It's report card time and the federal government of Stephen Harper is being called out for chronic absenteeism.
The College of Family Physicians of Canada has just published a report card that rates Ottawa's role in five key areas.
The exercise is a worthwhile one but it has received little media attention because the CFPC is wishy-washy in its comments.
"We have developed this report card not to scold but to highlight the specific areas in which the federal government should, in our opinion, assume a larger leadership role," Dr. Marie-Dominique Beaulieu, CFPC president, said in a release.
The CFPC, the self-described "national voice of family medicine" needs to be a lot more blunt in its assessment. Some scolding is in order.
The truth is that the current Conservative government is abdicating its responsibilities, hiding behind the bogus argument that, constitutionally, healthcare is strictly a provincial jurisdiction.
The reality is that it's a shared jurisdiction – constitutionally, legislatively and traditionally.
Sure, delivery of healthcare services is the responsibility of each province and territory within its jurisdiction. But Ottawa also has a constitutional obligation to provide care to its charges – aboriginal peoples, the military, RCMP and newly-arrived immigrants and refugees – as well as for public health and consumer health protection (notably drug safety).
Just as important, the federal government has a longstanding tradition, embedded in legislation and federal-provincial pacts, of providing funding to the provinces and territories. In return for that transfer of tax dollars, it sets conditions as a means of ensuring care is reasonably similar across the country – creating a semblance of a national system if you will. It is that latter role that the Harper government has shunned for ideological reasons.
In doing so, it may well be bolstering its vision of Canada as a decentralized confederation but it is also fuelling growing regional disparities and undermining the philosophy of medicare (providing essential care to all Canadians regardless of ability to pay or where they live).
As the CFPC states in its new report, there are several roles Ottawa should be playing in the health system, other than writing Canada Health Transfer cheques, notably establishing and upholding national standards for care and providing incentives to create new and necessary national programs such as pharmacare. (Though, to be clear, the CFPC does not take an explicit stand on pharmacare in this document.)
"There is reason to feel good about our tradition in health care and our great national program," the CFPC notes in its report card. "However, sustaining and improving the health of that system takes ongoing committed leadership from our federal government."
But, as the organization points out, that leadership is largely absent, across the board. Increasingly the federal government is assuming the role of silent observer rather than active participant in Canada's health system.
In its report card, the CFPC examines Ottawa's performance in five main areas:
1) Putting health care front and centre: The feds get a red light (no involvement) for their commitment to national home care and to a national immunization strategy. They get an amber light (some involvement but could do better) in areas such as timely access to care, support for electronic health records, ensuring every Canadian has a family doctor and support for the Patient's Medical Home (an approach the group has long advocated);
2) Caring for the most vulnerable: Ottawa gets its only green light (strong leadership) for having a national plan to address homelessness (though, it should be said, a lot of big cities would take issue with that score); the CFPC awards yellow for the national mental health strategy and the weak aboriginal health program. A failing red is awarded for a lack of national anti-poverty strategy and for no coherent approach to child and youth health;
3) Ensuring an adequate supply of health professionals: The lack of federal commitment to a national health human resources strategy gets a yellow. They are admonished for failing to track supply and demand of doctors, nurses, etc., and for failing to invest in ensuring health professionals stay healthy;
4) Establishing a vision for health care and measuring performance: Perhaps the most damning critique of all is pointing out, with a glowing red light, that Ottawa has no national health goals and no statement of purpose for medicare. It's hard to make progress when you don't know what you want to achieve. Even the much-ballyhooed increase in the health transfer merits only a yellow because it gradually decreases, pointing to a further pullout from the health field by the federal government over time;
5) Supporting health care research: Again, middling yellow for both levels of research funding and an overly generous yellow for using evidence to guide policy decisions.
All in all, a pretty poor bill of health from Canada's family docs – not the kind of report card you would want to take home to your parents or, in this case, onto the campaign trail in 2015.
But is there still time for remedial medicine?
André Picard is The Globe's health columnist.