With the release of the Canadian Institute for Health Information's report on the effect of the first wave of the pandemic on long-term care facilities in Canada, and enumerating the grim statistics of just how many people died, we got a renewed number of calls for the federal government to do something about long-term care in this country. As might be expected this has come with more than its usual share of handwaving away jurisdictional concerns that even though these facilities are within the domain of the provinces, that somehow the federal government can exert more of its benign influence and do the job of fixing these facilities where the provinces have repeatedly failed. This narrative, however, got even more complicated by the Supreme Court of Canada's reference decision on the federal carbon price.
The NDP, in particular, have put on a big song and dance about promising to fix long-term care with the creation of a Care Guarantee, which is possibly the NDP at its hand-waviest. (It's also with no small amount of irony that this is explicitly an election promise when they keep insisting that they don't want an election and have been pushing the Liberals to swear that they won't call one, as though it were up to them in a hung parliament). To add to that, their health critic, Don Davies, read the CIHI report and essentially blamed the federal government for all of those long-term care deaths, declaring "This is inexcusable. Appropriate government action could have saved the lives of many Canadian seniors." And he's right to a point the federal government provided what support they could under their constitutional constraints, both when it comes to increasing health transfers and providing top-up pay for workers in these facilities, and providing support from both the Canadian Forces and the Canadian Red Cross for facilities that have been hardest hit facilities that we cannot deny were overwhelmingly private ones in Ontario.
But there are very definite limits to what more the federal government can do on its own, which is why the NDP's "Care Guarantee" plan is so hand-wavy. To be clear, the current federal government has been engaged with negotiating with the provinces on creating national standards for long-term care that would accompany more federal dollars to tackle the problems inherent in the system. Those calls, however, have largely been met with indifference because the premiers would much prefer money without any strings attached something that any federal government that wants to see specific outcomes should never agree to. There is this conception that if the federal government puts money on the table with strings that the premiers will come running, lest they face the wrath of voters who would punish them for leaving money on the table. Reality is different, however.
So let's walk through this "Care Guarantee." After Jagmeet Singh offers up a falsehood about the federal government "underfunded health care and prioritized protecting the profits of big corporations and their wealthy shareholders" which is a bizarre accusation considering that the federal government doesn't regulate these facilities (nor have they been particularly friendly with Big Pharma, contrary to NDP claims) and a calculated lie about healthcare "cuts" crippling healthcare, never mind that health transfers have escalated continuously for decades now the immediate calls are fanciful.
They promise to achieve their goals by taking profit out of long-term care is going to be exceedingly difficult to do unilaterally by the federal government because there are a very limited number of federal policy tools they can use to achieve this at least unilaterally. They could achieve it through negotiation with the provinces, but you can bet the provinces will want to extract a hefty price before they take on tremendous new spending commitments. It's also something that you can't just wave Canada Health Act around like a magical talisman because it does not actually regulate provincial healthcare it stipulates conditions for federal health transfers, which is not the same thing. And they can't just make a top-down declaration because that is direct interference with an area of provincial jurisdiction, which the Supreme Court took a very narrow view of in their carbon pricing reference decision, determined to ensure that they did not open the door to other federal attempts at intrusion in to provincial territory.
"Working collaboratively with patients, caregivers, and provincial and territorial governments to develop national care standards for long-term care and other continuing care that would include accountability mechanisms and data collection and that would be tied and backed by adequate and stable funding," is essentially what the federal government is already doing in trying to negotiate with provinces for the imposition of national standards, which the provinces are balking at. Thinking they'll agree just because it's the NDP doing the negotiating is pretty fanciful.
More to the point, simply offering an additional $5 billion for long-term care and increased health transfers transfers which they have previously promised would be without strings attached is not without risks. Provinces have a demonstrated history of spending health transfers on things that are not healthcare we saw this under the old health transfer escalator formula, where the six percent per year increases were not being met with six percent increases in healthcare spending those increases were much lower, indicating that provinces were spending money on other things. We've also seen incidents where provinces turned increased federal transfers into tax cuts, which burned the federal government in the past. Not to mention, they can and do leave federal money on the table if they don't want to deal with the attached strings, which is why these negotiations are difficult.
Long-term care is but one of many areas in provincial jurisdiction that plenty of federal parties want a piece of, along with child care and pharmacare, and possibly even dental care. None of these can see any movement without negotiation, and promising otherwise is simply lying to would-be voters for the sake of scoring points. It's a sign that parties that engage in it are deeply unserious.
Photo Credit: CBC News
