The Globe and Mail

Health care and the economy are the two issues Canadians consistently say mean the most to them, but they're not getting that much substantive air time in the campaign. With this primer, The Globe and Mail addresses that. In this special feature, public-health reporter André Picard frames the problems and politics reporter Steven Chase tries to pin down the parties.

1. The Canada Health Act

The iconic 1984 law sets out the conditions the provinces and territories must meet to get federal health dollars and, de facto, spells out the principles of medicare. But there is near-universal agreement that the legislation, which defines “medically necessary” care only as hospital and physician services, is terribly outdated. Scrap it? Amend it? Or create complementary legislation? There is an opportunity here to fundamentally reshape medicare, but also the risk of opening a political Pandora’s box.

Question: Would you scrap, alter or leave the Canada Health Act as it is?

• Conservatives:

  Stephen Harper and the Conservative Party strongly support the Canada Health Act and its objective of a universally accessible, publicly funded health-care system in Canada. That is why he has increased funding for health care to record levels and why we will continue to increase funding for health care at 6 per cent a year to ensure that all Canadians have access to high-quality health care regardless of ability to pay.

• Liberals:

  A Liberal government passed the Canada Health Act, and we are firmly committed to enforcing the act in government. The reforms we will pursue in government do not require changes to the act itself, and can be accomplished through companion agreements arrived at through collaboration with the provinces and territories.

• NDP:

  New Democrats are committed to preserving public, not-for-profit universal health care. We would strengthen the act to bring out-of-hospital services such as home care and long-term care inside the public health-care system, helping to get costs under control.

2. Pharmacare/catastrophic drug insurance

Medicare was created in the 1950s and 1960s because families were being bankrupted by the cost of hospital and physician care. Today, families, particularly in poor provinces, are facing financial hardship (and sometimes ruin) paying their drug costs.

Question: How will you bring some fairness and affordability to the provision of essential drugs?

• Conservatives:

  We recognize the importance of affordable access to drugs as part of our high-quality health-care system. Provinces and territories are responsible for deciding which drugs are publicly covered. That is why we have increased funding to provinces and territories by 33 per cent since we formed government so that they continue to meet the health-care needs of their residents. How they use these funds is their decision, but the money can help provinces and territories with the costs of their drug plans, including catastrophic coverage.

• Liberals:

  We would engage provincial and territorial governments in a co-ordinated action on drugs, including measures to cover financially catastrophic drugs, cost-reducing bulk purchasing strategies, and improving access to breakthrough pharmaceuticals. These measures were included in the National Pharmaceutical Strategy established under the 2004 Health Accord, which was abandoned by the Harper Conservatives in 2006.

• NDP:

  We will work with the provinces to establish a universal prescription-medications insurance plan – saving billions from health-care budgets – and immediately create an independent Pharmaceutical Research Council to ensure that research dollars are spent in accordance with expert-driven, patient-centred research priorities.

3. Health human resources

There are more than one million health workers in Canada and the number keeps growing. We added 5,000 new doctors in the past five years and 27,000 new nurses in the past decade. Yet, there still seem to be shortages and growing waits for care. Are health professionals working to their full scope of practice? What is the best staff mix for timely, cost-effective delivery of care? Labour is, by far, the biggest health expense, yet there is no cohesive labour strategy.

Question: To deal with wait times and shortages, what do you propose other than hiring more doctors and nurses?

• Conservatives: