Provinces come to their senses and accept healthcare money

Ordinarily, provinces only want one thing from the feds –money.

So when the feds offer money in exchange for something, provinces are reluctant to accept.

All that has changed now that Canada is facing a shortage of health care workers and operating rooms.

image: Canada’s premiers

Other than universal health care, Canada has no central control of health delivery. It’s delivered by the provinces and overseen by the feds.

The provinces provide most of the funding for health care whereas the feds only contribute 22 per cent. It used to be greater. At the inception of health care in 1957 the feds paid 35 per cent. In the late 1970s, it dropped to 25 per cent.

The provinces do the heavy lifting while the feds try to initiate county-wide programs like dental care.

It’s a recipe for tension, an awkward and inefficient way to run a universal health system. Medicare would be easier to administer if it wasn’t fractured into fiefdoms. Other countries do a better job.

In Australia, the federal government funds and controls health care, There, the feds control the purse and the programs.

However, the crisis in our health care system has caught everyone’s attention, federally and provincially.

Conditions which the provinces rejected are now being reconsidered. It’s a new era of reciprocity; more of a forced marriage than cooperation.

The new era has left health ministers unfamiliar with the new terrain. First, they were willing to accept federal money last November when provincial health ministers met with their federal counterpart in Vancouver.

Then premiers nixed the deal, presumably because they didn’t like being told what the money would go for.

Now provinces are sensibly reconsidering the federal offer in exchange for some reasonable national goals.

In recent negotiations, Federal Health Minister Jean-Yves Duclos said there has been a “change in tone and direction” from the provinces and territories to accept Ottawa’s demands to modernize data sharing, reduce backlogs in surgeries and diagnostics, retrain and hire more nurses and use medical clinics to handle millions of Canadians without family doctors.

It’s an offer the provinces can’t refuse.

Duclos is using a divide and conquer strategy. Ontario’s premier Ford was the first to break from the pack of provinces. Ford announced that Ontario is willing to accept Ottawa’s key demands, including a national health data system.

In addition to that compromise on Ford’s part, the feds are negotiating special deals with Ontario that would see Ottawa transfer $70-billion to the province over the next decade.

And now Ontario is willing to have transfers for specific programs. Some of this money would be earmarked under a bilateral agreement for home care and building long-term care facilities to reduce the stress on hospitals,

Ford insists that he is not breaking in solidarity with other provinces. He insisted that any bilateral agreement would not come at the expense of other provinces and territories.

Then Quebec Premier François Legault said he also is ready to share data on the province’s health care systems.

Just wait, the rest of the provinces will come to their senses and follow.

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Threat of separation led to a superior immigration system

No federal government likes to give up control but in the case of immigration, it’s worked out for the best.

image: Study International

Our immigration system is admired globally. Canada has largely avoided the divisive immigration debates that have plagued our close allies: the United Kingdom, the United States, and Australia.

A Gallup poll shows that Canada is more welcoming to immigrants than any other country in the world.

Decentralization of immigration began in 1991 with Quebec’s demands to have more control over French-speaking immigrants in order to better integrate them into Quebec’s distinct society.

The federal government, worried about Quebec separation, acquiesced to Quebec’s demands. Ottawa still controlled family sponsorships, refugee migration, and ensured that newcomers passed health and security screenings. But other than that, Quebec could create its own system and decide how many new immigrants to accept each year.

Then the me-too effect kicked in. Once Quebec had some control of immigration, other provinces wanted it. Ottawa was happy to give up some control to provinces because, at the same time in the nineties, Ottawa was going through a debt crisis and was happy to transfer those costs to the provinces.

So, in 1996, the Provincial Nominee Program (PNP) was created. The federal government would retain the rights it had in Quebec’s case but the provinces would design the programs themselves and much of the work -and cost- would be borne by the provinces.

Under the PNP, employers and postsecondary institutions with the cooperation of the provinces, would select applicants.

The provincial programs offered an easier route to permanent residency than federal programs did.

Critics argued that the PNP would be a disaster. Employers, provinces, and postsecondary institutions, they argued, didn’t have national interests at heart. And they don’t have the expertise to support language skills and integration of newcomers. Those who ran the immigration programs were often unskilled and open to fraud.

Another criticism of the PNP was that Immigrants could shop around for provinces that offered the best entry programs and then move to wherever it suited them.

At first, it was so. Big cities attracted immigrants because of their existing multiethnic communities where newcomers share the same languages and observe the same customs.  Toronto, Montreal, or Vancouver were often the final destinations because they already had networks of friends and family to help them launch a Canadian life.

As a result, only 28 percent of nominated immigrants to Prince Edward Island since 2008 were still living there. Manitoba did better, retaining 84 per cent. The difference, says Kelly Toughill in her feature-length article, was each program’s ability to support newcomers (the Walrus, May, 2021).

But despite initial problems, decentralization of immigration has successfully continued with groups like the non-profit Kamloops Immigrant Services. The Canadian Labour Congress is now controlling some phases of immigration to fill the looming construction labour shortage.

The number of localized immigration programs has swelled to more than 100 scattered from coast to coast to coast.

Canada now has one of the most complex immigration systems in the world.

Flexibility means that provinces and agencies design programs attract who they want, where they want.

Our complex immigration system has also resulted in the highest public support for immigration of any country in the world. And it’s why Canada is winning the global competition for labour.