Harper's hands-off approach could be the most important change to health policy since Tommy Douglas.
Last week, the provincial premiers disclosed how they would respond to the Harper government's exciting new approach to medicare. The response indicates that, yet again, provincial politicians just don't understand the scale of the problems we face. Indeed, the group of premiers we currently have running the provinces may be too out of it, and too ideologically pre-programmed, to grasp the opportunity Prime Minister Harper has given them.
First, some background: The federal government helps the provinces pay for health programs, which our constitution stipulates are a provincial responsibility. The arrangement dates back at least to 1957, when prime minister John Diefenbaker's Tory government began subsidizing certain provinces' public hospital insurance programs. The Diefenbaker subsidy freed up enough cash for Tommy Douglas' provincial government in Saskatchewan to go ahead and fund the expansion of that province's hospital insurance program to include primary care, such as doctor's bills. The result? Saskatchewan led the country toward medicare.
In recent decades, the federal government has provided the health subsidy in exchange for the provinces fulfilling certain conditions. For example, Pierre Trudeau's 1984 Canada Health Act made the subsidy conditional on five principles. If the provinces didn't adhere to those principles, the feds wouldn't fork over the money. As a National Post editorial adroitly put it recently, "the entire structure of the Canada Health Act ... is essentially based on extortion."
Back in December, federal Finance Minister Jim Flaherty presented a new arrangement between the provinces and Ottawa. All the premiers grasped the implications of the overt, financial component: The Harper government pledged to continue the six per cent increases in federal health-care funding until 2017, then committed to increases equal to economic growth plus inflation until 2024, with a minimum annual increase of three per cent.
What few of the premiers seem to have understood is the more exciting, second part of the announcement: Harper and Flaherty told the premiers they were handing over the money without conditions. For the first time in decades, the deal was: no strings attached.
If the extortion is over -- if the Harper government truly means what the Prime Minister has said, and there truly aren't any restrictions on the money that the feds pay to the provinces -- then Harper's pledge would seem to effectively suspend the legislation that has defined Canadian health care for the last 27 years.
Even if Harper is merely signaling a looser interpretation of the Canada Health Act's five principles -- public administration, comprehensiveness, universality, portability, and accessibility -- this could usher in a new age of Canadian health care. Harper is challenging premiers to compete with one another in the pursuit of health-care excellence, and providing them with the freedom to innovate as they see fit.
But rather than accepting the challenge, thus far the premiers are doing the opposite. They are convening something called the Health Care Innovation Working Group, which will be chaired by PEI's Robert Ghiz and Saskatchewan's Brad Wall. According to one report, the group "will attempt to explore more co-ordinated management and to address competition across health systems" -- the goal being to avoid "competition" in regard, for instance, to health-workers' salaries.
That's just the sort of market-averse, socialist thinking that got us the problems we have today. "Competition" is a good thing, and the provinces should embrace it. Competition is how federalism is supposed to work. Federalism is a race among the provinces to achieve excellence. Since 1984, the Canada Health Act has hampered that race. No longer. Harper has fired the starter's pistol, even if none of the premiers appear to have heard it.
This article originally appeared in the National Post