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A consistent theme in the media, when writing about health care in Canada, is to use disparaging adjectives, such as ‘dilapidated,’ ‘ramshackled,’ ‘exhausted.’ They are not exaggerations. The main thing we know is that health care here underperforms and does not meet current needs, a fact distressingly visible during the disasters of the COVID-19 pandemic.
The 2022 federal budget does too little to begin the path toward reversing the deterioration of the health care sector, despite the one-time $2 billion (from 2021/22 expenditures) to deal with surgical backlogs and an increase in transfer payments to provinces for health care. In certain crucial areas it does nothing.
The most shocking deficiency revealed by the pandemic was the poor performance in long-term care (LTC), where Canada had the highest fatality rates among rich countries. This deficiency relates to a systemic problem of underfunding, over-crowding, inadequate staffing and the prominence of the private sector in care delivery. The Liberal election platform promised to deal with this issue by committing $6.7 billion to improve the quality and availability of LTC homes and beds. There was no move toward this at all in this budget. The problems in LTC require time and a federal national strategy to begin improving things.
Where’s the plan for long-term care?
You’d think that terrible experience of deaths in LTC would not so soon be ignored, but it was ignored in the budget. Considering that it takes years for things to happen—to examine the problem and put in place a program after lengthy consultations with provinces—the very least that could be done is to provide a budget line to plan for a LTC program with some sense of costs in the future.
Dealing with chronic and severe labour shortages is the other mostly ignored aspect of the public health system. Not having a doctor or nurse practitioner is common for too many throughout the country, the long-existing nurse shortage has grown to a critical stage and other health care workers are still too poorly paid to attract and retain these desperately needed trained workers.
The 2022 federal budget does too little to begin the path toward reversing the deterioration of the health care sector.
There is a nudge in the budget toward dealing with labour shortages in a section titled ‘Creating Good Middle Class Jobs,’ but again the measures are, for the most part, too little and too slow to begin to meet the vast problems in the health care sector. The fixes for labour rely mostly on providing some monetary incentives to encourage specific groups of doctors and nurses to work in remote, hard-to-serve areas, improving the recognition of immigrant’s credentials and encouraging the hiring of more temporary foreign workers.
The monetary incentives focus on expanding student grants and forgiving a portion of student loans for certain health professionals if they work in underserved rural or remote communities. Nurses could receive up to $30,000 and doctors up to $60,000 in this loan forgiveness program. The main problem with this is that it is the kind of incentive that will take a very long time to have much of an effect, considering the outsized demand for this labour in urban areas.
Workers and credentials
An important step in creating more health professionals will be through using the talents of people who are already in this country but who earned their degrees in other parts of the world. Enlarging the Foreign Credential Recognition Program is a good idea, especially because it intends to standardized national exams, provide easier access to information and ensure faster timelines. This could bring as many as 11,000 trained workers into the system each year for five years, an important change that is long overdue.
Expanding the Temporary Foreign Workers (TFW) program is a big part of the plan for providing labour in the short term. It is a program that has become important for keeping wages in check in specific sectors. The new initiatives are not necessarily targeted toward health care sectors, nor is it likely that the new expansion will solve some of the more serious problems of the poor conditions of too many TFWs. According to the budget, the new measures are intended to “increase protections for workers, to reduce administrative burdens for trusted repeat employers and to ensure employers can quickly bring in workers to fill short-term labour market gaps.”
However, over 90 per cent of the total of $156.7 million budgeted over three years is designed to make things easier primarily for employers. This is through the Trusted Employers Model, a program to expedite things for employers who frequently hire foreign workers; through a special attempt to increase government capacity to process employer applications; and through creating a new foreign labour program for agriculture and fish processing. Only 9 per cent of the new money will go toward making ‘improvements to the quality of employer inspections and hold employers accountable for the treatment of workers.”
The failure of comprehensive planning for labour, especially labour in the care sector, is especially serious considering the known aging of the population. But it also may indicate the lack of commitment to the expansion of the health care sector to deal with the enormous deficiencies in LTC, home care, mental health and the opioid crisis. All of these sectors now suffer not just from inadequate funding but also from severe shortages of trained workers.
Over 90 per cent of the total budgeted over three years is designed to make things easier primarily for employers.
In the minority parliament, there is in place a Confidence and Supply agreement to move on developing some of these programs. But as this budget shows, when and if these programs will happen and how much will be spent on them is entirely unclear. Let’s see the plan so there can be some confidence they will actually materialize. After the 50 year experience with promising child care before it happened, the public should be given a good idea of when and how current promises will be kept.
Title inspired by F.R. Scott. A version of this article was originally published by the Socialist Project with the title “Do Nothing by Halves That Can be Done by Quarters: Federal Budget 2022.”