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The Globe and Mail

Politicians must be clear on 'federal' health issues

Constitutionally, health care is a provincial responsibility. So, during a federal election campaign, there isn't much to say, right?

Wrong. The notion that health is exclusively a provincial matter has no basis in law or in fact. It's nothing but a convenient excuse for federal politicians to avoid uncomfortable questions.

Ottawa plays a key role in establishing and upholding national principles that are set out in the Canada Health Act and it provides substantial financial support to the provinces and territories.

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The federal government runs the country's fifth-largest health system. It is responsible for the direct delivery of health care to more than one million people, including status Indians living on reserves, Inuit, members of the Canadian Forces, the RCMP, eligible veterans, federal prison inmates and refugee claimants.

Finally, it is responsible for public-health programs and health-protection measures such as food safety, regulation of pharmaceuticals and medical devices and consumer safety.

Health Canada alone spends $3.3-billion a year, bigger than the entire budget of many provinces, and the $650-million allocated to the Public Health Agency of Canada exceeds the health budgets in many provinces. And let's not forget that more than $1-billion in federal tax dollars go to health research each year.

So what health issues should political hopefuls - and party leaders in particular - be addressing on the campaign trail?

The most pressing and politically delicate health issue the next prime minister will have to deal with is the renewal of the Health Accord, which expires in 2014.

When medicare began in the early 1960s, Ottawa enticed the provinces into adopting national standards by paying 50 per cent of their health bills. But the feds (Conservatives and Liberals alike) gradually weaselled out of that commitment and they now cover about 20 per cent of publicly funded health costs.

This year, Ottawa will provide $25.4-billion in cash and $13.1-billion in tax points to the provinces and territories under the Canada Health Transfer, and the amount increases 6 per cent annually. Moreover, those massive cash transfers come with no strings attached and little monitoring.

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Our wannabe political leaders should be clearly stating: a) how much they are willing to offer in CHT transfers; b) how they will keep spending in check and; c) what will they demand in return.

Ottawa needs to be more than a cash machine. Federal tax dollars should buy change and the parties need to state clearly what they would demand from the provinces. It could be more comprehensive prescription-drug coverage or expanded home-care/nursing-home coverage.

You can bet that the Conservatives, Liberals and New Democrats will make these issues - along with support for unpaid caregivers - major campaign platform items because they are hot-button issues.

The billion-dollar promises are coming, but the parties need to be explicit on how these programs will be funded and implemented.

But leadership in health care requires more than wooing baby boomers.

One of the health-care issues ignored during federal election campaigns is how Ottawa delivers care to its constituents, specifically to on-reserve natives and Inuit. The federal government, if it believes in universal medicare, should be leading by example.

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Yet, while the health coverage afforded these isolated groups is the most comprehensive in the country (it includes prescription drugs and dental in addition to medical care), the actual delivery of care is poor at best. Worse yet, these groups tend to live in such abysmal socio-economic conditions that good health is virtually impossible.

It is shameful that our wannabe leaders do not have to explain why, in 2011, we tolerate entire communities living without safe drinking water and reliant on "honey pots" (human sewage collected in buckets or plastic bags). Currently, there are more than 100 drinking-water advisories on reserves. This is a disgrace of global proportions in a wealthy country like Canada.

Surely it has to be one of our most pressing health and social issues and a recurrent topic on the campaign trail. So where is the debate about cleaning up drinking water on reserves? There was a bill, S-11, that died on the order paper. But the proposed law came with no funds for building the infrastructure to provide clean water; all it gave us so far was some unseemly lobbying.

Similarly, Ottawa has quietly transferred its network of hospitals for veterans to the provinces, contracting out care with little or no debate. The care provided to soldiers certainly deserves some public discussion. And there are many more "federal" health issues that deserve airing.

These are not just trivial matters. Debate would offer some clues about the political leaders' fundamental philosophy about medicare.

In a country that obsesses about health care, we should know, minimally, if party leaders believe in the five principles in the Canada Health Act - public administration, comprehensiveness, universality, portability and accessibility. We should know if they would they punish provinces financially for breaching those prerequisites for funding - which they do routinely. If not, what alternative do they propose? How would they like to see medicare reformed?

Only New Democrat Jack Layton has been crystal clear in his support for the law, but, let's face it, he has little chance of forming a government.

When Conservative Leader Stephen Harper headed the National Citizens' Coalition, he stated plainly that the Canada Health Act should be scrapped. He no longer says that, but his government simply does not enforce the law.

Liberal Leader Michael Ignatieff utters a lot of platitudes about the sanctity of medicare, but he's pretty fuzzy on the all-important details.

In fact, fuzziness is what we tend to get a lot of when health-care questions arise. If health truly matters - as the polls consistently indicate - then some clarity and vision would be welcome from our leaders, and they are long overdue.

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