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Prime Minister Stephen Harper, Liberal Leader Michael Ignatieff and NDP Leader Jack Layton are all promoting their ideas for improving the health care system on the campaign trail Monday. (The Canadian Press)
Prime Minister Stephen Harper, Liberal Leader Michael Ignatieff and NDP Leader Jack Layton are all promoting their ideas for improving the health care system on the campaign trail Monday. (The Canadian Press)

Jeffrey Simpson

The Liberals' health-care folly Add to ...

With their campaign fading, the Liberals desperately fiddled with their electoral dial. They changed the channel to health care, altered the tone to nasty, and turned up the volume.

The victim of so many disgusting attack ads by the Conservatives, the Liberals climbed down into the gutter, using a quotation about health care wrongly attributed to Stephen Harper. They blamed him, in the ad and in Michael Ignatieff's speeches, of planning to cut billions from health care - a charge that's wrong in history and wrong in future fact.

Mr. Harper has spent precisely to the dollar what the Liberal government of Paul Martin negotiated with the provinces. That agreement called for $41-billion in additional spending over 10 years, ending in fiscal 2013-2014, and was indexed at 6 per cent at a time when Ottawa was swimming in cash. No other government program enjoyed that kind of indexing. None of us enjoy that kind of indexing, either.

But health care is iconic in Canada, untouchable and ideological, incapable of being seriously debated, as this election campaign shows.

The Liberals, to their credit, developed one sensible policy: a tax credit for those who care for an elderly person at home. Then, with polls showing that health care had resumed its No. 1 position in an issueless campaign, the Liberals went over the top and began a bidding war.

They promised, notwithstanding Ottawa's weakened fiscal position, that, if elected, they would extend sine die the 6-per-cent indexing. The Conservatives instantly replied that they would extend the 6 per cent for another two years. Mr. Ignatieff then solemnly declared he would start negotiating a new federal-provincial accord after taking office.

There would be little to negotiate, Mr. Ignatieff already having guaranteed federal money with no strings attached. The provinces, as is their wont anyway, would simply say, "Show us the money," and leave town.

When it comes to health care, federal parties apparently can do little beyond outpromising the others to spend even more money on a system (or set of provincial systems) that already takes one of the largest shares of the national income in the world among countries with public health care.

They can make wild promises, such as the NDP's proposal to train 1,200 new doctors and 6,000 nurses, without the foggiest idea where the money will come from. Ditto for pharmacare, catastrophic drug care, home care and acute long-term care, programs that would cost megabillions.

An honest debate would say: The system needs X and here's how we propose to pay for it. We're going to raise taxes by Y, cut other programs by Z, borrow more money, or all of the above. But, instead, what we get are parties promising X, then leaving matters there.

No one wants to ask harder questions: Since 2003-2004, more than $30-billion extra (indexed each year at 6 per cent) has been poured into the system, with only marginal improvements. What's to say that another vast infusion will produce better results? If so, how?

Ottawa doesn't actually have much control over the health-care system. Even those who want the federal government to use the withered stick of the Canada Health Act to penalize provinces that allow private services would recoup disappointingly meagre sums in the context of overall health-care spending.

True, Ottawa runs health care for aboriginals (badly, but that's a different story) and the military. It checks pharmaceutical products and runs the Public Health Agency of Canada. Beyond these programs, it doesn't do much in health care except write cheques to provinces.

When Ottawa tries to attach conditions to those cheques, provinces ignore the conditions or pay lip service to them. Much bigger cheques, presumably beyond the hefty ones agreed to in 2003-2004, might give Ottawa more clout - but how would Ottawa pay for those bigger cheques without going back into deficit?

Foolish things, predictably, are being said about health care by parties trying to trump each other - starting with the Liberals, who, seeing their platform fail to lift off, tried in desperation to make something of health care.

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