Across Canada, the pandemic has demonstrated the urgent need for provincial governments to invest in their respective health care systems. However, as individual governments, the provinces cannot afford the financial requirements the health care sector needs to sustain its exponential growth, they require financial support from the federal government.

The Government of Canada has been gradually decreasing its funding of health services, as they used to fund nearly 50% of provincial health care and they now only fund 22%. While health and social services’ needs continue to grow, provincial governments receive billions of dollars less in additional funding for these services.

In Quebec, the need for increased federal health transfers is more urgent now than ever before to meet the various demands of critical health infrastructure and services including for long-term care, home care, solutions to counter the shortage of health professionals and the construction + renovation of facilities.

Premiers across Canada are relying on the 2021 federal election campaign to secure commitments from the federal parties to ensure that they’ll step up to the plate and commit or push for substantial increases in health transfers. Premier François Legault has been dedicated to this issue by building a common front alongside all his counterparts within the Council of the Federation. However, despite the prominence and importance of this issue in Quebec, the federal parties’ responses do not meet the demands of the provinces.


Political party endorsements

Since it will not form the next government, the Bloc Québécois (Bloc) is providing fair support of the provinces’ requests, confirming it agrees with their requests for an increase in health transfers. Bloc leader, Yves-François Blanchet, is increasingly strategic in his actions while campaigning in Quebec and has made efforts to highlight that his party stands with the struggling health care system. Notably he held a press conference in front of the Hôpital de Gatineau in the Outaouais region, an institution that is suffering from breakdowns in emergency services due to a shortage of personnel.

The New Democratic Party (NDP) is promising to end cuts to health care and supports the Council of the Federation’s call for an immediate 35% increase in health care funding. The NDP’s willingness to increase health transfers however deserves to be communicated to Quebecers with greater emphasis and creativity, as the current message and delivery is not resonating with the population, for a party that held 59 seats a decade ago, they now require further regional representation and engagement in Quebec.

The Conservative Party of Canada’s (Conservative) promises to Quebecers includes a commitment to predictable, stable and unconditional federal health transfers. Leader Erin O’Toole has already stated that a Conservative government would increase transfers by 6% per year, with no strings attached, as was the case under former Prime Minister Stephen Harper’s Conservative government. This is a concrete first step, but is likely insufficient to win over the Quebec electorate. O’Toole’s personal willingness to do more around mental health is additionally noteworthy, however if he wants to stand out in Quebec on the subject of health, he must do more. His reputation needs to be further strengthened within the region and he has the opportunity to become a health advocate, which increases approval from a progressive audience. However, this notion would impact his ambitions to balance the federal budget within the next ten years.

Finally, in the Liberal Party of Canada (Liberal), Prime Minister Justin Trudeau is resisting the provinces’ call for immediate increases in health transfers. So far, the unity between the provinces doesn’t seem to be influencing him; the Liberals are clearly opting for a different strategy. They are however promising major investments in health care and long-term care, though with many strings attached. In internal Liberal polls, this decision is popular with voters, but it raises some issues in Quebec.

All Quebec political parties and a large majority of analysts will, at every opportunity, point out that health is a provincial jurisdiction. The Liberals are well aware of this, but don’t seem to care as they are likely betting that voters across the country will appreciate commitments to future investments in health in a greater capacity than they appreciate provincial jurisdiction.

Notably, the Liberal government has just reached an unconditional $6 billion agreement with the Quebec government on childcare, with no funding restrictions or priorities identified. This is a contradiction that may be raised in the campaign. If a similar deal is really on the table for Quebec for health care, the Liberals would do well to mention it sooner rather than later.

The difference in approach between the Liberals and the Conservatives on health transfers demonstrates a significant difference in their respective views of Canadian federalism.

Health care is, after all, the government’s largest budget item and one of Quebecers’ highest priorities. Some federal policy makers seem to underestimate this aspect. One need only review the national and regional press each morning on health issues in Quebec to see the political opportunity that presents itself to federal parties. Quebec has an individualist approach to servicing and managing its health care system.

Quebec’s nationalist Premier François Legault has intervened with intensity in the federal election campaign. He strongly denounced that two federal parties want to increase health transfers with imposing conditions. The Premier explained that federal conditions on health care will mean more centralization, bureaucracy, bickering and further complications to an already struggling sector. These political arguments will resonate in Quebec. Within the province, this is going to be an important part of the campaign. It now remains to be seen whether it will affect voting intentions. Quebec’s strength will be determined by the composition of the next government in Ottawa.

In my opinion, the federal parties that stand out with their commitments to health care maximize their chances of making political gains. The French-language leaders’ debate on September 8 will be a unique opportunity for the party leaders to position themselves on health transfers. Will they seize the opportunity?