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Jeffrey Simpson (Brigitte Bouvier For The Globe and Mail)

Jeffrey Simpson

(Brigitte Bouvier For The Globe and Mail)

Jeffrey Simpson

Ottawa's health-care dollars should come with strings attached Add to ...

Stephen Harper, it is said, has a compartmentalized view of federalism. Let Ottawa do what Ottawa should do; let the provinces do what they should do. Let each stay out of the other’s hair.

This description of Mr. Harper’s views resurfaced recently when, quite suddenly, his government told the provinces what money they would be getting in health-care transfers – 6 per cent for the next three years; in the range of 4 per cent thereafter.

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Ottawa would not attach any conditions to the money. Provinces are “the ones who are responsible” for health care, Mr. Harper said. “They’re the ones who deliver the service,” he added. The federal diktat apparently underscored his compartmentalized view of federalism. But did it?

Leave the dollars aside and the predictable provincial whining that the dollars weren’t enough. The dollar figures are less important than the radical break the Harper government has made in health-care policy. By turning over money without asking for anything in return, the Harper government broke with 55 years of federal policy.

In 1957, Progressive Conservative prime minister John Diefenbaker (a Harper government icon – Conservative PMs Brian Mulroney, Kim Campbell and Joe Clark not being suitable for that role) agreed that Ottawa should pay half the costs of hospital construction. Federal money, in other words, would be targeted in a particular way to help build a health-care system.

Conservative or Liberal, every federal government since Diefenbaker has placed some conditions (or tried to) on federal transfers for health care. Federal governments wanted political profile, of course, for Ottawa’s money, but they also sensed that the public viewed health care as something “Canadian” that transcended provincial boundaries.

Ottawa was often frustrated, and sometimes even rebuffed, in applying conditions to the transfers. But federal governments felt, at a bare minimum, that provinces should somehow be “accountable” for the transferred money – if not directly to Ottawa, then at least to citizens. That is why successive federal governments harped on the word “accountability.” Indeed, Mr. Harper himself and his health minister were using that word right up to the weeks before the bombshell announcement.

Mr. Harper shared the old federal consensus when campaigning in 2004. In that election, Mr. Harper pledged that a Conservative government would assume all costs for catastrophic drug coverage for anyone over $5,000 per year. He also promised to build with the provinces a “national formulary” for drugs. The Conservatives budgeted $600-million to $800-million for these initiatives.

Mr. Harper insisted in 2004 that a Conservative government would insist on “accountability.” It would ensure performance indicators for timely access and quality. He went further: Conservatives would provide Canadians with a “list of common home-care services eligible for coverage.”

The Conservatives lost the 2004 election. The next year, in the 2005 election, Mr. Harper resumed proposing an active federal role in health care. As one of his party’s five core election promises, he pledged a Patient Wait Time Guarantee and allocated about $1-billion to that cause.

Any compartmentalized view of health care did not shape Mr. Harper’s thinking in his early years and later. Even in the last election campaign, Mr. Harper’s party promised to renew the Health Accord signed by prime minister Paul Martin and the premiers – that is, to renegotiate it with the provinces, including the goal of “better reporting from the provinces and territories to measure progress, and guarantees covering additional medically necessary procedures.”

The Harper government, elected with a majority in 2011, told the provinces without warning or negotiations in December what funds they would be getting. There was no “negotiation,” as Mr. Harper had promised during the campaign. There was no demand for greater “accountability.” The 2004-2005 campaign promises had been long forgotten about wait-time guarantees and catastrophic drug coverage.

For the first time, Ottawa would not even try to influence how provinces spent federal money. Ottawa would abandon the field, except for it constitutional responsibility to provide health care for veterans and aboriginals.

Politically, Mr. Harper’s radical departure gets health care off the agenda, since Ottawa will still be spending a lot. Politically, the departure also creates a vacuum that begs for another party to fill with a revised plan for federal action.

 
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