By Mark Kennedy
January 8, 2012
The former Saskatchewan premier, who led a royal commission on health care a decade ago, made the comments in an exclusive interview with Postmedia News.
Romanow said he is worried the Harper government has adopted a deliberate strategy to leave health care to the provinces — possibly to foster the development of more private, for-profit medical companies.
His concerns come as premiers are poised to meet in Victoria next week for a special health-care summit, and as Harper maintains his distance over direct involvement in the first ministers’ talks.
“The prime minister has to roll up his sleeves, he’s got to get in there, he’s got to articulate the values of the country — which I believe are as strong, if not stronger, than when I was around as a royal commissioner,” said Romanow.
He said that his commission found that Canadians viewed health care as a “social good” and that the national medicare system should be built on that foundation.
But Romanow expressed anxiety at signs coming from the federal government. In December, federal Finance Minister Jim Flaherty surprised his provincial counterparts at a meeting in Victoria by unveiling a non-negotiable long-term funding plan that falls short of what some provinces had hoped for.
Federal health-care transfers will continue to increase by six per cent until 2016-17. After that, increases will only be tied to economic growth including inflation — currently roughly four per cent — and never fall below three per cent.
Romanow said it appears the federal government doesn’t plan on adopting a leadership role in medicare reform.
He said Flaherty has no apparent intention of using money as a bargaining chip to ensure provinces attempt to reform the system — a reflection of the prime minister’s view that “open federalism” should involve less federal meddling in how provinces run their health-care systems.
“To say, ‘Goodbye and good luck’ could be the beginning of the end of a reformed modern-day functioning health-care system,” said Romanow.
“If that argument is advanced, we have a prescription for a patchwork-quilt series of programs by the provincial governments based on their fiscal capacity.
“It will mean more privatization in more provinces, or some combination of private and public. It will be a very much weakened fabric of national unity without Mr. Harper’s direct involvement.”
Romanow, a longtime New Democrat, said he doesn’t want to “be political” in his criticisms of Harper’s approach to federalism
“But I just feel very, very strongly about this.
“Where is it that this country was predicated on the notion that there is such a watertight set of compartments that there’s no intermingling on key issues? Medicare needs Ottawa at the table.”
“This is a very big turning point in the making of the federation.”
Romanow was appointed by then-prime minister Jean Chretien in 2001 to study medicare. The next year, he delivered a report concluding the system was financially sustainable if the federal government gave billions more to the provinces for health care on the condition they implement reforms in areas such as home care, primary care and pharmacare.
In 2004, Paul Martin’s government struck a 10-year accord to give provinces billions in extra cash, but Romanow said it came without the necessary strings attached for reform of the system.
In last year’s election platform, Harper’s Tories declared they were committed “to a universal public health-care system and the Canada Health Act, and the right of provinces to deliver health care within their jurisdictions.”
The party promised to “work collaboratively” with provinces to improve wait times for medical services.
“In our discussions we will emphasize the importance of accountability and results for Canadians.”
“In the spirit of open federalism, when renewing the Health Accord we will respect the fact that health care is an area of provincial jurisdiction and respect limits on the federal spending power.”
In a recent TV interview, Harper said it’s up to the provinces to find the “solutions” to a better health system.
“This government will ensure that there continue to be increases in health-care transfers,” said Harper.
“We’ll do it over the long term at a level that’s sustainable, but a healthy growth.”
He said some provinces are already starting to slow the growth of health spending “and they’re the ones who are going to have to really come up with the solutions on health-care delivery.”
The premiers will hold their health-care meeting Jan. 16-17. There are no immediate plans for them to also meet with Harper.
Harper is more likely to work individually with them — for the time being — to foster health-care reform.
Federal Health Minister Leona Aglukkaq has told provinces she is ready to work on a common plan to measure how well the health system is performing.
Romanow said Harper must get involved himself.
“You need the prime minister there. This is a test of leadership right across the board from the premiers, but I think primarily for the prime minister.”
Romanow said Harper’s interpretation of how the Constitution spells out responsibility for health care to provinces is wrong. He said there is a long history of federal prime ministers — dating back to Conservative John Diefenbaker and Liberal Lester B. Pearson — using the federal spending power to help build a national health system.
Romanow said only the federal government can provide the leadership to set programs and standards.
“There’s a question here of federalism and Canadian citizenship. Do we want to have the possibility of disparate regions in the country?”
“This is a question now of how you build the country. It’s federalism. It’s Canadian unity. And programs such as medicare define what it means to be a Canadian.”