{"id":18227,"date":"2021-12-03T14:19:01","date_gmt":"2021-12-03T19:19:01","guid":{"rendered":"https:\/\/www.ontariohealthcoalition.ca\/?p=18227"},"modified":"2021-12-12T14:22:48","modified_gmt":"2021-12-12T19:22:48","slug":"the-new-fiscal-federalism-will-change-your-life-but-how","status":"publish","type":"post","link":"https:\/\/www.ontariohealthcoalition.ca\/index.php\/the-new-fiscal-federalism-will-change-your-life-but-how\/","title":{"rendered":"The new fiscal federalism will change your life. But how?"},"content":{"rendered":"<p>(December 2, 2021)<\/p>\n<p>By: <span class=\"article__author-name\">Armine Yalnizyan, Toronto Star<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"\" src=\"https:\/\/images.thestar.com\/Oonm4CoxzAWxTw0OrJkI7AA46aQ=\/1086x724\/smart\/filters:cb(1638301287250)\/https:\/\/www.thestar.com\/content\/dam\/thestar\/business\/opinion\/2021\/12\/01\/the-new-fiscal-federalism-will-change-your-life-but-how\/thronespeech.jpg\" alt=\"Last week\u2019s speech from the throne, delivered in Ottawa by Gov. Gen. Mary Simon, noted that long-term care needs attention. Given the pandemic\u2019s revelation of the problems with elder care, that\u2019s long overdue, Armine Yalnizyan writes.\" width=\"522\" height=\"348\" \/><\/p>\n<p><em>Last week\u2019s speech from the throne, delivered in Ottawa by Gov. Gen. Mary Simon, noted that long-term care needs attention. Given the pandemic\u2019s revelation of the problems with elder care, that\u2019s long overdue, Armine Yalnizyan writes.<span class=\"caption-credit\">\u00a0\u00a0SEAN KILPATRICK\u00a0\/\u00a0POOL\/AFP VIA GETTY IMAGES<\/span><\/em><\/p>\n<p class=\"text-block-container\">How will the business world change in the wake of the pandemic?<\/p>\n<p class=\"text-block-container\">In Canada, it depends on how the meaning of one phrase evolves: fiscal federalism.<\/p>\n<p class=\"text-block-container\">The way we pay for basic public services such as health and education is changing as the federal government plays a bigger role in financing care.<\/p>\n<p class=\"text-block-container\">How the federal role affects the quantity, quality and costs of care will shape the type of economy we have and the type of country we live in. Population aging will expand the care economy\u2019s footprint in the broader economy. If the care economy becomes more driven by non-profit care, it would trigger a cascade of economic and social effects. If that doesn\u2019t happen, we\u2019ll all lose ground.<\/p>\n<p class=\"text-block-container\">Key in this evolution is the federal government\u2019s role. In the era of cash-strapped provincial budgets, it will determine what new public financing will pay for, and what will be provided through markets. The relative roles of governments and markets will shape the future of the care economy, which is the foundation of everything else we do.<\/p>\n<p class=\"text-block-container\">The federal role has changed dramatically over the course of the pandemic but, as we reimagine our post-pandemic country, it helps to recall how much this role has already changed over time.<\/p>\n<p class=\"text-block-container\">The feds\u00a0<span style=\"color: #3366ff;\"><a class=\"text-block__link\" style=\"color: #3366ff;\" href=\"https:\/\/www.canada.ca\/en\/health-canada\/services\/health-care-system\/reports-publications\/health-care-system\/canada.html\">started cost sharing<\/a><\/span>\u00a0provincially regulated public services, including health care, in 1957. Twenty years later, they gave provinces cash and tax room to raise money for their own priorities. But, by 1995, when everyone was cutting taxes and Liberal finance minister Paul Martin cut billions in cash, too, the provinces found themselves once again doing the heavy lifting. Since then, the provinces have been saying \u201cjust give us the money.\u201d<\/p>\n<p class=\"text-block-container\">That\u2019s what they\u2019re still saying, but the pandemic helped birth something entirely new. Provinces short on revenue and faced with demands for expanded services can get \u201cfree\u201d money from the feds. They don\u2019t need to match funds with more of their own money, but federal cash comes with conditions that aim to change outcomes.<\/p>\n<p class=\"text-block-container\">The exemplar of this new deal for Canadians is not health care but the\u00a0<span style=\"color: #3366ff;\"><a class=\"text-block__link\" style=\"color: #3366ff;\" href=\"https:\/\/peopleforeducation.ca\/our-work\/2021-2026-canada-wide-early-learning-and-child-care-agreements\/\">nine provincial and territorial Early Learning and Child Care Agreements recently signed with the federal government<\/a><\/span>. Federal cash has to reduce costs to parents, expand access to care, improve the quality of care, and increase recruitment and retention of qualified workers with better wages and working conditions. That framework still leaves plenty of provincial\/territorial ability to define priorities, as the recent\u00a0<span style=\"color: #3366ff;\"><a class=\"text-block__link\" style=\"color: #3366ff;\" href=\"https:\/\/edmonton.ctvnews.ca\/3-8b-federal-deal-promises-to-bring-10-day-child-care-to-every-corner-of-alberta-by-2025-1.5665959\">\u201cmade in Alberta\u201d<\/a><\/span>\u00a0deal emphasized. (As of today, Ontario, New Brunswick, Nunavut and Northwest Territories have not signed, but negotiations continue.) While there are new questions about the significance of these variances in provincial approaches, there are emerging standards for improvement of care, if not its standardization.