Does medicare actually matter at the ballot box?

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So that’s it, then.

It is a ritual as old as the country. Canadians puff our chests and hold our hands over our hearts as we proclaim our eternal love for medicare. Vague promises are then made – with politicians avoiding specifics because they see health care as a vote loser, never a vote winner. And then voters move on.

In this campaign, we’ve already had the requisite ritualistic rhetorical exchange about the evils of privatization and “two-tier” health care. Fearless leaders have promised billions more for the status quo. So now, apparently, we’re onto other issues – even though year after year, Canadians tell pollsters that their number one concern is health care.

This time was supposed to be different.

COVID-19 shone a bright and unflattering light on weaknesses in the health care system and its poor cousin we used to call welfare. From the mass carnage in long-term “care” homes through to the mass poisoning by opioids unfurling on the streets, the pandemic revealed a frayed social safety net and a health care system built on an outdated and increasingly shaky foundation.

Yet, against this backdrop – an unprecedented opportunity for change – the best opening volley the Liberals could come up was a clumsily edited video suggesting that the Conservatives are purveyors of privatization and, hence, opposed to universality.

Liberal Leader Justin Trudeau claimed that his chief rival, Conservative Leader Erin O’Toole, was “unequivocally in support of private health care, in terms of for-profit health care.” The latter answered: “I one-hundred-per-cent support our public and universal health care system.”

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But the repartee is pointless because words like “universality” and “privatization” have become meaningless bromides.

The sad reality is that Canada has the least-universal universal health care system in the world.

What that means is that our beloved medicare offers the narrowest range of publicly-funded health services imaginable. Only hospital and physician services are deemed “medically necessary” and funded 100 per cent from the public purse; everything else is all over the map, from six per cent public spending on dental care to 40 per cent of prescription drug costs.

Similarly, Canada has among the highest rates of private health care spending in the developed world, at about 30 per cent. Canadians are very dependent on private insurance, and they pay a lot out-of-pocket for medical services that aren’t covered by medicare. Beyond that, a lot of health-related goods and services are publicly-funded and delivered by private, for-profit providers.

If they were being honest, all the major parties would say they support a role for private providers and funders within the health care system, to varying degrees. They need to stop pretending this is a black-and-white issue and, instead, try and answer the question: What should and shouldn’t be covered by medicare? Just as importantly, what mechanism should be used to make that determination? That’s the policy discussion we need.

The campaign promises on health care are as predictable as the debate, with every party vowing to spend more. The Conservatives and New Democrats want to increase health transfers to the provinces by six per cent per year, with the Liberals promising “only” three per cent, plus scads of targeted funding.

There’s a really interesting discussion to be had on exactly how much Ottawa does and how much it should pay for health services. Currently, it’s somewhere between 23 and 32 per cent of the $185-billion in annual public spending, depending on whose numbers you believe. Beyond the dollar amount, should Ottawa attach conditions to the transfer? That’s one of the only areas where there are profound philosophical differences between the major parties.

One of the great disappointments of the federal campaign so far has to be the lack of attention paid to actual reform amid a very real catastrophe. Clearly that should begin with fixing long-term care, where more than 18,000 of the 27,000 COVID-19 deaths have occurred in Canada. The failure of all the parties to make fixing eldercare a priority dishonours the dead and shames us as a country.

Similarly, the pandemic exposed a glaring health human resources problem, with grave shortages of everything from personal support workers to nurses – a reality that is going to have grim consequences for years to come.

If we want the shortcomings of our health system addressed in a serious manner, Canadians will have to demand answers day after day – and, more importantly, be willing to make these issues a deciding factor at the ballot box.

If health care really is our number-one concern, we cannot continue to content ourselves with well-worn platitudes and inaction.

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