“But this is a government with an aversion to slimming down — it’s like asking a chocoholic to learn to love lettuce.” — John Ivison, National Post, Oct. 25, 2017
Despite record economic growth, the fall economic statement predicts a deficit of $19.9 billion — double that promised in the Liberal election campaign. The Fraser Institute reported that from 2015-2019, the per person federal debt will increase by five per cent per year.
Meanwhile Newfoundland and Labrador will have a deficit of $778 million for 2017-18 and a total debt of $ 15.2 billion — the highest per capita debt of any province.
A health ministers conference occurred in Edmonton on Oct. 19-20. The agenda included Indigenous health, federal support for the feasibility of a national pharmacare program, opioids, medical assistance in dying, bulk purchase of expensive equipment and marijuana legalization.
Inadequately discussed was ensuring the financial sustainability of health care. Several issues impacting patients and health professionals should have been added thanks to recent Liberal mismanagement of tax reform proposals and immigration and inflexibility regarding enforcement of parts of the Canada Health Act (CHA).
This will make it more difficult to retain physicians and other health professionals in Newfoundland and Labrador.
According to Candice Malcolm (Ottawa Sun, Sept. 30), 32,000 illegal migrants have entered Canada so far this year. Welfare benefits are $20,000 annually, so the total is $640 million per year. Ottawa is fast-tracking work permit approvals. Social supports remain the responsibility of the provinces and territories.
Also consider that 280,000 Salvadorans plus others from Central America and Africa face possible deportation from the U.S. in the next few months. If many attempt to come to Canada, what will be the cost to taxpayers until they find employment?
It appears that certain provinces may bear a disproportionate increase in their costs for supporting these migrants, leaving a lesser amount in their budgets available for health care. Finance Minister Bill Morneau’s targeting of small businesses is counterproductive. It is they that might provide jobs for many new immigrants to Canada, so that they do not remain a permanent burden on taxpayers.
If Morneau’s initial proposals are minimally changed, some older physicians may retire prematurely, and some younger, mobile ones may leave for the United States. Physicians remaining in practice will be pressuring their provincial and territorial governments for additional funds to compensate them for the loss of the financial benefits of incorporation.
Several months ago, premiers of the provinces and territories reluctantly agreed to accept a cut in the annual increase in federal transfers from six per cent to 3.5 per cent (plus some targeted funding). Sadly, Ottawa has “doubled down” and remained inflexible on enforcing certain parts of the CHA, and in so doing is precluding provinces from permitting a limited amount of privatization that could make the health-care system more financially sustainable.
In the mandate letter to Health Minister Ginette Petitpas Taylor from Justin Trudeau, she is required to “promote and defend the Canada Health Act to make absolutely clear that extra-billing and user fees are illegal.”
All of this will exacerbate the health funding shortfall for most provinces. This will make it more difficult to retain physicians and other health professionals in Newfoundland and Labrador. New sources of revenue for health care must be found.
Clearly it is time to start having a discussion about amending the CHA, beginning with permitting medical tourism. This would provide employment for the hundreds of recent Canadian orthopedic graduates unable to obtain OR time and hospital privileges, to nurses, and other health professionals. It would provide badly needed extra revenue to hospitals and ministries of health.
As the federal government seems blind to the fiscal reality of the provinces, health ministers should set up a committee to study how most countries in Europe — with much shorter wait times than here — are able to successfully blend a public and private health-care system.
Dr. Charles Shaver