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Truth Tracker: Would O’Toole’s “unconditional” health transfers conflict with universal health care?

TORONTO – Conservative Leader Erin O’Toole’s stance on health care in Canada has been the subject of debate throughout this election.

He has always expressed support for “public / private synergies,” praising programs like the private MRI clinics offered in Saskatchewan. He made the increase in the amount of the Canada health transfer a key part of the Conservative platform, promising unconditional funding to the provinces. But he also expressed unequivocal support for Canada’s public and universal health care system.


During last week’s English debate, CTV News’ Evan Solomon asked O’Toole what kind of private healthcare innovation he would like to see more of and if he would enforce the Canada Health Act by withholding funding if a province introduced more private medical care.

“I 100% support our public and universal system. I said this is paramount. And after COVID-19, we have to rebuild it. So we have the most substantial plan to do it. Six percent of increase per year, stable, predictable, unconditional funding to partner with our provinces. We will respect their operation and prioritize to reduce wait times, to give more choices for universal public access, this is what we need, ”O’Toole replied during the debate, but did not answer Solomon’s questions directly.

Is it a contradiction to support universal health care while promising unconditional funding to the provinces?


The Canada Health Act was passed by Parliament in April 1984 under the Liberal government of Pierre Trudeau. It sets out five criteria, two conditions and two provisions that provinces and territories would have to meet in order to receive money from Ottawa under the Canada health transfer.

More specifically, it states that the primary objective of Canadian health care policy is to “protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial barriers. or others”.

In the 2019-20 fiscal year, provinces and territories received $ 40.37 billion in the health transfer. Health care is the second largest government expense after Old Age Security payments, according to 2021-2022 estimates.

Among the criteria provided for by law, the province’s health insurance plan must be comprehensive, universal, transferable and accessible. “The objective of the Act is to ensure that all eligible residents of Canadian provinces and territories have reasonable access to medically necessary hospital, medical and dental surgical services that require hospital establishment on a prepaid basis,” the 2019-2020 Health Canada Act annual report explains.

The law grew out of a review of Canada’s health care services and the debate that followed, which warned that overcharging and user fees collected by doctors and hospitals was creating a two tier system that “threatened l ‘universal accessibility of care’.

Since the law was passed, some $ 10.5 million has been deducted from the provinces, according to the annual report. This excludes the initial three-year transition period and other deductions that were refunded afterwards.

“The Canada Health Act, what it represents, is that in exchange for the money that the federal government gives to the provinces, the provinces will meet certain conditions. For example, no two-tier health care, ”Colleen Flood, University Research Chair in Health Law and Policy at the University of Ottawa, told in a telephone interview.

Flood says the Tories cannot support universal health care without enforcing these conditions, but noted that during the debate O’Toole said immediately after expressing support that he would not place any conditions on it. money he would give to the provinces.

“So there is a contradiction between these two things. They cannot go together.”

By pumping money into the health transfer, you are implicitly still expected to protect and enforce the law, says Gregory Marchildon, professor and Ontario Research Chair in Health Policy and Systems Design at the University of Toronto.

There are penalties associated with additional billing and usage fees that are triggered automatically and not discretionary, Marchildon said in a telephone interview. These fall under the two provisions set out in the law.

The five principles, however, are more discretionary by the federal government, he said. In the past, the federal government has called for certain practices to be stopped and the provinces have complied, but in other cases, such as the portability criteria, Marchildon says it is doubtful that Ottawa actually enforced it. . Portability allows, among other things, emergency coverage when residents transition to another jurisdiction or temporarily move away from their home province or territory, but it is coverage that Quebec does not recognize from the same way, he explained.

Quebec has spoken openly about the demand for unconditional health transfers, arguing that health care falls under provincial jurisdiction.

“There is leeway and there are a lot of opportunities for the federal government to just look the other way and do nothing,” he said, adding that governments in general don’t have not been too aggressive in tackling breaches of the law.

Even so, liberal governments have historically been a bit more cautious and concerned with violations than conservatives, he noted, pointing to the Harper government which he believes viewed health transfers as essentially unconditional.

Federal governments don’t want a major clash with provincial governments, Marchildon said, citing Quebec in particular.

“The second reason is that the federal government is not in a good position to monitor what is going on. The provinces are supposed to report on their own, but it is not really in any province’s interest to report any transgression themselves. of the Canada Health Act.

All of this suggests that O’Toole and the Tories would not enforce the law, according to Flood and Marchildon.

“He didn’t specify and it’s a bit confusing what he means by that… the way I would interpret it is, he plans to send the money through the Canada Health Transfer. and he does not intend to apply it, ”he said. .

It also suggests that further privatization across Canada would be expected, Flood added, saying that law enforcement depends on the will of a government of the day.

“They have nothing to do. It’s easy for them. By doing nothing they are undermining or sort of gutting the Canada Health Act. He can say he supports it because he is not going to do it. actively dismantle, ”she said. .

“It is a law that gives Canadians no rights over anything. All it is is that in exchange for federal dollars the provinces will do these things.

Erin Strumpf, associate professor in the Department of Epidemiology, Biostatistics and Occupational Health at McGill University, says the Conservatives are also likely to bend somewhat in Quebec.

“You can’t say, I believe in the Canada Health Act and not attach any conditions to it because the Canada Health Act is much more about ropes,” Strumpf said in a telephone interview. At the same time, she says O’Toole doesn’t want to tell provinces how to spend the money or direct them to certain areas like mental health or long-term care, explaining that this kind of restriction or guidance is different from the “strings” associated with the act.

“So it’s not a contradiction, I don’t mean to say that I believe in the Canada Health Act, and I think there is a place for private delivery in the Canadian health care system, because we absolutely have it for services that are not covered. “

She mentions services like psychotherapy that are not covered by the state, but adds that a private surgical clinic or specialized hospital would be different because they overlap with treatments already available to the public.

“It’s two sides of a coin, isn’t it?” People recognize that provinces and territories have jurisdiction over their health systems, a lot of control over how they spend the money and the policies they put in place… and [their] ability to meet the needs of their particular population.

This flexibility in local decision-making and priority setting can help spur innovation, Strumpf said. At the same time, not all Canadians have equal access to the same drugs, for example, showing that Canadians want more equitable medicare.

“There are also perceived benefits to having a certain consistency and a certain base across the country and these things are inherently in tension with each other,” Strumpf said.

Marchildon also noted that while there are conditions attached to transfers, it is actually difficult to determine what happens to the money once it goes into a provincial government’s general revenue fund.

“They don’t have to use it for health care… there is no guarantee that the money transferred will be used for the purposes desired by the federal government,” he said.

“So it is doubtful whether this is a very efficient vehicle in the first place.”


Our experts agree in principle that O’Toole’s position is a contradiction. He did not say how he would support universal health care while giving provinces money without “strings attached.” This leaves some of our experts interpreting his request as suggesting that he would not apply the Canada Health Act, which is based on the precept that provinces and territories must meet nine conditions to be eligible for funding for health care provided. by Ottawa. However, there is room for interpretation as to what he means in relation to unconditional transfers and whether certain types of restrictions or requirements would be considered an overrun by the federal government.

Edited by Michael Stittle


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