The Conservative government’s surprise health-care offer to the provinces is fair, reasonable and appropriate. It does not bill itself as a plan to save Medicare. It does not hold the provinces’ feet to the fire. But Canada had its supposed fix for a generation, and it didn’t take.
The government is throwing the ball of innovation into the provinces’ court, where it belongs. The plan is generous (six per cent in each of the first three years, at least three per cent thereafter, and possibly more, depending on economic conditions), but not so generous that the provinces can sit back and attempt to do business as usual. The deal is to last 10 years, so the provinces can plan.
It is the inverse of prime minister Paul Martin’s approach in 2004 – being held to ransom while presenting himself as Medicare’s saviour and declaring that he had “bought change.” Instead, Finance Minister James Flaherty stated the terms of the deal in take-it-or-leave-it fashion and offered no grandiose vision.
But the outlines of Mr. Martin’s fix still exist. Focus on measuring wait times in five key areas, and reducing those waits. Transform primary care (first points of contact with doctors and nurses) and expand home care and pharmacare for the 21st century. There is nothing to stop the provinces from sticking to or improving on these approaches. They should accept federal Health Minister Leona Aglukkaq’s offer to work together toward common goals, though they might not be able to extract more cash for doing what they promised to do the first time.
What did Canada buy for $41-billion in the 2004 accord? The Health Council of Canada, after exhaustive study of the effect on wait times, concluded: “The answer is not straightforward.” The system muddled along. You would muddle along nicely, too, on six per cent a year.
British Columbia is happy with the new offer, but Ontario is screaming bloody murder – identifying a federal scapegoat should it find itself, through its own poor planning, unable to cope without slashing services. (In 2017!)
Six per cent a year is unsustainable. The provinces’ budgets would eventually be swallowed by Medicare. All that cash was the wrong kind of “fix” – it induced reliance, not change. The federal government is asserting, not abdicating, its role in maintaining a public health system. Now the provinces need to get to work.