The federal government has asserted its role in health care. There is to be no big vision about saving medicare, and no strings are to be attached to future funding. Now, it appears, there may be no health accord, either.
Finance Minister Jim Flaherty’s take-it-or-leave it offer, which runs for a decade, is entirely reasonable and transparent. As for setting policy and holding the provinces to account, the federal government seems disinclined; the administration and delivery of health care are provincial responsibilities.
This approach is very different from Paul Martin’s $41-billion “fix for a generation,” which expires in 2014. His health accord came with large ambitions and larger hopes of buying change.
Though laudable, the accord’s record is mixed. There have been improvements on wait times in five areas, including joint replacements and diagnostic tests such as CT scans, but no national pharmaceutical strategy. A significant amount of accord money went toward income increases for the highly paid – doctors, nurses and hospital administrators.
Prime Minister Stephen Harper said recently in a radio interview that provinces are “going to have to look seriously at what needs to be done to make the system more cost-effective.”
Talks between federal and provincial officials begin in Victoria on Monday. The provinces are already signalling their concern that there is no mechanism to ensure national standards or service improvements. It frets that Ottawa is distancing itself from one of Canada’s most cherished programs. The reality is that the federal government – save for the accord – hasn’t taken a strong leadership role in health policy for decades, despite the supersized Health Canada bureaucracy.
The provinces don’t need formal federal guidance to fix health care, and the outlines of Mr. Martin’s accord remain. Wait times should continue to be reduced, home care expanded and pharmacare for the 21st century needs to be created. Common accountability measures can be created, with an oversight role for the Health Council of Canada. The Council of the Federation could be used as a secretariat.
The provinces should see this change not as a crisis but as a historic test through which they must pass.