Defunding healthcare.

The Canada Health Act of 1984's five principles – public administration, comprehensiveness, universality, portability and accessibility – are spot-on and definitely must guide federal healthcare policy. But the Act is an aspirational document, equivalent in its own way to a politician's promise to put a chicken in every pot with no concrete plan for how to achieve it.

A Nov. 9, 2020, Canadian Medical Association Journal article, "Canadian federal-provincial/territorial funding of universal health care: fraught history, uncertain future" is a must-read for anyone wanting to understand how Ottawa has mangled funding of Canada's erstwhile world-class universal healthcare system.

According to the CMAJ article: "As early as 1970, the federal government began weighing how it might limit increases in its share of health spending to the rate of growth of gross national product (GNP). (Gross national product adds net income receipts from abroad to gross domestic product [GDP], which was later adopted as the preferred national benchmark for cost sharing.)"

Further: "Six federal budgets between 1985 and 1995 variously scaled back the GNP escalator on combined health and social cash transfers or completely froze payments. In a 1991 background paper, Alistair Thomson calculated that health transfers cumulatively reduced by $30 billion from 1986/87 to 1995/96. Further reductions through to 1998/99 trimmed another $11.2 billion relative to the 1977 agreed terms."

Plucking percentages of GDP out of thin air is no way to fund a healthcare system.

Absolutely no federal legislation enacted since the Hospital Insurance and Diagnostic Services Act (HIDA), passed in 1957, or the Medical Care Act, adopted in 1966, explicitly requires Ottawa to pay a specific share of actual provincial and territorial healthcare costs. Every "reform" has calculated the federal funding share in terms of financial criteria that have nothing to do with present or future healthcare costs.

Ottawa, in fact, has never produced legislation mandating healthcare funding on the basis of future needs assessed in terms of actual demographic, epidemiological, and evidence-based clinical requirements.

HIDA and the Medical Care Act themselves were not forward-looking but fundamentally reactive to previous expenditures; and every finagling by Ottawa of its healthcare funding responsibility since 1966 amounts to "Do more with less," which is the single most destructive human resource management approach ever conceived.

Block grants, initiated with the Federal-Provincial Fiscal Arrangements and Established Programs Financing Act of 1977, are the go-to method for eradicating public services (because block grant money can be "borrowed", spent on anything else, and never repaid). And transferring taxing authority from Ottawa to the provinces and territories, as the 1977 Act did, amounts to rearranging deck chairs, another cynical exercise in smoke and mirrors.

The history of defunding Canada's healthcare system is a case study in financialization and is the root cause of years of chronic understaffing, ensuing burnout, and today's nurse and doctor shortages and ER closures.

There is money in the Canadian economy to begin now to correct these problems, but it is tied up in the financial assets casino and infrastructure projects designed to pump life into the fossil fuel industry, hastening the eradication of human civilization as we know it.