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Sean Speer: Despite all the attention, the health-care funding plan is not a big deal—and that’s a good thing

Commentary

The elevation of single-payer health care to something of a national icon means that technocratic discussions about funding formulas and service delivery provisions tend to loom larger over our politics and society than they probably ought to. The wall-to-wall coverage of this week’s first ministers’ meeting is a case in point. 

If one strips back the political hyperbole and the tendency on the part of governments to obscure facts by mixing new and old funding and choosing long timeframes, the crux of the federal-provincial deal is itself not that big of a deal. And that’s actually a good thing. 

Let me explain but bear with me: it requires a bit of policy context including the evolution of the growth rate for the Canada Health Transfer over the past decade or so. 

The Harper government (of which I was part) inherited its predecessor’s 10-year health accord with the provinces which included a promise to increase the CHT by 6 percent annually. We sustained the commitment and even extended it for three more years. 

Yet Finance minister Jim Flaherty informed the provinces in December 2011 that thereafter CHT’s growth rate would be set based on a three-year rolling average of nominal GDP. The shift was designed to put CHT’s growth on a sustainable footing that tracked the economy on a cyclical basis. 

But we also included a 3-percent floor as an insurance policy. If for some reason nominal GDP dropped precipitously over a three-year period, federal transfers would remain stable. At the time, then-Prime Minister Harper asked Finance officials to check the historical data to see if such a scenario had ever occurred. Their answer was no: if the formula had been in place over previous decades, the 3-percent floor would have never been triggered. 

As Flaherty told the media and his provincial counterparts, the expectation was that under the new policy, the CHT’s annual growth rate would change from 6 percent to something approximating 4 or 4.5 percent on an ongoing basis. 

The pandemic confounded Finance’s analysis. The massive economic contraction caused by a public health crisis would have reduced the growth in federal health transfers at the precise moment that provincial health-care systems were facing once-in-a-lifetime pressures. The Trudeau government rightly stepped in to stabilize and ultimately augment federal health-care funding to the provinces. 

Then as the economy jolted out of the pandemic, the CHT’s growth rate grew along with it. At least for the next couple of years, tying the CHT’s growth to nominal GDP has the effect of essentially restoring its growth rate to roughly 5 or 6 percent. 

That brings us to this week’s federal announcement. The Trudeau government’s proposal is somewhat complicated involving a combination of a short-term boost and a medium-term increase to the escalator. But, according to University of Calgary economist Trevor Tombe, the cumulative effect is to essentially raise the CHT’s floor from 3 percent to 5 percent and change its average annual growth from just over 4.5 percent in the baseline to just under 5.5 percent.  

Put differently: federal health transfers will now be a bit higher than they would have otherwise been in the coming years and a bit less than they were in the previous decade. We’ve essentially ended up somewhere between the growth rate under the 10-year health accord and where the Harper government set it back in 2011. 

It will translate into incremental health-care dollars—the federal government projects $46B over the next decade—spread across ten provinces. But it doesn’t fundamentally change the basic challenge facing provincial governments which is a structural gap between health-care supply and inexorable demand. 

In that sense, those who are understandably concerned that an infusion of federal funding would blunt the incentives to pursue the kind of reforms recently announced by Ontario Premier Doug Ford can find some relief. The marginal increase in federal funding shouldn’t in and of itself cause provinces to abandon their reform ambitions. A one-percentage-point increase in the growth rate of federal health transfers is no substitute for solving the supply-demand disequilibrium at the heart of Canada’s health-care conundrum. 

The real question will be whether there are any incremental federal conditions attached to these funds. While there’s a strong case for loosening the pre-existing conditions under the Canada Health Act (including permitting greater experimentation with co-payments and other forms of extra billing), they haven’t been a major impediment to the recent string of provincial reforms to leverage greater private delivery within the single-payer model. 

If, however, these federal funds come with greater strings attached—especially given that they don’t fundamentally change the equation for the provinces—they would be wise to reject them. It wouldn’t be worth it. 

But if the extra dollars come with few conditions—and in fact, validate the current trajectory of provincial health-care reforms—then this week’s announcement is a mostly innocuous development that, notwithstanding the noise and attention, leaves us in the same position we were in last week. 

Meaningful health-care reform is ultimately going to come from the provinces using a mix of policy tools, including the private sector, to expand the supply of doctors, nurses, surgeries, tests, and so on. It was never going to come from Ottawa. And this week’s federal-provincial deal merely confirms it.

Paul W. Bennett: New Brunswick tried to ram through French immersion reforms. Here’s why it failed

Commentary

Tampering with French Immersion is a perilous undertaking in K-12 education. In New Brunswick, Canada’s only officially bilingual province, it is proving to be like “touching the third rail” in education politics. A proposed plan to change French-language education by eliminating French Immersion in New Brunswick’s Anglophone schools is being overridden by a firestorm of popular resistance.  

