Adam Kassam is a senior resident physician at the Schulich School of Medicine & Dentistry
Maxime Bernier really wanted to be a federal party leader. And as the founder of the new People’s Party of Canada, he’s betting that Canadians are frustrated enough with our health-care system to elect him Prime Minister.
Earlier this month, Mr. Bernier introduced a portion of his health care policy, which is likely to be a central tenet of his 2019 election platform. As he did during his unsuccessful bid for leadership of the federal Conservative Party, Mr. Bernier proposed the replacement of federal health transfers with tax points of equivalent value. He wants the federal government to wash its hands of health care entirely, preferring instead that this responsibility be downloaded exclusively to provinces.
Although it is naive to think that provincial governments should be trusted to improve health care delivery on their own, Mr. Bernier has taken the unique step as a federal leader to recommend that we follow countries who provide better universal health coverage through blended payer models.
This is a decidedly bold position – and a risky gambit – for Mr. Bernier. Health care is the third rail in Canadian politics. His suggestion, however, might be exactly what this country needs to finally have an honest conversation about health care reform.
In 1962, Tommy Douglas helped create comprehensive health insurance in Saskatchewan. Since that time, Canadian health care has become an intrinsic part of our national identity.
Nevertheless, our communities have also changed dramatically since then. Canada’s population has more than doubled in size, life expectancy has grown and our aging society has led to increased health care utilization and spending. Combined, these factors have contributed to our ongoing health care crisis.
What, then, are the solutions for a system buckling under its own pressure? Do Mr. Bernier’s ideas help move the chains on progress? The answer is maybe.
While his headline-grabbing anti-multiculturalism and immigration stances garner the most attention, Mr. Bernier is right about the quality of Canadian health care lagging behind other high-income nations. This has happened under the watch of elected officials who have lacked the courage to debate the need for serious change because they care more about re-election than they do about patients. This is also why populist movements have taken hold in communities that feel ignored by politicians.
He may also be right about wanting to reduce the federal government’s influence on health care. As it stands, Ottawa merely transfers money to the provinces and lets them decide how to administer care. So, if it’s not responsible for actually providing that care, why should a national government be in the business of it at all? This is a legitimate point and builds on other criticisms of federal involvement in areas – such as pipelines – where its expertise is lacking.
A health-care system funded completely by the provinces would theoretically allow them to better plan for the future. Provincial governments would no longer be subject to the uncertainty of changes to federal health transfers, which is a chronic problem that leads to friction between layers of government.
However, whether Mr. Bernier’s proposal to give provinces more autonomy will help improve challenges such as hallway medicine and wait-times is unclear. Indeed, universal coverage doesn’t mean equity of access as politicians, athletes and the well-connected are given priority. Punting health care to the provinces doesn’t fix this.
In its current form, the Canadian medical system clearly cannot be sustained to provide the quality care that Canadians need and deserve. Our first task should be to define the key principles of Canadian health care by determining what our system deems essential – a nuanced conversation often fraught with polarized disagreement. We have already done this to some degree with the cost of medications and certain elective and cosmetic procedures being paid for by individuals instead of by the government.
Mr. Bernier’s lust for attention has created a real opportunity for Canadians to challenge the partisan nature of our health care debate during the upcoming election campaign. This discourse is one that has unfortunately devolved into a focus on ideology instead of policy. Ultimately, Mr. Bernier’s resignation from the Conservative party has finally given him the freedom to speak his mind. If only he weren’t so focused on his immigration dog-whistle, we might be able to listen to his ideas on health care.