Tuesday, February 7, 2012

Is this the end of Canadian medicare?

Stephen Harper once said ‘you won’t recognize Canada when I get through with it.’ It seems he’s starting with medicare.

The Hill Times
Feb. 06, 2012

 Hedy Fry, Liberal MP
PARLIAMENT HILL—The Conservative government’s announcement that it would impose cuts in federal health transfers after 2017, came as a shock to provincial premiers and health-care groups, who had been calling for a first ministers meeting on health care for more than a year. They were united in their condemnation of the unilateral nature of the decision and the subsequent refusal of the Prime Minister to meet with them to discuss the issue.

The Canadian federation has, over the last 50 years, attempted to function in a mutually respectful manner, with regular meetings and negotiated agreements between federal, provincial and territorial first ministers. Consequently, the unilateral health transfer decision was unprecedented and could be seen as a strong signal from the federal government that federal-provincial-territorial collaboration was at an end.

What this change from a cooperative federalism could mean, not only to health care, but to Canadian unity, should be cause for concern.

With the 2004 Health Accord set to expire in two years, provinces and other stakeholders were preparing for a new round of negotiations for a Health Accord in 2014. Now they are forced to move forward without the federal government and with reduced fiscal capacity.

The Conservative government would have you believe that the 2004 Accord was a flimsy document with no objectives and no accountability. However, there were clear goals, objectives and funds for innovation and transformative change. There were structures in place such as the Health Council of Canada, Wait Time Alliance, and the Canadian Institute for Health Information (CIHI) to monitor and evaluate progress.

In the 2004 Health Accord, first ministers agreed that “timely access to care across Canada is our biggest concern and a national priority.” Foremost on the 2004 agenda was “a need to make timely access to quality care a reality for ALL Canadians ... and to better manage wait times.” Evidence showed that hospital and physician-based care were no longer the best delivery models and should be limited to acute, emergency and tertiary care whereas management of chronic diseases through home/community care models with multidisciplinary caregivers would provide better outcomes.

First Ministers agreed that these objectives will require cooperation amongst governments and new funding for innovation. The Health Accord heralded a new jurisdictional flexibility in managing health care. It moved away from the old role of federal government as a mere cheque writer and established joint responsibility for development of strategies in four specific areas: pharmaceuticals, home care, electronic health records and health human resources. The current federal government walked away from those agreements and, since 2006, refused to meet with premiers. These are clear signals that the possibility of a 2014 Health Accord is not on the Conservative federal government’s agenda.

While the debate has centered around the cuts in health-care transfers; the real issue is the move away from the federal, provincial and territorial collaboration needed to achieve significant and necessary changes in the system.

One can agree that in times of fiscal restraint, government must find ways to curb spending. However, the essence of good fiscal management is deciding where to “cut” and where to “invest.” Healthy people work and contribute to the economy, therefore spending on health care will create a return on investment; while spending $13-billion on new jails, unless it is the federal government’s housing and mental health strategy, fails the cost/benefit test.

The Parliamentary Budget Office’s report states the share of cash payments in the health transfer will decrease substantially from 20.4 per cent in 2011 to 11.9 per cent in 50 years. This will eliminate Ottawa’s deficit, but cripple the provinces and territories financially. As the PBO reports, provinces and territories will have to cut medicare services and increase taxes to pay for health care.

None of this should come as a surprise. The Prime Minister’s vision for health care was clearly stated in his 2001 “firewall letter” to then Alberta premier Ralph Klein. In that letter, he outlined a shift in federal health transfers from cash to tax points and a fixed formula that would leave provinces to raise the remainder of health-care funds on their own.

Since not all provinces will be able to generate the necessary funds, the health-care system will become fragmented, resulting in unequal access to the care Canadians need when they need it. It will also mean an end to the pan-Canadian innovations that evidence showed were necessary to transform and sustain the Canadian health-care system for the 21st century.

Following the imposed health transfer announcement in December, the premiers called on the federal government to establish a health innovation fund of $100-million. This was denied. So we enter the final two years of the 2004 Health Accord with great concern. Stephen Harper once said “you won’t recognize Canada when I get through with it.” It seems he’s starting with medicare.

Liberal MP Hedy Fry is the Member of Parliament for Vancouver Centre and Liberal Health Critic. She practised medicine for 20 years in the City of Vancouver and was president of the British Columbia Medical Association.

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