When universal health care was adopted in 1966 with the passage of the Medical Care Act, it signified a profound moment in Canadian political history. Rarely before had an alliance of ideologically opposed figures – the socialist Tommy Douglas, Progressive Conservative John Diefenbaker and Liberal prime minister Lester Pearson – delivered legislation that would enshrine in collective consciousness the universal values of health and dignity; touchstones that still define this country and its society today.
Indeed, medicare is a fundamental pillar of Canadian identity. It projects our national values onto the world stage, delivers positive outcomes to patients and supports a vast infrastructure of globally recognized caregivers, physicians, researchers and front-line workers.
It is also a system that relies heavily on federal funding and cash transfers.
In 2004, the Health Accord was established as an agreement between the government and each province and territory. It provided all regions with stable funding to deliver adequate medical care that met national standards. The $41-billion pact was a response to deep cuts throughout the 1990s and aimed to address issues around wait times, pharmaceuticals and term care. For much of the past 10 years, federal support hovered around 23 per cent.
The accord rightly placed the government in a position of leadership on health care, one from which it could co-ordinate medical delivery and uphold common principles for all Canadians.
Under the Harper government, however, the agreement began to erode. In 2011, three years before its expiry, the Conservatives announced major cuts to the Canada Health Transfer of $36 billion over a decade beginning in 2017. Instead of the traditional annual rise of six per cent, funding would now be based on the rate of growth of Canada’s GDP.
Then, in 2012, after agreeing to extend monopoly drug patents to European countries in a far-reaching trade agreement, the government increased pharmaceutical costs to Canadians by an estimated $1 billion.
Two years later, the Health Accord was not renewed; every province and territory was left on its own to determine how it will fund growing and aging populations into the uncertain future.
The retreat of the federal government from its position of authority on national health care is a troubling trend, one made all the more distressing in light of recent projections outlined in a report compiled by the Canadian Federation of Nurses Unions. In the document, The Canada Health Transfer Disconnect, economist Hugh Mackenzie argues lower GDP growth estimates mean federal support for medicare will drop from 23 to 19 per cent by 2025. This represents a shortfall of $44 billion.
Based solely on GDP and distributed by population, the platform is “insensitive to the differences in the drivers of the costs of health care,” Mackenzie writes. Most importantly, this includes an aging population. Within the next 25 years, the number of Canadians aged 65 and older will double, reaching a staggering 10 million.
The premiers want the Health Transfer increased to at least 25 per cent of all health-care spending. Without it, the provinces and territories will face insurmountable financial pressure. In real terms, this means fewer nurses, home care visits, primary care centres and long-term beds.
Since the election of a Conservative majority government, taxes are at their lowest levels in more than half a century. In its myopic vision of deficit reduction and austerity, Ottawa now collects $45 billion less in revenue. It is no wonder the Canadian public is being told it cannot “afford” adequate levels of health-care funding.
Without negotiations in place to renew the Health Accord, Canada’s most cherished public institution is at risk of crumbling at an inopportune historical moment of generational change.
At worst, these changes signal the advent of a for-profit, two-tier system that favours the wealthy while driving up costs and delivering poorer outcomes for the rest. From the perspective of the private sector, after all, access to essential care is not based on need, but the ability to pay.
Hyper-partisanship is a symptom of an ailing democracy and should not be responsible for the erosion of an institution that protects basic human rights. It is therefore the responsibility of all Canadians to recall our shared history and uphold a just standard of public morality.
Together we may continue to see our nation as Tommy Douglas envisaged it, “like a little jewel sitting at the top of the continent.”
Harrison Samphir is an editor, writer and policy analyst based in Toronto. His work has appeared in CBC, Jacobin, NOW Magazine, Huffington Post, rabble.ca, Ricochet, Truthout, and the Winnipeg Free Press, among others. In 2016, he completed an MA in International Relations at the University of Sussex. Harrison has served as Dimension’s web editor since 2014.
This article originally appeared in The Winnipeg Free Press.