Talking about health care as a means to avoid doing something

Less than a decade ago, some of Canada’s top public policy wonks looked long and hard at medicare. They did so from a variety of angles and from a host of different perspectives.

Less than a decade ago, some of Canada’s top public policy wonks looked long and hard at medicare. They did so from a variety of angles and from a host of different perspectives.

Every government, regardless of its level or its political stripes, got engaged in the exercise of rethinking Canada’s most popular social program.

A Senate committee led by Liberal Michael Kirby came up with a provocative list of proposals.

At the request of then-prime minister Jean Chrétien, former Saskatchewan premier Roy Romanow held hearings across the country in 2001. The following year he, too, handed in a sweeping set of recommendations.

While not all task forces arrived at the same conclusions, it is fair to say that they collectively left no stone unturned in their search for options to improve and sustain medicare.

In the end the mountain gave birth to a mouse.

Over the past decade there has been limited and uneven progress toward a comprehensive ehealth network. Some jurisdictions have found more effective ways of delivering health care.

But a national pharmacare regime remains elusive and home care is very much a work in progress. And while some provinces have arranged a rapid expansion of private-pay-as-you-go medical care, none has really managed to rein in the ever-rising costs of its public health system.

Over the same period, medicare vanished from the federal radar.

In 2004, Paul Martin negotiated a 10-year, multi-billion dollar funding arrangement with the provinces. The ink was barely dry on the accord when Stephen Harper endorsed it.

Since then, a general preoccupation with minority rule combined with the advent of a Conservative regime that is ideologically inclined to leave the leadership of the social union to the provinces has turned the federal government into an absent shareholder at the medicare table.

The medicare file lost impetus.

In a recent interview, Romanow noted that the progress accomplished since his report fell well short of his hopes and expectations.

Despite the injection of billions of dollars, the opportunity to buy lasting fundamental change to the system had largely been squandered. And, over time, squaring the medicare circle has become more — not less — problematic.

Since the Romanow report, Canada’s public finances have deteriorated. As governments turn to the task of rebalancing the books, it will become harder to find more public dollars for medicare.

At the same time, though, the many middle-class Canadians who have just seen their pensions take a hit in the recession have become even more wary of being forced to shoulder a larger financial burden for their health care.

In Quebec, Premier Jean Charest was recently forced to abandon a controversial plan to impose user fees on medical visits. He did not have enough political capital to sustain a backlash on the sensitive health care front.

But Charest had also found no support for his proposal among his fellow premiers.

Governing parties with uncertain re-election prospects dominate the current federal-provincial scene and they have little inclination to think out of the box on medicare.

In this risk-adverse environment, The Canadian Press reports that yet another federal task force on medicare could be in the making. Its purpose would be to facilitate a non-partisan national conversation on the future of the health system.

But the last such conversation ended up going around in circles for lack of leadership. The notion of another government consultation sounds more like a ploy to take medicare off the table of the next federal election than a serious attempt to address the already well-documented challenge of maintaining the program.

Chantal Hébert is a national affairs writer for The Toronto Star.