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Canada's Conservative Party leader Erin O'Toole speaks to a crowd of supporters as he campaigns for the 20th of September General election, at Prarieland Park in Saskatoon, Saskatchewan, on Aug. 20, 2021.KAYLE NEIS/AFP/Getty Images

On Sunday, New Democratic Party Leader Jagmeet Singh bid for some election traction by invoking Jack Layton, calling for the renaming of a Toronto riding in the late NDP leader’s honour.

Also on Sunday, the Liberals accused Conservative Leader Erin O’Toole of (yet again) having a secret agenda, this time to undermine medicare. They even tweeted a video snippet from 2020, allegedly showing Mr. O’Toole advocating just that. Twitter promptly slapped it with a “Manipulated media” label.

Why mention these two stories together? There’s a connection. Mr. Layton was the target of similar allegations in the 2006 election; it happened because most people miss an important detail about medicare, Mr. Layton among them.

In the mid-1990s, the then-Toronto city councillor needed hernia surgery. He was sent to Shouldice Hernia Hospital, an 89-bed facility in the Toronto suburb of Thornhill. It calls itself the world’s only hospital dedicated to hernias. Mr. Layton was referred by his doctor, underwent the procedure, and returned to his life. Another Canadian public health care success story, apparently.

But in 2006, the surgery became an election issue. The NDP leader, as he was by then, was accused of having made a “secret” visit to a “for-profit” hospital. He appeared baffled by the allegation. His bafflement appeared genuine. He’d had no idea he’d been in a private hospital.

“Every family I knew, every middle-aged man that ever ran into a hernia, went to Shouldice,” he said. “It’s just part of the system,” he said. “The doctor says, ‘Go there.’ You pay with your [Ontario health] card. It never occurred to me [it was] anything other than medicare, which it is.”

A decade later, Republican U.S. Senator Rand Paul chose Shouldice for hernia surgery. Like Mr. Layton, the ultra-libertarian was accused of hypocrisy – in his case, because the hospital is part of Canada’s allegedly “socialist” health system.

So why didn’t Mr. Layton’s surgery undermine medicare? And why are Mr. O’Toole’s 2020 comments, including musing on the possibility of greater use of private resources in Canadian health care, likely not an attack on medicare?

Because medicare is about universal public health insurance – not universal delivery of every aspect of medical services by public employees and institutions. Canadians want to know that their procedure will be 100 per cent covered by their provincial insurance plan, not that the person or entity doing the procedure is 100 per cent owned by taxpayers.

The principles of the Canada Health Act are universality, comprehensiveness, portability, accessibility – and public administration of insurance. Again, that’s public administration of insurance, not public ownership of each and every aspect of the health care system.

Each province uses the private sector to deliver at least some insured services – ranging from outsourcing the hospital cafeteria, to using private testing companies, to family physicians themselves, who are private business people. But regardless of those behind-the-scenes contractual arrangements, if you need care from a physician or hospital, medicare is supposed to mean that your provincial health insurance plan picks up the bill.

Which is what would have happened with Mr. Layton’s hernia surgery. Just as in a public hospital, he would not have been billed for the operation.

And though Mr. O’Toole in the 2020 video praised Saskatchewan for outsourcing some diagnostic services, the Conservative platform does not mention a greater role for private delivery in publicly funded health care. In any case, that’s largely a provincial matter.

The Conservative platform also pledges to increase provincial health transfers – worth $43.1-billion this year – at the rate of economic growth, or 6 per cent, whichever is greater. The Liberals have the same formula, but a lower floor of 3 per cent.

If Mr. O’Toole had an agenda to undermine Canada’s most cherished social program, he would be in for a world of hurt from voters. Which is why the Liberals keep hoping to find evidence of something that does not appear to be there.

Oh, and the notion of renaming a riding after a politician? It’s a transparently partisan move, and hence a bad idea. Should Calgary Heritage become “Calgary-Harper”? Should Montreal’s Mount Royal riding be rebaptized “Pierre Elliott Trudeau?” That’s a hard no.

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