The shift from cooperative to fiscal federalism was a response to provincial demands for control of health and other areas of exclusive jurisdiction. But what did that mean for maintaining national standards? When wage and price controls were lifted in 1978, Canadian doctors began to negotiate with provincial governments to make up lost income. So did nurses’ unions and other public service unions. Between 1966 and 1982, newly formed nurses’ unions across the country held 32 strikes to gain better working conditions and higher wages. Rising costs coincided with inflation and a severe recession in 1981–1982, with the result that some provincial governments appeared to be ignoring actions that threatened access to medically necessary services in order to off-load some health care costs.
The public, however, was well aware of the impact of extra-billingand user fees. Doctors in Ontario were charging an additional $150 for obstetrical care, while similar services in Alberta had a “balance billing” fee of $350. In March 1979, Ontario began to charge an extra $9.80 per day to chronic care patients in general hospitals after their 61st day of care, while British Columbia and Newfoundland added daily surcharges of $7.50 and $3.00 to their hospital costs, respectively. But now that Canadians saw medicare as a right of citizenship, what could the federal government do to alleviate these problems, since it did not have more money to transfer to the provinces?