Editor's note: In an earlier version of this column, Stephen Harper was quoted as having said the following when he was vice-president of the National Citizens Coalition: "It's past time the feds scrapped the Canada Health Act."
In fact, that statement was written by David Somerville, president of the NCC, in the June 1997 edition of The Bulldog. This online version has been corrected.
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Does Canada still have a federal health minister?
And, more important, does it have a government with the slightest interest in maintaining the national health-insurance program called medicare?
For all practical purposes, the answer to both of those questions is a resounding "No."
Leona Aglukkaq, who holds the title of Minister of Health, was glaringly absent this week from the Canadian Medical Association gathering in Niagara Falls, Ont.
It is the first time in living memory that the steward of medicare failed to address the annual meeting of the so-called parliament of medicine.
Ms. Aglukkaq cited "pressing and conflicting business" for her failure to attend. Instead of engaging in dialogue with Canada's doctors, she was watching Prime Minister Stephen Harper announce funding for upgrades to the airport in Churchill, Man. Heady stuff, no doubt, but surely the minister responsible for overseeing the $183-billion-a-year health-care system should have other priorities.
Ms. Aglukkaq is an intelligent, thoughtful politician; she has a superb grasp of the health file, which she demonstrated as the health minister for Nunavut.
But she is an abysmal federal health minister for the simple reason that she is a victim of political glossectomy performed by the hatchet men in the Prime Minister's office.
There are those who will say: "It was just a meeting. So what?"
But the PMO's decision to keep the minister away from the CMA general council is powerfully symbolic. It should send a shiver down the spine of everyone who cares about the future of health care.
The ministerial no-show is a monumental snub. It is a snub to the CMA and a snub to medicare.
Mr. Harper's government has taken the view that health is exclusively a provincial matter.
As Paul Hébert, editor of the Canadian Medical Association Journal, pointed out this week, this is a "position that has no basis in fact or law." (It should be noted that the journal, while owned by the CMA, is editorially independent.)
Constitutionally, health is a provincial domain. But to suggest it is exclusively a provincial domain is the political equivalent of a literal reading of the Bible.
Regardless of what constitutional fundamentalists contend, Ottawa still has a tremendous responsibility in the delivery of health care and its oversight.
Canada has 14 health systems - 10 provinces, three territories and the federal one. The federal system, which covers first nations, Inuit and Métis people, as well as members of the Canadian Forces and the RCMP, is the fifth largest.
Health Canada's annual budget, $3.3-billion, is bigger than that of some provinces. The budget of the Public Health Agency of Canada, $650-million, is more significant than those of some provincial and territorial health ministries. Not to mention that almost $1-billion in federal tax dollars go each year to health studies, via the Canadian Institutes for Health Research.
The federal government is also a major funder of provincial and territorial health care. This year it will provide them with $25.4-billion in cash, about 20 per cent of all public spending, and billions more in infrastructure money, for everything from hospitals to electronic health records.
It is true that when medicare was born Ottawa picked up 50 per cent of the bill, and over time it has gradually weaseled out of its financial duties.
Even if the federal government underfunds health care, it still has the obligation - legal and moral - to ensure that care is delivered fairly and equitably to all Canadians, regardless of where they live. The mechanism it has given itself to do so is the Canada Health Act, which sets out five guiding principles for medicare: public administration, comprehensiveness, universality, portability and accessibility.
Ms. Aglukkaq, as mentioned earlier, was "busy" posing for photos with the Prime Minister in the Arctic, so she did not attend the CMA meeting.
In her stead, Human Resources Minister Diane Finley delivered a platitudinous recitation of banalities that was no doubt penned by the PMO, the most disingenuous of which was telling doctors that Ottawa "shares your passion" for health care.
More telling than what Ms. Finley said was what she did not say. In her speech, which lasted almost 40 minutes, the word "medicare" never once crossed her lips.
In fact, you would be hard pressed to find a federal minister who utters the word medicare publicly, let alone shows leadership on the file.
The Canadian public, which loves medicare to a degree so ridiculous that it is often blind to its shortcomings, would never tolerate a prime minister or a political party that openly dissed and undermined the iconic social program.
But, oddly, the Canadian public seems to tolerate benign (and not so benign) neglect.
Having a Health Minister who is silent and invisible is part of that strategy.
Today, with the challenges posed by an aging population, fiscal pressures, technological advances and ever-increasing expectations, we desperately need leadership on health care.
We need national leadership. We need a health minister who is articulate and unmuzzled. We need a government that believes in medicare and is willing to reform the public health insurance system to make it sustainable for future generations.
We need vision and passion.
What we have instead is a shocking abdication of responsibility. And destructive silence.