Five public health care issues worth watching in 2023

The health crisis continues, and there is no end in sight for what health professionals describe as a perfect storm for hospitals caused by a surging number of patients in emergency rooms, staffing shortages, and even erratic supplies of medicines.

New programs and spending promised by the Liberals remain largely undelivered while the Prime Minister and the Premiers argue over funding percentages and accountability. Meanwhile private, for-profit health care corporations are circling the provincial health budgets like sharks.

This could be a make-or-break year for public health care.

Here are five issues worth watching closely in 2023:

1. Will the Prime Minister meet with the premiers to address the health care crisis?

The health care emergency is compounded by the political conflict between premiers demanding more federal funding without strings attached, and the Prime Minister seeking accountability and information-sharing before boosting transfers further.

How much longer can Justin Trudeau refuse to meet with the premiers while health care workers burn out and wait times grow longer for patients? Pressure will mount on the Prime Minister to convene a First Ministers’ meeting on health care this year, as the premiers and the federal NDP have demanded.

But some cracks in the premiers’ coalition are showing. For instance, Nova Scotia Premier Tim Houston said last month he doesn’t oppose guaranteeing outcomes and benefits for additional health funding from the federal government. This could provide the Liberal government room to maneuver and work with willing provinces to implement new programs such as pharmacare.

2. Will Health Minister Jean-Yves Duclos enforce the Canada Health Act to protect the public health care system?

Canada’s Health Minister is responsible for enforcing the Canada Health Act, national legislation to ensure provinces protect Canadians from user fees and extra-billing for treatments, and provinces abide by essential principles such as access to universal health care. If provinces don’t follow the Act’s provisions, the Health Minister can withhold federal financial transfers – costing millions of dollars to provinces that run afoul.

Minister Duclos will table his Canada Health Act Annual Report to Parliament in February, providing a score card on the provinces’ performance under the Act. His report could perpetuate the “go along to get along” approach adopted by many previous Health Ministers, or it could launch a national discussion over the provincial government’s need to be accountable for health care funding.

3. Will the Liberals (finally) deliver national, universal pharmacare legislation and drug cost control measures?

Prime Minister Justin Trudeau promised to pass the Canada Pharmacare Act by the end of 2023 in the landmark Liberal-NDP agreement with NDP Leader Jagmeet Singh. The Act is an essential step toward establishing long-promised universal drug coverage as described in the Liberal-appointed Advisory Council on the Implementation of National Pharmacare, led by former Ontario Health Minister Dr. Eric Hoskins in 2019.

Pharmaceutical companies allied with the insurance and pharmacy industries have been opposing universal public pharmacare and other means to control drug prices, which now cost as much as doctors’ salaries. Their lobbying efforts have been successful so far, and Canada remains the only country in the world with a public health care system that does not cover the cost of prescription drugs for everyone.

But the minority Liberal government may have difficulty dodging its commitment to pharmacare if it wants the NDP’s support to remain in power. The clock is ticking to introduce, debate, and pass all the necessary legislative steps before next New Year’s Eve.

4. Will the Supreme Court of Canada reject the appeal by Cambie Surgeries Corporation of its failed challenge to B.C.’s Medicare Protection Act?

Private, for-profit corporations are gambling that the crisis and growing wait times might help build support for a two-tiered health system. Cambie Surgeries Corporation in Vancouver unsuccessfully challenged the province’s Medicare Protection Act in a B.C. court in 2020, and then lost its appeal in 2022. Now it’s owner, Dr. Brian Day, wants another shot.

Cambie Surgeries Corporation has asked the Supreme Court of Canada for leave to appeal the B.C. courts’ decisions. Experts anticipate an answer from the Supreme Court of Canada early in 2023. If granted, and the corporation is successful, then a Supreme Court of Canada decision in favour of privatization could have serious ramifications for Medicare well beyond British Columbia.

5. Will British Columbia and Ontario uphold their prohibitions against paid-plasma collection?

Last summer’s announcement by Canadian Blood Services of a contract with a multinational corporation that pays people for “donating” plasma shocked health safety experts, advocates, and front-line health workers. Recalling the 1990s Tainted Blood Scandal, former Federal Health Minister Allan Rock took to the media warning for-profit plasma collection would threaten the fragile public trust in Canadian Blood Services to manage Canada’s voluntary blood system.

The practice of paying people for plasma is allowed in Alberta and a handful of other provinces but is explicitly prohibited by legislation in British Columbia and Ontario. Canadian Blood Services says that a loophole allows the multinational corporation to operate as its agent in those provinces. But B.C.’s Health Minister disagrees, setting the stage for a show-down in B.C. and potentially Ontario.