Who's Afraid of Health-Care Reform?

Preserving Canada's public, universal system means accepting changes.

Canadian voters consistently rank health care among their highest priorities, so it is not surprising to see it pop up as an issue during this federal election campaign. However, by promising to renew the 10-year deal with the provinces and territories on the Canada Health Transfer, all the main party leaders are able to avoid explaining in detail what they would do to reform and revitalize the health system. More disquieting, however, is the fact that their commitment to this deal removes any motivation for the premiers to sit down with whoever becomes prime minister to set a new direction for medicare. After all, the money has been promised with no strings attached.

This is most unfortunate because, whether we like it or not, “business as usual” in health care is not a viable option. We must choose which road of reform we want to go down. There have been some positive efforts to improve the quality and timeliness of targeted public health-care services, but these actions have been too incremental, too sporadic, and, well, just too small to be real game-changers. While both the federal and provincial governments had the luxury of pumping money into health care over the past decade without running deficits, this will not be possible in the coming years – the recent recession and rising inflation almost guarantee greater public-sector restraint. Meanwhile, the cost of “business as usual” is ballooning, with health care taking up between 40 and 50 per cent of program spending in the provinces.

We have two possible, contrasting approaches to health reform. One assumes that universal medicare has been a failure and that we need to build something else entirely, while the other argues that, building on the achievement of medicare, it is time to implement its second phase.

The anti-medicare approach goes like this: Given the impact of aging, we cannot continue to spend billions of taxpayer dollars on health care. It is time to be grown-up about this, and to make Canadians assume greater individual responsibility for health care by delisting services and imposing user fees and co-payments. This way, we can release the pressure on public budgets by funding more health care privately. Moreover, since health care is a provincial responsibility, the federal government should reduce, or eliminate, federal transfers to the provinces, and allow them to experiment with private funding – even if this means getting rid of the Canada Health Act. In effect, this approach to health-care reform assumes that the problem is on the funding side, and thus advocates replacing a tax-based pooling with private financing as the fix. Far from being a visionary, future-oriented approach, this is in fact a trip back to the past, to the era before the existence of universal medicare.