcoming election campaign – unless it is placed there by the Premiers. For the sake of our already endangered health care system and their own credibility, tattered from their 2023 cave-in, the Premiers should do that forthwith.

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