For the last 18 years I've fought alongside countless Canadians to protect the least advantaged members of society from losing the little they have.
In the mid 1980s, after the most profound recession since the Great Depression, we fought for full-employment policies, and lost.
In the late 1980s we fought to improve training opportunities for the unemployed, and lost.
In the early 1990s we fought to prevent cuts to unemployment insurance benefits and welfare, and lost.
In the mid 1990s we fought to preserve social housing programs, and lost.
In the late 1990s we fought for sufficient investment in core infrastructure to assure clean water and affordable electricity, access to community centres and libraries, and lost.
We lost every time because the counter-argument was "the cupboard is bare".
To my dismay, the fight has now turned to securing the future of public health care, the social program most treasured by Canadians. And the reason that we are struggling to assure everyone's access to this most quintessential human right - timely, quality health care - is again because "the cupboard is bare".
That line is not as credible as it once was. Not when you have $20 billion in tax cuts this year from the federal level and another $20 billion at the provincial level. Not when unanticipated and planned surpluses in the federal budget since 1997 have devoted almost $47 billion to one purpose only - paying down the debt. Not when the inflation-adjusted size of the economy is two-thirds bigger than it was in the early 1980s.
The fiscal basics are there to protect health care. But it will take a critical combination to ensure we win this fight: more money; targets for common/national objectives for improvement; public ways to monitor progress; and the political champions who will push this agenda forward.
The meeting of Canada's Finance Ministers in mid-December certainly was not a promising start. The feds are low-balling the amount of money needed to relieve the pressures on the system. The provinces are refusing to accept money tied to conditions of any kind.
That federal Finance Minister Manley maintains the cupboard is bare is no surprise. The November 2000 election was called primarily to determine what should be done with the emerging surplus. Former Finance Minister Paul Martin laid out the path: the books would be balanced by a major commitment to tax cuts and debt reduction. The point was to make the cupboard bare.
That line of thinking was first scripted in the 1995 budget, when Martin set out to "redesign the very role and structure of government itself". The stated objective was to make the federal government as small as it was in 1951. Today, it is smaller than it was in 1949.
Back then, we didn't have Medicare. In 2003, we won't be able to afford Medicare if the goal of our elected representatives remains small government at any cost, including the loss of quality public health care. This is a matter of political choice, not fiscal capacity.
We need at least $3.5 billion next year, and rising with every subsequent year, to prevent rapid erosion of public health care. The $3.5 billion is Romanow's price tag, and it is likely too modest, given the pressures on the system. We also need better systems of public accountability about how the money gets used. Here's why.
In September 2000 the federal government agreed to hand over more than $21 billion over five years to the provinces in new cash for health care, with virtually no strings attached. Two years later, nobody can identify how these re-investments are making the system work better. People are still talking crisis. So clearly more money, alone, is not the answer.
We need clear targets for improvement, with commonly accepted objectives, and an ability to publicly monitor progress. Otherwise public health care will simply be seen as the monster that ate everybody else's lunch - be that investment in housing, education, clean water, or [insert your favourite cause here].
More importantly, if the feds insist that the cupboard is bare, the provinces will be left to deal with the pressures as best they see fit. This has inspired some provinces to turn to private investors to provide the money to for expanded capacity in buildings and equipment.
Evidence cautions us that such policy drift may risk the quality and access to medically necessary services; or make the public system too expensive to keep running at the present scale of service. In either case, you can kiss the principles of Medicare good-bye.
Let's be clear: the feds are signaling they may be prepared to let Medicare slide to meet a fiscal agenda based on tax cuts and debt reduction.
So why did the federal government even bother to put Romanow on the road?
First of all the cupboard is not bare. Secondly, the public has clearly and repeatedly said they are willing to pay more taxes to invest more in health care if they get their money's worth. With or without a big surplus - which could and should be used to address other critical issues - the public has said they want the necessary investments made to protect and secure the future of public health care.
Minister Manley and the Prime Minister are thus far missing the mark. Canadians are looking for federal leadership to implement the modest, do-able plan Romanow laid out for health care.