Ignatieff blows best opportunity

Quebec put medicare back in political play and Liberal Leader Michael Ignatieff immediately punted his party off the electoral field.

"In our opinion, what matters is maintaining universality of access to the system," he said. "We believe, and it's a question of details, that Quebec's propositions conform to the Canada Health Act."

He is wrong. Universal access is lost. Quebec's proposals violate the CHA.

Health care perennially ranks first or second when Canadians are asked to name their top concern. The Liberals are identified as the party of medicare because they introduced the CHA in 1984 to protect the five principles of medicare -- universality, comprehensiveness, accessibility, portability and public administration -- from the privatizers.

The act had teeth. Provinces that limited universal access with user fees, private clinics, extra-billing and other forms of "two-tier" health were penalized by having health transfers docked -- one dollar for every dollar charged patients.

The Liberals lost power to Brian Mulroney's Conservatives later that year. Pummelled by ideological hostility, concern over rising federal deficits and debt, not to mention the clarion call of provincial rights, the health act began its long slide towards dead-letter law.

Provinces can now flout it with impunity, as Quebec's recent budget proves. Jean Charest's Liberals imposed a $25 user fee for every visit to the doctor, exempting only the very poor. As well, the budget imposed annual medicare premiums of $25 per person rising to $200 by 2012. Premiums are not explicitly banned by the CHA.

Quebec is often considered the most socially progressive province. Yet this budget is the second time Quebec has originated an assault on medicare. In 2005, the Supreme Court of Canada agreed with Montreal surgeon Dr. Jacques Chaoulli that the Canada Health Act violates the Canadian Charter of Rights and Freedoms by barring individuals from purchasing private health care.

Although all the federal parties seem to be washing their hands of medicare, polls show Canadians are of a very different mind. A new Leger Marketing poll finds 77 per cent of Quebecers oppose the Charest budget. A major survey commissioned by Health Canada released in February found that fewer than one in 20 Canadians supports user fees or an expansion of private health care. Forty-six per cent disagree that Canadians should be allowed to pay to get faster access to health care. Less than 40 per cent think they should.

Medicare and the Canada Health Act will be kept on life support until 2014 thanks to former Prime Minister Paul Martin's 2004, 10-year health accord. It gave the provinces an additional $41 billion cash to reduce wait times.

But four years from now, all bets will be off. Prime Minister Stephen Harper has pledged not to touch the accord while it exists. But he is a constitutional strict constructionist. If he is still in power in 2014, he will likely move swiftly to terminate Ottawa's role in health care, which he considers an exclusive provincial jurisdiction.

Every medicare investigation has ended up rejecting private delivery, even the Senate and Alberta commissions, chaired respectively by Liberal Senator Michael Kirby and former Conservative finance minister Don Mazankowski, whose premises were to prove privatization's benefits. They and all the others concluded two-tier or for-profit health care leads to inferior health outcomes and so ends up inherently more expensive.

The waffling from Ignatieff on what is a clear abridgement of the CHA could be because he believes, like the prime minister, that health care should be left to the provinces.

Or it could be because he agrees with the privatizers' arguments: spiralling health costs are driven by frivolous patient demands requiring deterrence by user fees; health care is too expensive to be universal and publicly financed; wealthy people shouldn't have the poor in their way when they want to see a doctor; doctors and hospitals should be free to charge whatever the traffic will bear.

A new Ipsos-Reid poll places the Ignatieff Liberals 10 points behind the Conservatives and only 12 points ahead of the NDP. With the NDP starting to nip at their heels, the Liberals are cementing their image as ideologically indistinguishable from the Conservatives by walking away from the most compelling election issue on offer in decades.

Frances Russell is a Winnipeg author and political commentator.

Republished from the Winnipeg Free Press print edition April 14, 2010 A13