Opinion: Reason for optimism about a federal-provincial health accord

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The provinces are joining forces these days to force the federal government to increase its cash transfers for health. For its part, Ottawa could try to divide the provinces by trying to negotiate a bilateral agreement with each of them, as has happened in the past.

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At the heart of this conflict is a fiscal imbalance: the provinces do not have enough revenue to meet their constitutional responsibilities, while the federal order of government has exactly the opposite. This imbalance, which appears to be a fundamental, structural and permanent characteristic of Canadian federalism, is at the origin of the famous “federal spending power”.

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Three considerations stand out when we look closely at how this spending power in health matters is exercised.

First, the federal government has for some time wanted its investments to be made through targeted funds, which has historically been denounced by Quebec (and sometimes by other provinces) as being too restrictive. However, such criticisms do not seem justified, given that these funds remain vague and general, and that federal and provincial objectives and intentions often coincide, such as spending on home and community care, addictions or mental health. .

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Second, the Government of Canada tends to hold the provinces accountable for the use of federal funds. It is more difficult because the provinces generally do not want to have to justify to Ottawa the decisions they make in their areas of jurisdiction. Nevertheless, it would be good if the provinces voluntarily committed to making public their data concerning their respective performance in the health sector.

This data sharing could be done under the auspices of the Council of the Federation. Overall, this provincial/territorial body could play a major role in achieving pan-Canadian health goals. In other words, the provinces (and territories) should work together to achieve goals that transcend the provinces and territories and contribute even more effectively to the improvement of the country’s health system. Better interprovincial cooperation would also make federal intervention unnecessary.

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Third, the federal government continues to insist on compliance with the Canada Health Act of 1984, which over the years has become landmark legislation. The provinces agree to the terms of the act, which are relatively vague; these conditions are also fairly loosely enforced by the federal government. The fact remains that the Act limits provincial action in the health sector, while health falls essentially (but not exclusively) within the constitutional jurisdiction of the provinces. Ideally, the provinces should be invited by the federal government to have a say in the interpretation and practical application of this legislation.

Given the above considerations, the federal and provincial governments may not be far from an honorable compromise on health care, despite their differences. It is enough for each of them to put a little water in his wine.

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Of course, when it comes to the Legault government, there is an additional challenge; in 2003, the Charest government succeeded in concluding a special agreement with Ottawa, evocatively titled Asymmetrical Federalism, which respects Quebec’s jurisdictions. It was a very lucrative transaction for Quebec, without conditions. Be that as it may, the current Quebec government can certainly make concessions to Ottawa without compromising Quebec’s constitutional autonomy within Canada.

The fact is that there are ways of doing things in intergovernmental relations that respect both the sovereignty of the provinces in their areas of jurisdiction and the federal agenda. This is not in itself an insoluble problem. Within the framework of Canadian federalism, federal-provincial/territorial cooperation is desirable in as many areas as possible. Cooperative federalism has its own virtues when it is not one-sided.

In the area of ​​health care, there is reason to be optimistic that a political compromise is achievable and may be on the horizon, despite the strong and seemingly irreconcilable positions of the federal and provincial governments involved.

Benoît Pelletier, a law professor at the University of Ottawa, is a former Quebec cabinet minister.