Because it is the No. 1 issue for Canadians, health care has become a first ministerial responsibility.
This was already clear at the federal level: The new Health Minister, Anne McLellan, is probably more competent (and certainly less ambitious) than her predecessor Allan Rock, but the Prime Minister has this file on his desk, and the man he appointed to head the federal commission on health, his old friend Roy Romanow, informally reports to him.
Now, the same sense of priority applies to the provinces. This was quite obvious at last week's premiers' meeting in Vancouver. Contrary to a well-established tradition, the premiers didn't focus exclusively on funding, and devoted their two-day meeting to policies. They talked about private hospitals, generic drugs, medicare coverage and gene patenting.
At the end of the conference, all first ministers carefully weighed their words to avoid open confrontation. Even Jean Chrétien, reacting to the premiers' final declaration, said that as long as Alberta Premier Ralph Klein sticks to the "five principles" of the Canada Health Act -- as Mr. Klein swears he does -- he's "happy" and says "hallelujah." Still, the table is set for a major confrontation.
The premiers have just snatched the agenda on health care away from the federal government. They have taken the first step toward a serious review of the system, even as Mr. Romanow's commission is still crunching numbers and shuffling papers. The provinces agreed to disagree on issues such as delisting and privatization -- but by initiating co-ordinated changes on various "cost drivers," such as drugs and the shortage of nurses, they have forcefully challenged the status quo that the federal government favoured for so long.
As with the birth of medicare in Saskatchewan, the push for reforming it comes from a Western province. The Klein-Mazankowski solution might be debatable, even deserving of condemnation, but at least something is happening, things are moving.
Good ideas often come from provinces because their governments are closer to the daily realities, while the federal government can enjoy the luxury of sticking to lofty principles without having to implement them.
Not only are provincial governments the managers of the health-care services, which gives them an expertise that the federal government lacks, they are now the ones paying the fiddler. As the federal contribution has decreased over the years, the provincial capitals, not surprisingly, want to call the tune.
But the Chrétien government will do anything and everything to take back the lead on health care. When the idea of running for a fourth mandate springs to his mind, Mr. Chrétien certainly sees medicare as the ideal election platform: He would be the saviour of Canada's so-called most sacred trust, leading a crusade against the "privatizers."
As for Quebec Premier Bernard Landry, he brilliantly managed to walk on eggs last week without breaking any. He couldn't be seen by Quebeckers as playing politics with health care. On the other hand, he had to stick to his sovereigntist line.
So he refused to be part of the other province's consensus (except on the call for more funding from Ottawa), while vowing to co-operate with them by exchanging information.
In other words, he sat at the table -- but pulled back his chair for most of the meeting as if he was a visiting neighbour, albeit a convivial one, rather than a participant.
The act perfectly fit Mr. Landry's vision of sovereignty association.
Lysiane Gagnon