By Thomas Walkom
The Toronto Star
January 18, 2012
Think of the current impasse between Ottawa and the provinces over medicare funding as part of a long game.
On one side is the Canadian public, which overwhelmingly supports the publicly funded, universal health insurance system known as medicare.
On the other are the federal and provincial governments, which, for a variety of reasons (some political, some ideological), find medicare a bother.
They are reluctant to spend the money that a successful health system requires — and even more reluctant to raise the taxes that would fund it.
In normal times, the two levels of government simply squabble over who pays how much. The provinces want Ottawa to pay more so they can pay less, and vice versa.
The gun to their heads, in such normal times, is public opinion. While few like to pay taxes, polls show that the vast majority of Canadians value medicare dearly.
And when the public senses that its elected governments are endangering the national health-care system, it tends to react badly.
But these are not normal times. That’s why the premiers’ attempt this week to pressure Prime Minister Stephen Harper into amending his diktat on future federal medicare transfers failed so badly.
First, the economic slump makes all governments even more reluctant to spend money. Ontario Premier Dalton McGuinty can hardly complain about federal stinginess when Ottawa’s take-it or leave-it offer — a reduction in future health transfer growth to a minimum of 3 per cent annually — matches Queen’s Park’s own projected spending cutbacks.
Second is the Harper factor itself.
Canadians gave a parliamentary majority last year to a federal Conservative government that is deeply suspicious of medicare.
True, Harper has not tried to ditch the Canada Health Act, the federal statute governing medicare. His government even continues to enforce it in some manner.
Since the Conservatives came to power in 2006, Ottawa has levied $335,568 in fines against provinces — mainly British Columbia — that failed to abide by the conditions of medicare.
But the principles behind Canadian medicare are an offence to Harper’s brand of conservatism, which, in its purest form, is often better expressed by the Prime Minister’s ideological soul mate and sometime co-author Tom Flanagan.
Writing in The Globe and Mail this week, political scientist Flanagan attacked the very idea of Ottawa spending money in areas of provincial jurisdiction like health. He lauded Harper for moving “incrementally” towards a more classic form of federalism, where aberrations such as national medicare would not exist.
Programs like medicare, Flanagan wrote, “create the illusion for both levels of government that they are spending something less than 100-cent dollars” and thereby lead to more debt.
All of this suggests we are in for a grim few years on the health-care front.
Don’t expect the Harper government to attack medicare directly. It’s too popular with voters.
But what we can expect is a hands-off approach from Ottawa, which, when coupled with federal transfer cutbacks, will encourage cash-strapped provinces to search for more privately funded alternatives — from user fees to private-pay clinics.
Quebec has taken a couple of false starts down this route, including an attempt to introduce user fees for patients that would have put it in direct conflict with the Canada Health Act. British Columbia is already happily breaking federal law by allowing some clinics to extra-bill patients. Ontario is talking vaguely of massive structural change.
In this segment of the long game, it’s not clear that any government at any level is willing to speak up for medicare and for the vast Canadian public that cherishes it.