New Canadian health deal is flawed

by Robbie Mahood

On Sept. 16, 2004, the Canadian federal government signed a major agreement with the provinces aimed at shoring up Canada`s ailing health care system. The terms of the agreement will see Ottawa provide some $18 billion in additional funding for the operation of provincially administered health care programs over the next six years, a further increase of 6 percent per annum in federal transfer payments for health care for the next 10 years—and finally, a separate side agreement with Quebec, billed as an exercise in ‘asymmetric federalism’.

The agreement reflects the outcome of the June 28 federal election, which saw the Liberal Party reduced to minority government status with a strengthening of the vote for the Bloc Quebecois and the New Democratic Party. The Liberal Paul Martin government was under pressure to settle with the provinces and mollify Quebec.

Prime Minister Martin was quick to claim a landmark deal that would “fix medicare for a decade”, although he had promised during the election campaign to “fix medicare for a generation”. The provincial premiers were more than happy to pose as tough but responsible negotiators.

Beyond the obvious grandstanding of the negotiating parties, the pact drew approval from across the mainstream political spectrum. The positive reviews ran from ex-Saskatchewan NDP Premier Roy Romanow, who headed a Royal Commission on Canada’s health care system in 2002, to federal Conservative leader Stephen Harper, who embraced the deal as being in line with his party`s election program.

Defenders of publicly funded health care would be well advised to hold their applause and subject the agreement to the searching criticism it deserves. That Stephen Harper likes what he sees there should be warning enough.

At the most fundamental level, it is clear that Ottawa and the provinces closed the door on any significant extension of medicare or major reform of the health-care system that would place it more firmly in the public realm and protect it from encroaching privatization. Violations of the Canada Health Act will continue with impunity. De-listing of services and drugs, contracting out, establishment of for-profit clinics—these and other attacks on medicare will continue. There will be no national pharmacare plan. Antiquated fee-for-service remuneration for physicians will remain the norm.

The pact may allow provinces to reduce waiting times for cardiac and cancer treatments, diagnostic imaging, joint replacements and eye surgery. It allocates paltry amounts for home care and catastrophic drug coverage. In other words: band-aid solutions, while underlying structural problems are ignored.

From a fiscal standpoint, the agreement is far from providing the stable funding base that its architects claim. Total federal contributions will amount to the seemingly astronomical figure of $41 billion by 10 years. But at somewhat over $4 billion per year this represents a small proportion of the $121 billion Canadians currently spend every year on health care.

The federal contribution to health care spending is set to rise by 45 percent. But this is after 20 years in which federal health and social transfer payments to the provinces were slashed to the bone—much of it during Paul Martin’s tenure as Liberal finance minister under previous Liberal Prime Minister Jean Chretien. The federal contribution to health care funding will hardly rise to 10 percent. Medicare’s fiscal crisis will be ongoing.

Even within the limited objectives it sets itself, the new agreement is vague on provincial accountability and standards. Panels of experts will try to come up with “evidence-based benchmarks” for “acceptable” waiting times, and the provinces agree to “meaningful” reductions in waiting times by 2007.

The separate agreement with Quebec is something of a chimera. It turns out that Quebec signed on to the same vaguely worded conditions as the other provinces. (Quebec is not just a province in the Canadian Confederation; it is an oppressed nation entitled, in our view, to the right to national self-determination and self-governance.)

Martin, however, has signalled that down the road Ottawa could come to similar side arrangements with other provinces. From a back-handed concession to Quebec’s national reality, the term “asymmetric federalism” has now mutated to provide cover for continued federal disengagement from national social programs in the rest of Canada.

Supporters of socialized health care should resist the seductive sound of federal dollars falling into provincial coffers. The newest federal-provincial deal holds out at best a temporary respite from the pressures that have built up in the publicly funded system after 20 years of neoliberal austerity. But it contains more than enough flaws to accelerate the emergence of two-tiered health care by pro-business provincial administrations with the connivance of the federal government.

Countering this dynamic requires a bold program not just to defend past gains, but also to bring health care more fully under democratic social administration and control. Robbie Mahood is a physician and a member of Socialist Action living in Montreal. This article first appeared in the October 2004 issue of Socialist Action newspaper.