Last week, the premiers of all 13 provinces and territories gathered in Victoria. A key item on their agenda was to discuss the future of medicare in light of the federal government’s long-term take-it-or-leave-it health financing deal.
By now the details are well-known: Ottawa will increase the Canada Health Transfer – currently worth $27-billion in cash and $13.6-billion in tax points annually – by 6 per cent per annum until 2016 then tie the increases to economic growth (meaning they will be around 4 per cent a year) for another decade. In the future, Ottawa will dole out the money on a strict per-capita basis, with no adjustments based on the economic status or demographics of the provinces and territories. (There was an equalization formula in earlier deals.)
There will also be no strings attached, meaning the provinces and territories can spend the money as they see fit and that the federal government will no longer try to entice the provinces to tackle common problems like wait times or lack of electronic health records, nor will it use the money to ensure that provincial programs are equitable across the country.
Before the meeting there were dire warnings that drastic cuts to health-care delivery would be necessary in some provinces; others said it could spell the end of medicare as we know it, and so on.
What is certain is that Prime Minister Stephen Harper has fundamentally changed the federal-provincial relationship in the shared jurisdiction of health care, essentially relegating Ottawa to the role of disinterested benefactor of a decentralized system.
“The premiers were unanimous that the federal government’s decision to unilaterally decide funding was unprecedented and unacceptable,” said B.C. Premier Christy Clark.
A crisis requiring firm action indeed.
The premiers huffed about the lack of money Ottawa was offering and they puffed about the feds abdicating their responsibilities. And then they drew in a big breath and mightily declared that … more study was necessary.
By the end of the meeting, having tapped all their collective wisdom, political savvy, economic insight and social policy expertise, the cream of the crop of Canadian politics came up with a hard-hitting response … forming two committees.
Let’s pray there’s some secret plan they’re not telling us about because this is pathetic.
Mr. Harper took the 13 premiers to the woodshed – albeit with a velvet paddle – and their response was a vigorous bout of committee forming?
Mr. Harper is no Chuckles the Clown but he must be laughing himself silly at how easy it was to divide and conquer the provinces and save himself a few tens of billions in transfers in the process.
There was a golden opportunity here for the provinces and territories to say: “We have common interests and, despite Ottawa’s indifference, we’re going to ensure a semblance of a national health-care system remains.”
For example, the premiers could have agreed to a set ofcommon standards for reimbursement of prescription drugs, an area where there are gross disparities between jurisdictions. Creating this kind of national (not federal) program would be immensely popular with Canadians because it would be a de facto expansion of medicare. (Currently there are common standards only for coverage of hospital and physicians services.) The additional cost would be minimal and, with a united front, they could probably shame the federal government into paying for it.
The premiers could have shown leadership on a file that has festered for decades and started the process of dragging medicare into the 21st century.
Instead, we got a boatload of platitudes for public consumption and a new reality in health care where the rich provinces got richer and the poor ones got poorer.
With the fundamental principles underlying medicare – equity and fairness in health-care delivery and funding – crumbling, the premiers are fiddling.
We now have a new working group, chaired by Manitoba Premier Greg Selinger, to examine the federal government’s new funding formula (even though the federal government says it is not open for discussion). We also have a new Health Care Innovation Working Group, composed of all provincial and territorial health ministers and co-chaired by PEI Premier Robert Ghiz and Saskatchewan Premier Brad Wall.
This bold exercise in innovative thinking will focus on only three areas: the scope of practice of health professionals (important but hardly a task for premiers); human resources management (read: Hey guys can we stop stealing doctors and nurses from each other by co-ordinating what we offer them in collective agreements?) and encouraging the development of clinical practice guidelines (another triviality best left to professional associations.) That is work for bureaucrats, not premiers. When the first ministers meet, they should be articulating a vision for the future of medicare, not whimpering like snubbed school children.
We don’t need more studies or committees. Every royal commission, provincial inquiry, independent analysis for the past five decades has come to the same basic conclusions about what we need to do reform medicare:
* Control spending by limiting medicare coverage to essential treatments that work;
* Modernize primary care by moving away from solo physician practices to interdisciplinary teams;
* Create some kind of universal prescription drug plan;
* Shift money from institutional care to home care so we can look after people where they live, in the community and at home;
* Instead of spending obscene amounts of money to marginally extend survival of the terminally ill, invest it in palliative care.
The premiers have six months until their next meeting. In the interim they should be making plans, real plans, for improving medicare – with the money they have (which is about $141-billion in public funds and another $59-billion in private dollars.) There is no magic bullet, least of all more money. The improvement needs to be made, little by little, but that can’t begin to happen until there are specific goals and leadership from the top.
We don’t need more working groups. We need work to begin. Now. Seriously.