<\/p>\n<p class=\"text-block-container\">Last week\u2019s <a href=\"https:\/\/www.canada.ca\/en\/privy-council\/campaigns\/speech-throne\/2021\/speech-from-the-throne.html\"><span style=\"color: #3366ff;\">speech from the throne<\/span><\/a>\u00a0noted that long-term care needs similar attention. Given the pandemic\u2019s revelation of the problems with elder care, it\u2019s long overdue.<\/p>\n<p class=\"text-block-container\">The Ontario Health Coalition just raised the alarm on how things could play out. Providers of 31,000 long-term-care beds in Ontario see their existing 30-year licences, issued under Conservative premier Mike Harris, expire by summer 2025. That\u2019s almost half the current stock of beds. The\u00a0<span style=\"color: #3366ff;\"><a class=\"text-block__link\" style=\"color: #3366ff;\" href=\"https:\/\/www.ontariohealthcoalition.ca\/index.php\/report-public-money-private-profit-the-ford-government-the-privatization-of-the-next-generation-of-ontarios-long-term-care\/\">Ford government has been favouring for-profit providers<\/a><\/span>\u00a0in issuing licences for the next 30 years, perhaps in keeping with the status quo: the majority\u00a0<span style=\"color: #3366ff;\"><a class=\"text-block__link\" style=\"color: #3366ff;\" href=\"https:\/\/www.cihi.ca\/en\/long-term-care-homes-in-canada-how-many-and-who-owns-them\">(57 per cent) of LTC is now run as a for-profit service<\/a><\/span>. It\u2019s a troubling truth that even a pandemic and the offer of more public funds haven\u2019t compelled some of these owners of aging for-profit facilities to improve conditions.<\/p>\n<p class=\"text-block-container\">What are the standards of care we should expect and pay for as taxpayers?<\/p>\n<p class=\"text-block-container\">At last count (June 2021) Ontario had\u00a0<span style=\"color: #3366ff;\"><a class=\"text-block__link\" style=\"color: #3366ff;\" href=\"https:\/\/www.cihi.ca\/en\/how-many-long-term-care-beds-are-there-in-canada\">78,902 long-term-care beds, serving a population of 2.6 million people aged 65 and older<\/a><\/span>. While most seniors will never use a facility before they die, the number of seniors is poised to grow, so the province plans to add another 30,000 beds over the next decade. There\u2019s a lot of money on the table, but also many quality issues. There have been\u00a0<span style=\"color: #3366ff;\"><a class=\"text-block__link\" style=\"color: #3366ff;\" href=\"https:\/\/covid-19.ontario.ca\/data\/long-term-care-homes\">3,837 COVID-related deaths<\/a><\/span>\u00a0in LTCs in Ontario so far. For-profit homes had\u00a0<span style=\"color: #3366ff;\"><a class=\"text-block__link\" style=\"color: #3366ff;\" href=\"https:\/\/covid19-sciencetable.ca\/sciencebrief\/covid-19-and-ontarios-long-term-care-homes-2\/\">twice the rate of infection, and 78 per cent more resident deaths<\/a><\/span>\u00a0than non-profit and public institutions.<\/p>\n<p class=\"text-block-container\">People pay out of pocket for care, but\u00a0<span style=\"color: #3366ff;\"><a class=\"text-block__link\" style=\"color: #3366ff;\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1764560\/\">all providers, whether for profit or not for profit, get the same amount of public funding per patient<\/a><\/span>. The quality of care we buy as taxpayers varies tremendously. We should lean into expecting better governance of what we pay for.<\/p>\n<p class=\"text-block-container\">The care economy will grow in the coming years. How it grows matters to your quality of life. It\u2019s time for ambition, both for those who need and those who provide care. It\u2019s time for better standards, and enforcing rules, for the organizations that care for those among us too young, too old and too sick to fend for themselves.<\/p>\n<p class=\"text-block-container\">Should new federal funds for health care and elder care be modelled on new deals for child care? Should public finances pay for more private profits or dividends in this sector?<\/p>\n<p class=\"text-block-container\">\u201cJust give us the money\u201d is what robbers say during a holdup. Somebody\u2019s going to get hurt without a clear plan for making things better with that money. That\u2019s just what a new fiscal federalism could avoid.<\/p>\n<p><span style=\"color: #3366ff;\"><a style=\"color: #3366ff;\" href=\"https:\/\/www.thestar.com\/business\/opinion\/2021\/12\/01\/the-new-fiscal-federalism-will-change-your-life-but-how.html\">Click here for original article<\/a><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>(December 2, 2021) By: Armine Yalnizyan, Toronto Star Last week\u2019s speech from the throne, delivered in Ottawa by Gov. Gen. Mary Simon, noted that long-term care needs attention. Given the pandemic\u2019s revelation of the problems with elder care, that\u2019s long overdue, Armine Yalnizyan writes.\u00a0\u00a0SEAN KILPATRICK\u00a0\/\u00a0POOL\/AFP VIA GETTY IMAGES How will the business world change in [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[21],"tags":[],"class_list":["post-18227","post","type-post","status-publish","format-standard","hentry","category-ohc-in-the-news"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>The new fiscal federalism will change your life. But how? - Ontario Health Coalition<\/title>\n<meta name=\"description\" content=\"(December 2, 2021) By: Armine Yalnizyan, Toronto Star Last week\u2019s speech from the throne, delivered in Ottawa by Gov. Gen. 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