A series of four scheduled and managed public consultations from January 17-26 attracted huge crowds and not only sparked a backlash, but sent Minister of Education Bill Hogan reeling and put the Blaine Higgs’ Progressive Conservative government at risk. It was exposed by the Canadian Parents for French NB as a rather ineffective attempt to apply the Delphi Technique—a decision-making strategy that utilizes seating in circles and is conceptualized as a learning activity that is designed to contain and diffuse dissent.

Why managed consultation imploded 

As a strategy for managing public consultations, popularly known as the “World Café,” it essentially crashed and burned. The overwhelming majority of parent and teacher participants saw it as a “con job” and every speaker denounced the plan to introduce the changes in kindergarten and grade one, beginning in September 2023. Manufacturing consent can and does backfire, especially when utilized in a thinly-veiled fashion to ram through school reforms or facilitate school facility changes such as school closures. 

Organizers in New Brunswick were totally unprepared for the crowd, mobbed by speakers, and unable to answer fundamental questions. A harried-looking education minister went on the defensive, first threatening to dismiss the unruly crowd, then conceding that, if not enough French teachers could be found, it would be started in grade 1 and delayed at the kindergarten level. By the end of the consultations, he was now insisting it was “not cast in stone.”  

Education Minister Hogan has been dealt a bad hand. Appointed in October 2022 to succeed Dominic Cardy, a confident, fluently-bilingual public performer, he finds himself fronting a massively unpopular French language education initiative that is opposed by as many as three out of four New Brunswickers. What’s worse is that a rushed implementation is planned for September 2023 and the initial 22-odd Language Learning Opportunities (LLO) pilot programs were never properly assessed in terms of their effectiveness in improving the fluency and proficiency of students.  

Signs of implementation disaster

The minister and his deputy minister, John MacLaughlin, were left scrambling under the glare of extensive media coverage. All the signs point to either a full retreat or an impending implementation disaster. After two years of planning and almost two dozen pilot projects, how did it come apart so fast?  

The sacking of Cardy deprived Premier Higgs of his most effective and persuasive communicator and the department never recovered. Without Cardy fronting the project, the remaining trust dissolved among French-speaking New Brunswickers as well as the province’s most articulate Anglophone bilingualism advocates, French immersion parents, and graduates. 

Political skeletons sometimes get released from their closets at the most inopportune times. Few remembered Blaine Higgs’ 1989 Confederation of Regions leadership campaign pledge to eliminate immersion until it resurfaced again in a politically-damaging October 2022 commentary. From that point on, the fix was in on the high-risk policy proposal.  

Absorbing the school reform lessons 

Education Minister Hogan and his senior officials have broken all the rules in the textbook on how to implement successful education reforms. It’s all neatly synthesized in one of my favourite sources, David Tyack and Larry Cuban’s 1995 modern classic, Tinkering Toward Utopia. It begins by taking stock of previous initiatives and learning from the past. 

In the case of New Brunswick and French immersion, that means asking whether any other Canadian province has ever succeeded in eliminating the program and learning from past mistakes. The prime example would be former Minister Kelly Lamrock’s politically-bruising attempt in 2008 to delay the entry point to grade 6, then grade 3, before eventually abandoning it in the face of fierce opposition. Then, as now, it was all based upon the claim that the province was, according to Maclean’s “failing miserably at graduating bilingual students.” 

Education reform initiatives proceed, in stages, from policy talk to policy action to implementation. In the education sector, changes falter mostly during implementation. The key reasons are short timelines, lack of leadership capacity, or insufficient human or resource support to make it work. Implementation is much slower and more complex and governments tend to move on to other priorities. That explains why the evaluation of initiatives, including data-gathering, falls far too often by the wayside. 

Overcoming the gravitational pull of the status quo is not easy and, in the words of American education psychologist Robert Evans, most initially embrace change with as much enthusiasm as they do changing a baby. Inspiring and skillful leadership is required to overcome the initial sense of loss and convey a sense of renewed purpose going forward.

Introducing an upgraded universal French language program in place of French immersion is unlikely to work. With an election ahead in the fall of 2024, it all looks to be based upon election cycles rather than policy change cycles. Even if the change in the French language program gets authorized, it will be far too rushed in its implementation, half-baked in conception, and impossible to staff given the dire shortage of French teachers with the requisite competencies. 

A better path: deliberative engagement

Public engagement is quite distinct from public consultation in that it, under the right conditions, provides an open approach and a genuine commitment to breaking the mold. Being open, transparent, accountable, and responsive does require unique, well-calibrated skills. In the education leadership field, it often involves unlearning ingrained practices and habits. Finding a common cause, sizing up the conditions, leading with questions rather than answers, and meeting groups where they are are all critical ingredients. 

New Brunswick’s disastrous public consultation taught us a fundamental lesson about the critical need to engage citizens and build support for reforms. Canadian public engagement specialist Don Lenihan (Middle Ground Engagement, Ottawa) now calls it “deliberative public engagement.”  It may work in New Brunswick if the provincial government realizes that it’s time to start again, from ground zero. 

There’s got to be a better path forward in advancing bilingualism through the schools. Deliberative public engagement would be more likely to both find an acceptable and sustainable rapprochement and raise the number of bilingual graduates from Anglophone schools.