'A lot of work to do' but Trudeau 'confident' premiers will agree to health funding deal

Prime Minister Justin Trudeau says federal health Minister Jean-Yves Duclos was right in saying there is "still lots of work to do" before reaching a deal with the provinces for increased health-care funding, but that he's "confident" that the two levels of government will get there.

"I'm glad that the health minister is pointing out that there's still a lot of work to do, because there is. But, I'm also very pleased to be able to say that I am confident that we're going to get to a good place, because premiers have been hearing the same things that I have," Trudeau said during an event in Windsor, Ont., on Tuesday.

Earlier in the day, Duclos said there was "still lots of work to do" before reaching a deal, despite increasing indications from other key players that the federal government is nearing a funding agreement in exchange for improvements to the system.

Seeming to pour some cold water on the prospect of being very close to an agreement on increasing the Canada Health Transfer, Duclos told reporters on Prince Edward Island on Tuesday that it is something both sides will have to keep working on "in the weeks to come." 

"Lots of work still needs to be done before we come to an agreement on the importance of those results and how we're going to achieve them," Duclos said, speaking about five categories of health-care improvements the federal government wants to see tied to any funding boost.

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The five metrics Duclos said the federal government wants the provinces to commit to results on are:

• Access to family health teams;
• Reducing backlogs in surgeries and diagnostics;
• Retaining, recruiting, and recognizing the credentials of health care workers;
• Investing in mental health; and
• Modernizing the system so medical records can be shared with various providers, electronically.

"So yes, we are all looking forward to a final agreement at some point, but we are all very mindful and there is still lots of work to do before we get there," Duclos said.

Asked on Monday about the status of the talks and getting provinces to sign on to an agreement with strings attached — which some premiers have recently voiced a willingness to do — Trudeau said he's looking forward to "being able to announce positive steps forward in the very near future."

Asked to clarify what the status of the deal was given the contrasting comments on its imminence, the prime minister said that it's both true that progress is being made, and that more work will be needed to see a deal finalized.

Trudeau said that there has been "a lot of hard work" done over the last few months to make sure that any increase in funding does come with an understanding from the provinces that the money goes toward ensuring the system is "able to respond not just to the challenges that we just lived through over the past couple of years, but the challenges that are coming as well."

"I'm looking forward to continuing our work and delivering for Canadians soon," he said.  

Seeing the federal government commit to increasing the Canada Health Transfer—which funnels federal dollars into provincial health-care systems—to 35 per cent up from the current 22 per cent of coverage for health-care costs has been a longstanding demand of the premiers.

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But, in recent months premiers have been ramping up pressure for Trudeau to meet with them to discuss an increase, as hospitals and health-care facilities appear to be in crisis mode.

From staffing shortages and a cold-weather surge of illnesses compounding extended wait times in emergency rooms, to hundreds of thousands of surgeries and medical procedures backlogged due in part to COVID-19 cancellations, there are steady calls from those in the sector for urgent action as Canada's population continues to grow and age.

In agreeing that the system is "strained, if not broken" Trudeau has said that the federal government is willing to go beyond the one-time top ups offered to the provinces during the pandemic and agree to send "billions more."

However, Trudeau hasn’t been willing to pull up a chair with the premiers until there was a more concrete plan for provincial accountability on the table.

While some premiers initially pushed back on the idea of federal conditions, in recent interviews on CTV News Channel's Power Play and in press conferences, certain premiers have signalled a willingness to agree to conditions and an undertaking of accountability, in exchange for more money.

On Tuesday, Quebec Health Minister Christian Dube told reporters that he is "quite encouraged" by the current state of the talks.

"The fact that we're talking about a meeting of the premiers and the prime minister, I think this is very encouraging," he said. "The discussion that I had with our premier is very encouraging." 

• 'Very constructive conversations': Here's what's being said about a health deal

Even with Duclos signalling it could be weeks still before a deal is ready to be finalized, the health-care funding talks appear to have come a long way from November, when an in-person meeting between Duclos and provincial health ministers ended in acrimony, with Duclos blaming the breakdown on the premiers telling their ministers to stop negotiating. 

On Tuesday, the federal health minister said the two sides have "worked very hard and quite well over the last year" to try to map out how to address the health sectors' challenges, pointing to the more than a dozen meetings he's had with his provincial counterparts.

In an interview on CTV News Channel's Power Play with Vassy Kapelos on Tuesday, Intergovernmental Affairs Minister Dominic LeBlanc said it's fair to say, as Saskatchewan Premier Scott Moe said on the program on Monday, that an agreement is much closer, compared to a month ago.

