Academic journal article
By McIntosh, Tom
Canadian Public Administration , Vol. 47, No. 1
Sommaire: Le present article porte sur les nouvelles et anciennes dynamiques intergouvernementales concernant les transferts accordes par le federal aux provinces pour le financement des politiques sociales et de sante, qui ont decoule du Rapport Romanow et de la decision de scinder le Transfert canadien en matiere de sante et de programmes sociaux (TCSPS) en deux composantes distinctes. Quoique les provinces aient accepte la scission, le gouvernement federal a entrepris de proceder unilateralement a l'affectation des paiements aux nouveaux Transfert canadien en matiere de sante et Transfert canadien en matiere de programmes sociaux. Simultanement, ces dernieres annees, le gouvernement federal a accru ses propres depenses sociales dans des domaines de juridiction provinciale. Face a cela, les provinces ont adopte une position de plus en plus intransigeante a l'egard des initiatives unilaterales d'Ottawa comme le demontrent la creation du Conseil de la federation et sa concentration sur le soi-disant desequilibre financier au sein de la federation. Cette dynamique fait que l'engagement intergouvernemental envers le federalisme de collaboration sonne plutot vide. L'article soutient que l'inaptitude des deux ordres de gouvernement prendre au serieux le federalisme de collaboration et l'interdependance politique represente une forte menace, non seulement pour la sante de la federation, mais aussi pour les efforts visant a creer un politique publique saine.
In its final report, the Commission on the Future of Health Care in Canada, headed by former Saskatchewan Premier Roy Romanow, recommended that, beginning in 2005-06, the Canadian Health and Social Transfer (CHST) be split into two separate all-cash transfers, one for health care and one for both postsecondary education (PSE) and social policy spending. (1) This somewhat fundamental rethinking of federal transfers to the provinces received relatively little media coverage and virtually no comment from either federal or provincial government politicians at the time of the report's release. While the minutiae of fiscal federalism and the complexity of the debate over federal transfers to the provinces hardly makes for easy reporting, one might have thought that a recommendation designed to clarify the seemingly endless debate over "how much does the federal government contribute to health care?" would be worthy of more sustained analysis. This is especially so given the unprecedented degree of media coverage accorded the release of the Romanow report generally (coverage that prompted one print journalist to rename the CBC the "Romanow Broadcasting Corporation" for its saturation coverage of the event on television).
Yet the lack of public discussion about this aspect of the Romanow Report has not meant that the recommendation has been ignored. The 2003 First Ministers' Accord on Health Care Renewal was agreed to by eleven of the fourteen first ministers (the three territorial leaders having opted to not accept the document over the lack of attention paid to rural, remote and northern health-care issues) and included a commitment that "The Government of Canada will establish a new long-term Canada Health Transfer (CHT) by March 31, 2004. It will include the portion of the current CHST (both cash and tax points) corresponding to the current proportion of health expenditures in provincial social spending supported by this transfer. In establishing the CHT, the federal government will ensure predictable annual increases in health transfers. (2)
This commitment, though, is unsatisfactory for a number of reasons. First, the federal government continues to include the value of the tax points originally transferred over a quarter century ago into the value of the transfer--furthering a debate that is as unnecessary as it is unhelpful. Second, the federal government appears uninterested in reinstating an escalator clause into the transfer formula. Thus, the federal government alone will continue to determine the promised predictable increases, and there is no commitment that "predictable" will also mean "sufficient. …