Make health a national issue again
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Hey there, time traveller!
This article was published 14/09/2015 (2755 days ago), so information in it may no longer be current.
More than half way through the longest federal election campaign in modern history and hardly a word about one of the biggest issues on Canadians’ minds. What is the future of Canada’s public health-care system?
What should be the federal government’s role in building a national pharmacare program? How can the health of First Nations and Inuit people be improved?
Those questions, and the fact the federal government is cutting back on increases to provincial health transfers, are just some of the issues of particular concern.
And yet no one is seriously talking about any of them in this election, at least not yet.
Part of the reason may rest in the federal government’s approach to health care and, in particular, the prime minister’s approach to intergovernmental relations.
Since taking office, the Conservative government of Stephen Harper has consistently disengaged from intergovernmental entanglements with the provinces. Its approach to federalism has been to assert that each order of government should “stick to its knitting” and not interfere with the other. So the federal role in health care comes down to writing a cheque to the provinces and telling them to get on with it.
As a result, the debate over health care’s financing, reform and overall direction has been stripped of the federal-provincial back-and-forth that characterized so much of the discussion in previous decades: Accusations the provinces are misspending and the feds are under-spending. The provinces are ganging-up on Ottawa; the feds are interfering in provincial matters.
The bickering was a barrier to reform, frustrating Canadians who just wanted governments to do something. But on the other hand, it provided a national platform for a debate about what should be done, who should do it and how it would benefit Canadians regardless of where they live.
All of the provincial reports — Fyke in Saskatchewan, Clair in Quebec, Mazankowski in Alberta — and the two national reports, by Michael Kirby and Roy Romanow, that gave voice to serious reform agendas in the 1990s were motivated by and built off of that federal-provincial argument over health-care financing and organization.
Perhaps Harper’s legacy on this file is he has succeeded in making health no longer a national issue. It is an issue for each provincial government in terms of the day-to-day operation of its individual insurance systems. It is even, to some extent, an interprovincial issue as provinces struggle to act collectively without a federal presence. And it is a federal issue insofar as that government has its own limited agenda over what it intends to do in its own areas of jurisdiction.
But for a decade it has not been a national issue because the federal government refused to engage in a health-care conversation with the provinces. Perhaps this absence has atrophied our ability to articulate a national perspective on the issue. Perhaps it has forced provinces to find alternative ways of talking about health, thus creating an interprovincial conversation in place of a national one. Perhaps this is why the recent Naylor report on innovation in health was so summarily ignored by the federal government. It was predicated on there still being a national conversation the government had no interest in.
But I am not convinced the public prefers the now-disentangled world of health-care policy and politics. While they may appreciate the silence that comes when one party to an argument leaves the room, they are well aware the silence does not indicate the argument is over. It has been abandoned, not resolved. The problems, dilemmas and challenges are all still present in their lives and in the lives of their families.
This leaves a very big opening for the two opposition parties to again articulate a national approach to health care. But therein lies the rub. Both the Liberals and New Democrats have a disturbing tendency to swing the pendulum too far in the other direction: Provinces not doing enough to reform the system? No problem, Ottawa will do it for them. And that would be just as damaging to the future of public health care as the disengagement practiced by the Conservatives.
But if one of them can articulate a health-care agenda that respects and understands the provincial role in health care, then a new federal role can emerge. And the party that does it right could break the deadlock that we have seen in the polls in the last few months.
Tom McIntosh is a head of the politics and
international studies department at the
University of Regina.