Roy Romanow, the former NDP premier of Saskatchewan, has been vehemently attacking the Harper government for reneging on its so-called leadership role in health care. In that, he has been echoing the recriminations of the opposition, which is incensed at the government’s decision to stop using federal transfer payments as bargaining chips to force the provinces to submit to federal standards.
I think the government’s approach is highly commendable, a welcome break after decades of federal intrusion into a provincial jurisdiction.
In December, Finance Minister Jim Flaherty tabled a non-negotiable plan for long-term funding that was financially generous, and represented a much-needed change: In the years to come, Ottawa won’t try to negotiate specific changes to the way health care is administered by the provinces, and they’ll be free to do what they want with the federal money.
This is in line with the “open federalism” favoured by Prime Minister Stephen Harper, and a perfectly sensible move since it’s the provincial governments that know best about the needs of their citizens. The federal government has no particular expertise in health care; it’s only responsible for veterans’ health-care plans and for health-care services on aboriginal reserves – with less than sparkling results. This is a reality that both the Liberals and the NDP systematically ignore when they offer “promises” in every federal election to, for instance, increase the number of doctors in outlying regions.
Back in 2002, Mr. Romanow authored a royal commission report on health-care reform. Predictably, he didn’t suggest any fundamental change to the system that Tommy Douglas, the NDP’s Holy Father, created 50 years ago.
His conclusion was that the federal government should pour additional billions into the system but that, in exchange, the provinces should proceed to reforms in pharmacare, and home and primary care. This is exactly what Quebec has been doing on its own: It has an extensive public drug plan and worked hard on the two other fronts. Yet, the emergency wards are overflowing, waiting times are unacceptably long, and the system is bursting at the seams – which shows that Mr. Romanow’s prescription didn’t work.
What’s needed is real change, ideally along the lines of what’s been done in France, which developed (under several Socialist governments, to boot) a mixed public-private system that the World Health Organization rated the most efficient in the world in its last comparative report.
What does Mr. Harper believe? My guess is, like many others, he feels that, after 50 years, medicare needs to evolve. Considering the current state of public opinion, the law can’t be abruptly modified to include, for instance, private medical clinics based on the models prevalent in Western Europe. So change must come from the bottom, and it would be for the greater good if the provinces were free to experiment with new formulas.
This is exactly what Mr. Romanow fears. He believes, as he told Postmedia News, that “national unity” would be imperilled if the provinces evolved differently. But he’s in denial. Uniformity doesn’t exist and never really did. The provinces are very different from each other on all counts, including health care. They don’t have the same policies regarding access to home care, public drug and health plans or hospital management. Far from being a “patchwork-quilt series of programs by the provincial governments,” as Mr. Romanow says, it’s the normal situation of a country that’s as diverse as it’s large.