MRG Principles and Policy Statements
MRG Statement on the Necessity for a Strong Federal Role in Setting Canadian Health Policy
We believe that the issue of whether the federal government should be
involved in setting and maintaining standards for delivery of social services
is fundamentally an issue about the model of society we want for Canada.
Within health care, it is a debate about whether we want to maintain a universal
single-payer model, or whether we want to move to a privatized, U.S.-style
mixed model, with much more payment by the health-care users. Evidence suggests
that those who claim otherwise are either disingenuous or misguided.
We shall cite three lines of evidence to substantiate
our viewpoint. One is historical, the second examines the
political orientation of those advocating reducing or eliminating
the federal role in maintaining standards, and the third has
to do with the nature of the federal role.
In the early 1960's Canada had a mixed private-public
system of health care, with a prominent role of user fees and
financial disincentives for care. The universal, single-payer
system was solely a federal initiative. Indeed, many provinces
resisted the move to the single payer system. They adopted the system
only because the federal incentive (at that time, paying 50% of the
cost of services) was too attractive. A compelling testimony to the
provincial resistance is a comment made by John Robarts, then Ontario
premier, about the federal governments' plan for national health
insurance covering all physician and hospital services. "Medicare
is a glowing example of a Machiavellian scheme that is in my humble
opinion one of the greatest political frauds that has been perpetrated
on the people of this country." This 'fraud' has turned out to be
our most successful and popular social program, contributing in important
ways to both Canadians' health, and their sense of self-definition.
With the rapidly growing economy of the 1960's
and early 1970's the new universal single-payer system worked
very well. As the economy slowed down and increases in physician
reimbursement schedules decreased, tensions emerged. Physicians
across the country began to increase their extra charges to patients
beyond what health insurance would reimburse. Provincial governments
increased user charges for other services. The fundamental goal
of the program, equal access without financial disincentive, was
threatened.
The federal government, once again on its
own, responded to this threat. Over some provincial objections,
Ottawa introduced the Canada Health Act. As with the initial
introduction of medicare, the federal government could not decree
compliance with its principles. It could, however, penalize provinces
that allowed user fees for insured services by reducing transfer
payments.
The effect of the Canada Health Act has been
profound. It has presented a formidable barrier against the
backsliding in health delivery which was occurring at an accelerating
pace, and which appeared destined to end the era of equal access to
high quality health care without financial deterrents. Each of the provinces
enacted legislation ending physicians' opting-out and extra-billing,
and universality has been preserved.
Since the mid-1980s the provinces have periodically
challenged the federal resolve to enforce the Canada Health
Act. Prior to the recent federal decision to once again penalize
provinces, user fees were growing, particularly in Alberta and
British Columbia. It is clear that without federal action, the trend
would have continued.
Historically, then, we see that universal
health care would never have been instituted had it not been
for the federal initiative, and would have been destroyed had
it not been for strong federal action that has lead to its maintenance.
The second consideration has to do with the
political orientation of those advocating ending Ottawa's
role in maintenance of social standards. Ralph Klein and Mike
Harris (former Premier of Ontario) are both on the far right
of Canadian politics, with evident sympathies for the one political
party, the Reform, which has openly endorsed two-tiered medical
care. The Klein government has been the most aggressive in pursuing
user fees, and their enthusiasm for making the sick patient pay lead
to a confrontation with the federal government. There is little
doubt where these governments would lead their provinces with the
freedom that would follow from an end to federal standards.
Finally, we note that federal intervention
has been uni-directional. No federal government has ever prevented
provinces from extending covered services (such as to dental care
or pharmaceuticals); the interventions are all related to attempts
to dismantle universal, single-payer care. Provinces wanting to
strengthen health-care need not worry about restrictions from the
federal government.
In health care, the debate over federal standards
is a debate over universality, and should be treated as such.
The Canadian public should know this. Our current health care
system suffers from the financial pressures facing every health
delivery system in the world. Nevertheless, we have achieved and
so far maintained a system that has achieved, to an extraordinary
degree, its goals of universal, high-quality care. Canadians strongly
support medicare. If we are to maintain this system, continued
federal power in setting standards, and federal resolve to enforce
those standards, remain a necessity.
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