"I was heartened by his comments last night, and if you think of a month ago or four months ago, I think the circumstance is lot better to get to the right place for Canadians and ensure that the health-care system is world class, is sustainable, and is accessible, which is obviously a concern that we're seeing in many jurisdictions across the country, big and small," LeBlanc said.

WILL FEDS AGREE TO PROVINCES' FINANCIAL DEMAND?

Should "weeks" be the timeframe for a deal to be ready for Trudeau's consideration, it is possible that an agreement could come to fruition ahead of the 2023 federal budget, which typically is presented in early spring.

Whether the agreement would be for the full 13 per cent share increase the premiers are after remains to be seen, even a more modest boost to how much the federal government is willing to put in provincial coffers would likely come with a multi-billion dollar price tag.

LeBlanc wouldn't confirm whether the federal government is willing to offer up the full amount premiers are after.

"Obviously that is the kind of conversation that we're having with the provinces. I don't think anybody's landed on our precise quantum yet," said LeBlanc, declining to elaborate publicly, on the kind of dollar figures being discussed in private.

That said, LeBlanc noted that "in recent days" the federal government has sensed "a desire amongst all orders of government… to get to the right place quickly."

'LEGITIMATE' PRIVATIZATION CONCERNS BEING RAISED: DUCLOS

In the meantime, some provinces have announced plans to forge ahead with initiatives to address their specific health-care system's needs. 

The most recent example of this is Ontario Premier Doug Ford, who on Monday announced that his province is moving to allow private for-profit clinics to perform more surgeries, with the aim of reducing what are now lengthy wait times for certain medical procedures. 

This move has revived the privatization debate and raised questions over whether it contravenes the Canada Health Act, which ensures all eligible residents have reasonable access to publicly funded health services. In order to maintain eligibility for their full Canada Health Transfer, province are required to uphold the Act's criteria and ensure there is no extra-billing and user chargers for insured health services.

"Having driven the public hospitals into the worst staffing crisis that we've ever seen, and underfunding them, like every large hospital in the province has operating rooms that don't operate at full capacity… Why not open them up to capacity? Why not support our public hospitals? Why rebuild that at public cost in private for-profit clinics… that already violate Canada's health care laws?" said Ontario Health Coalition executive director Natalie Mehra in an interview on CTV News Channel on Monday.

Ford's announcement also caught the ire of federal NDP Leader Jagmeet Singh, who is calling on Trudeau to make protecting the universal public health-care system a condition of any future increase to the federal health transfer. He wants to see Trudeau withhold funding from Ontario for moving to allow more private delivery.

"The real question is, where does the prime minister stand if he says he's going to defend public health care, and he's allowing this to happen in Ontario? To me, it looks like the prime minister is not interested in defending public health care, which I think is wrong," Singh said in an interview on CTV News Channel's Power Play with Vassy Kapelos on Tuesday.

Singh wouldn't say whether or not he'd be willing to pull out of the Liberal-NDP supply-and-confidence deal if the prime minister doesn't heed his calls, suggesting generally that his party will continue to look to use the agreement to leverage progressive wins.

Asked Tuesday whether he thinks that Ontario sending public money to private clinics is in line with the Canada Health Act, Duclos said he and Trudeau will be following along as Ford's three-step plan rolls out, while recognizing "the federal government cannot and should not pretend that it would be managing and micromanaging hospitals and the health-care systems in Canada."

Duclos noted that while there are "legitimate concerns" being expressed about how more privatization could lead to the weakening of the public health system, there are key Canada Health Act principles, such as public funding and equitable access, that he still thinks "everyone agrees on."

"Whatever is done across Canada—and we all recognize that things need to happen because our health-care system and our health-care workers are in crisis—whatever is happening across Canada must maintain public funding," Duclos said.

"We have to move forward in ways that will repair the damage caused by COVID-19 and prepare for the future of our health-care system. We have many, many huge challenges around health and health care in this country for the years and possibly the decades to come."

LeBlanc backed Duclos up in stating he thinks Ontario agrees the principles of Canada's universal health care system needs to be upheld, noting that Ford has communicated to him privately that "he fully intends to respect the elements of the Canada Health Act."

"We'll obviously see the details of what he rolls out… Our job is to ensure the Canada Health Act is enforced and respected. We intend to do that but we want to work with the government of Ontario and other provinces and territories as they make the decisions in their own jurisdictions to improve access and reduce wait times, that is certainly an objective that we share as well," LeBlanc said.