Health care budget tensions return

(Anja Niedringhaus/Associated Press)

The federal government will bring down its budget in March. And the federal finance minister has already signalled there will be a bit of belt tightening, as Ottawa tackles a growing deficit.

But Jim Flaherty has also promised to leave transfers to the provinces alone.

The health care accord, signed in 2004, has given the provinces predictable increases every year in the amount of money they receive from Ottawa.

But that accord expires in March 2014.

And that has people starting to wonder what might replace it.

People such as Dr. Robert Roberts, the president of the Ottawa Heart Institute.  When he took over six years ago, it took six months to get a cardiac catherization, a routine diagnostic procedure. But after building new labs, and renovating others, Roberts says the wait is now much shorter.

"And as a result, we now have a wait of two or three weeks, so that's one good example," Roberts said.

But despite a $50 million investment, Roberts predicts wait times will become a problem again.

"We estimate over the next few years there will be a 15 per cent increase in people who will move into that age bracket who will require more [treatment for] heart disease, and so while we are well-balanced at the moment to meet the needs, somewhere in the next five or six years we will plateau again, and require further facilities."

When Roberts was taking over the heart institute in 2004, former prime minister Paul Martin was signing a ten-year health care accord with the provinces, promising it would be a fix for a generation.  But was it?

Carolyn Bennett was the minister of state for public health at the time.

"Well, I think what the observers who were there at the time would say is that we bought peace, we didn't buy change," she told CBC.

Roy Romanow is the former health care commissioner. He has a theory as to why the accord didn't buy change.

"There were insufficient, if any, conditions on the provinces which would motivate the provinces to implement the kind of transformative change which would make the system  more responsive and less costly," he said.

The last time Ottawa and the provinces were battling over health care, the federal government was rolling in surpluses. The question then was how much should the provinces get of that pot of money.

Now, Romanow points out, all governments are battling deficits.

"We're on the verge of another acrimonious, and I would say needless, discussion about this business about private pay and private delivery. It's sad we didn't make the reforms when we could have and should have, but I think we're headed back into that debate," he said.

Anne Doig is a family physician in Saskatoon, and she's president of the Canadian Medical Association (CMA). She says Canada spends a lot of money on health care, but no one is looking at how well it's spent.

"No one is looking at the fact that our health care costs are increasing at a rate that is outstripping the revenue sources to our provincial funders, and no one is also questioning the fact that we spend a very high per capita amount on Canadian health care without necessarily achieving good outcomes," she said.

Consider the numbers:

Canada ranks fifth-highest among OECD countries for the total amount of money it spends per capita on health care. The United States tops that list. But the average, thanks to many European countries, is much lower than Canada's: about a thousand dollars less, per person.

Doig believes Canada has to stop looking south of the border and feeling smug about how much better our system is here.

"It's very nice to look backwards over your shoulder and say, 'well, I'm better than he is,' but unless you also look forward and say, 'oopsy daisy, there are 25 out there who are better than we are,' it's a useless comparison," Doig said.

One country the CMA suggests Canada look to is Britain.

Bob Bell is a Canadian who now runs the Royal Brompton Hospital in London, England. There, hospitals have targets that must be met, or administrators face penalities. Bell says they began with shorter wait times, but targets are expanding to quality outcomes too.

"Your mortality rate, your readmission rate to the hospital, your ability to treat certain patients within a period of time, length of stay management... those quality indicators are the next wave of what is happening, and there's no question in my mind that Canadian hospitals have to get ready. This is where most publicly-funded governments are going," he told CBC.

Bell has one key piece of advice for Canadians: forget looking at medicare like a sacred cow.

He says the National Health Service in Britain has co-existed with a private health care system since 1948, with no problems.

"And it has been a good thing to, in effect, create a sense of competition, particularly in reducing wait times and waiting strategies, as driven by government by the fact that public hospitals have to compete for their business, and in order to compete, not just with other public hospitals, [but] equally with private hospitals, in order to be able to sustain their activity," he said.

So far the debate in Canada has been quiet. Premiers meet, and it's not even on the agenda.

But CBC asked a few provincial ministers about their thoughts on the topic, and here's a bit of what they're saying now:

"I would hope that after [the current accord expires] there will be a new agreement negotiated that recognizes the increased costs that all jurisdictions in the provinces are facing, in regards to the pressures of health care particularly, and social services," said Saskatchewan Finance Minister Rod Gantefoer.

It's a similar message from the other side of the country:

"You can appreciate that all provinces are going to be indicating the challenges that they are facing, especially with the demographic challenges that provinces like New Brunswick have, and we'll certainly be making a case for adequate funding for health," said New Brunswick Finance Minister Greg Byrne.

Before Roy Romanow was the health care commissioner, he was the premier of Saskatchewan. And his advice for provinces is to look to next month's federal budget for a sign of what is to come.

"Now the prime minister has assured us the current transfer payments are not going to be touched. But in the case of health care, that means in another 4 years or so, they run out. And right now, provincial treasuries are planning not only their year-to-year budgets, [but] their four to five-year budgets, as are the federal budgets. So the debate is here. The problem is, it's behind closed doors. It's not out in the public," he said.

It won't take long for that murmuring to erupt into something much louder.

A debate that will most certainly become heated and emotional, like last time.

Listen to Susan Lunn's documentary feature for The House: