Canada's premiers ended their two day summit in Victoria B.C. by calling on the federal government to stop negotiating through the media and sit down with them to discuss the future of health-care funding.
"Twenty-four months ago, we were collaborating in an unprecedented way," B.C. Premier John Horgan, this year's chair of the Council of the Federation, said Tuesday in Victoria.
"There was unprecedented collaboration and the federal government was right there and we applauded that engagement … and now, eight months later, we're exchanging notes through the media. Where'd the love go? Everything was so fine and then it wasn't."
Horgan said Prime Minister Justin Trudeau promised the premiers that, once the pandemic public health emergency was over, the two sides would meet to hash out the future of health-care funding in Canada. No such meeting has been set and his calls for a sit-down meeting have gone unanswered.
"I've written to the prime minister in December, no response," Horgan said. "We've sent a package of principles that we felt would guide a discussion. No response. And now it's, 'We want you to spend it on specific things.'
"We're fine with that … but there's differences and nuances depending on where you live."
Horgan said that because each province's health system has different needs, the federal government and the prime minister must engage with them individually.
The premiers say the federal government is only covering 22 per cent of health-care costs in Canada. They say they want that federal share raised to 35 per cent and maintained at that level over time.
The federal government, meanwhile, disagrees with the math the provinces are using to determine who should pay for what.
"It's past time for the federal government to stop quibbling, to stop saying that we don't have a problem with our publicly funded national health-care system, and sit down at a table with the 13 premiers from provinces and territories," Horgan said.
A disagreement over basic facts
In 1977, the way the federal government funds health care was changed. Direct federal funding for hospital and physician services was reduced and the provinces were given authority to collect more in income and corporate taxes to fund health services directly.
The federal government says the tax points given to the provinces cover between nine and 10 per cent of the cost of public health-care services. The premiers say the Canada Health Transfer (CHT) — the largest federal transfer to the provinces — covers about 22 per cent of the cost.
The federal government says that when the CHT and those tax points are combined with the money Ottawa spends on bilateral deals for long-term care, home care, mental health and some other services, the portion of health care spending covered by the federal government in 2021-22 came closer to 38.5 per cent.
"Right now, the federal spending to support public health care is about a third of all spending," Intergovernmental Affairs Minister Dominic LeBlanc told guest host Paul Hunter on CBC News Network's Power & Politics Monday.
"They use this fake figure of 22 per cent because they deliberately refuse to acknowledge that $20 billion was generated last year by provinces and territories in tax points that the Government of Canada withdrew from, and they then took up immediately to generate revenue for themselves."
WATCH | Premiers call on Ottawa to provide more health-care funding:
Lee Soderstrom, a retired associate professor of economics at McGill University who has studied the economics of health care in Canada, said the figure cited by the federal government is about right.
"The provinces have already long received about 35 per cent of their total spending on health care. Moreover, contrary to critics of federal cost-sharing, Ottawa has not reduced its share of provincial health costs," Soderstrom said in an email to CBC News.
Horgan said Tuesday that while the federal government can quibble over who pays for what, Canadians simply want a system that works.
"Back and forths about what number is correct, are tax points as relevant as they were in the 1990s today, as we look forward, those are debates that we should be having together, not through the media," Horgan said.
"That's why we are reinforcing today our unanimity to have the federal government call a meeting. We'll arrive … we can sit down and solve these problems for Canadians."
A federal government official speaking on background told CBC News that the premiers' demand for a $28 billion annual increase to the CHT — without a discussion about what the money would be used for — will not fly with Ottawa.
LeBlanc repeated that position again on Monday. He said that any increase in federal health-care funding must come with conditions and with a commitment from the provinces to maintain current levels of funding and keep pace with any increases in federal funding.
"Of course there'll be strings attached in the sense that we're not going to increase the federal spending to provinces for health care so they can then reduce their own spending. That would be absurd," LeBlanc told Hunter.
Horgan said that provincial governments are held accountable for how they spend money through their respective budgeting processes and that every dollar provinces spend is debated in regional legislatures.
"The so-called strings make it sound like there's some sort of a serf relationship here," Horgan said. "We are co-governors. We are equal orders of government. There's not a hierarchy here, we are the same, and we're saying we need to sit down collectively and figure out where we go from here."
Federal Health Minister Jean-Yves Duclos told CBC News Network's Power & Politics Tuesday that details of the specific outcomes the federal government would tie to any additional health funding can be worked out between himself and provincial health ministers.
Horgan and Ontario Premier Doug Ford dismissed that proposal and said it would be insulting for Prime Minister Justin Trudeau to refuse to meet with them.
"It's pretty disingenuous when you have the minister come out and say, 'Here are a few ideas and, by the way, hand it over to your ministers of health," Ford said. "Its just one request, come to the table … It's unacceptable. We need to sit down."
Horgan also said that he does not see how the provinces can continue to have discussions on sharing the costs of a national pharmacare or dental program until the overall funding issue has been put to bed.
"We shouldn't be doing that until we have a firm foundation for our entire program," Horgan said.
Affordability and global challenges
The premiers also released a five-page communique asking the federal government to help them tackle cost-of-living, supply chain and labour challenges facing Canadians.
The premiers said they need federal help in unsnarling supply chains, fighting climate change, improving energy and food security, improving mental health and addictions services, bolstering Arctic sovereignty and addressing the labour shortage.
Ford said Ontario is facing a once-in-a-generation labour shortage. He said the federal government needs to help bring in economic migrants to fill hundreds of thousands of job vacancies in his province.
"As of this morning, the numbers I received from our team, we're short 378,000 people," Ford said. "That's 378,000 people that could be contributing to our economy and ... if we don't fill those jobs, someone else around the world will fill them."
Ford said one of the biggest roadblocks to filling those posts is a cumbersome immigration process that can take up to 26 months to bring an immigrant to Canada and declare them qualified to enter the workforce.