Canada’s Medicare   Part 3 of 3: Securing the future

Life of the present health accord

The present 10-year Health Accord between the federal and the 10 provincial and three territorial governments ends in two years! Their health ministers met two months ago to prepare the groundwork for review of its accomplishments. Reportedly, laudable progress has been achieved in reducing the wait list for hip and knee replacement, eyesight restoration and heart surgery as well as for cancer care and diagnostic imaging. Painfully slow, however, has been the pace of progress for the wider use of electronic health records, which enable practitioners, by having readily available complete patient information, to deliver better quality care for their patients and prevent harmful drug reactions and unnecessary and expensive diagnostic tests.

In addition, the country is nowhere near accomplishing the following:

1. creating a national prescription drug strategy;
2. establishing a national home care program;
3. achieving primary health care reform nationwide;
4. prescribing a method for accountability and reporting to citizens;
5. ensuring timely access to care in the north;
6. instituting effective health promotion and illness prevention strategy;
7. implementing a national action plan for health human resources; and
8. adopting a formalized mechanism for dispute avoidance and resolution.

These are the remaining eight of the 10 areas for work to be done during the 10-year period ending 2014.

Outlook for a future health accord

With barely two years remaining in the life of the present Health Accord and with the increasing realization that sustainability of Medicare is in peril, the future does not look healthy for our most valued health care system. More than ever in the history of our nation, Canadians need the creative and collaborative leadership and stewardship of our Prime Minister, provincial Premiers and territorial leaders. At stake is the future of Medicare – the crown jewel of our social programs, the signature of our shared identity.

It is in this context of apprehension that most Canadians, I believe, received in fear our Prime Minister’s recent announcement of his unilateral, non-negotiable funding contribution to the provincial and territorial budgets for Medicare. Compounding this fear was his further announcement that the federal cash transfer payments would be based solely on population number and would not take into account its demographic composition such as the number of senior citizens as a proportion in any given provincial population. Reality tells us the health care needs of senior citizens are far greater than the general population.

It was, therefore, welcome news to learn that provincial premiers and territorial leaders met a month ago to precisely discuss how to: 1. modernize the health care system and 2. secure its sustainability in terms of both costs and revenues for the present and the future. While their conference ended with no united response to the Prime Minister’s funding plan, they were one in voice in their criticism of his unilateral decision without prior consultation. How indeed, one asks, could there be a renewal of agreement – a future health accord – without provincial consultation?

Threats to the survival of medicare

First, recall the federal birth and evolution of Medicare. It started during the leadership of Prime Minister (PM) Louis St. Laurent when Parliament passed the 1957 Hospital Insurance and Diagnostic Services Act, which guaranteed 50% federal funding of provincial hospital insurance program; through the leaderships of PM John Diefenbaker who crafted the 1961 National Hospital Insurance Plan that was accepted by all the provinces; PM Lester Pearson who prescribed the five national standards for provinces to comply in the 1966 Medical Care Act; and PM Elliott Trudeau who brought in the 1984 Canada Health Act that added to the five national standards the prohibitions against extra-billings by doctors and health care facilities.

Indeed, the birth and growth of Canada’s Medicare came about as a result of a series of invitations from the federal governments of different times and political colours and it underscore the pre-eminent and creative role of federal leadership. The federal government has since continued to use its spending power to co-opt the provinces, which have exclusive constitutional jurisdiction on health care delivery, to the five principles and two prohibitions enshrined in our Medicare law.

Consultation and negotiation have been the hallmarks of our continued success. Departure from this long-held convention threatens not only harmonious federal-provincial relations but also the integrity of our shared national identity. Absence of federal leadership threatens the very survival of Medicare.

Why Medicare needs Ottawa

“There’s more to leadership than writing cheques,” opined former Saskatchewan Premier Roy Romanow and co-authors Linda Silas and Steven Lewis in their recent commentary with the same title in The Globe and Mail’s Editorial & Comment Section (January 16). Let me paraphrase their seven reasons:

1. Medicare is very much a part of our unifying societal ethos and citizenry engagement;
2. its simplicity as a health plan and its pan-Canadian universality in application have been a gift to our national prosperity;
3. federal leadership is the most effective national intelligence agent the country has had for ensuring excellence in health care and research in best health-delivery approaches;
4. federal leadership holds the key to achieving meaningful transformation of our health system;
5. federal eyes act as a powerful deterrence to bureaucracy and redundancy;
6. federal leadership exerts a more persuasive, not intrusive, force as the overall conscience of the system for responsibility and accountability by all stakeholders; and
7. the federal government is most uniquely positioned to serve as the champion of our a single-payer, not-for-profit, publicly administered system.

Already Canadians have successfully trumpeted that health is a public good, not a simple commodity. We decided more than half a century ago that we could not stand for a two-tier health system: one serving the rich citizens and another serving the poor. And we have become a great nation in the world. Today, Canada cannot afford to create a two-tier system of another variety (as columnist Gary Mason for the Globe & Mail intuitively termed): “one system for the rich provinces and one for the poor.”

Indeed, federal leadership holds the key to sustainability of Canada’s Medicare. Canadians have a duty to watch! Only then can we secure the future of Medicare.

Dr. Rey D. Pagtakhan is a former Professor at the University of Manitoba Faculty of Medicine, Member of Parliament and senior federal minister. He is widely published and has lectured in Medicine and Politics and has also received many awards and honours, including the honorary Doctor of Science and Doctor of Laws.

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