Relationship rescue

How to fix Canada's health care woes
January 1, 2004

If there is anything the First Ministers and the new Prime Minister Paul Martin need before they meet to discuss health care late this week, it's a good dose of Dr. Phil, the ubiquitous TV psychologist.

It's not news to hear the provinces are heading into the meeting demanding more money with no strings attached. It is news that Canada's self appointed financial management guru, Paul Martin, appears poised to give away $2 billion to the provinces, no strings attached. And more amazing that he'd do this twice, given what happened last time.

The money is ostensibly for health care but will go to the provinces to spend as they see fit, like the $2.5 billion "signing bonus" for the Health Accord of last year - most of which was used to balance provincial books, not save public health care.

The approach is remarkably similar to the one Chretien took with the provinces with the September 2000 Agreement ($23 billion over five years) and last spring's Health Accord ($35 billion over five years). The Federal Liberals basically said to the provinces: here's a bunch of money, stop your whining and spend it on whatever you want, maybe even health care.

Many billions of dollars later, Canadians still clamour for shorter wait times for health care, prescription drug costs are soaring out of control, and more private health care looms large on the political horizon.

As Dr. Phil would say: "How's that workin' for ya?"

Clearly, throwing more money at health care is not what the good doctor ordered.

It's time for a relationship rescue.

Dr. Phil would say: Life leaves lots of little clues

What's the first clue that the 'add money and stir' approach to health care isn't working?

After the September 2000 Agreement, we discovered millions of dollars went unspent or misused by the provinces, such as using diagnostic and medical equipment money for grass-cutters and floor-polishers in New Brunswick.

Not long after Health Accord 2003 was signed, B.C. made it harder for some seniors to get prescription drug coverage. Ontario sanctioned P3 hospitals while claiming to oppose two-tier medicine. Quebec declared an openness to private health care partnerships.

How can we spend billions more on health care and yet still be talking private health care and limited access?

Life may leave little clues, but Canada's health care system is leaving a lot of big clues that something is amiss.

Dr. Phil would say: It's not what you're doing - it's what you're NOT doing.

It's easy to understand why the provinces keep saying gimme more.

Health care in Canada was conceived of as an equal partnership between the two senior levels of government.

Since 1986, and especially between 1996 and 2000, the federal government unilaterally cut back on funding, leaving the provinces responsible for rising costs of health care with fewer resources.

When the federal government decided to re-invest in their share of the partnership, they acted as though money alone would fix health care.

Handing $2 billion more to the provinces might feel good, but it's what Paul Martin is NOT doing that continues to put public health care at risk.

Dr. Phil would say: Relationships aren't 50-50, they're 100%-100%.

As anyone who has repaired a soured love relationship knows, success doesn't come by saying: "OK, I've contributed 50%, now it's your turn." Success only comes when both parties agree to give it their all - 100%-100%.

If the provinces and federal government truly gave it 100%, Canada would have common objectives for improving public health care. We would have health care standards that no region could fall below. Money would buy real change.

Governments don't even have to re-invent the wheel. The Romanow Report laid it all out.

Ironically, Canadians in nine provincial and territorial jurisdictions went to the polls in 2003 and voted for leadership to protect public health care.

Asking for more money is not leadership. Giving it, free of conditions, is not leadership. It's raw politics.

Paul Martin is banking on a feel-good meeting with Canada's First Ministers on Friday.

He'll be happy to blow $2 billion on the photo op as he sails into a federal election, predicted this spring. You can bet he'll use that election to promise shorter waiting times for health care - a promise no province has yet been able to deliver. (Alberta is backing off its promised 90-day guarantee).

Make no mistake: more privatization will be the sleeper hit of the season if governments don't come up with nationwide strategies on how to cut waiting times in the public sphere.

Upon accepting the Liberal leadership, Paul Martin promised to rebuild medicare.

Promises without action, we don't need. As Dr. Phil would say, we need to get some verbs into those sentences.

Without standards and objectives, commitment and leadership - without action - public health care remains in peril. Doing anything less is a prescription for failure.

Armine Yalnizyan is an economist and is the first recipient of the Atkinson Award for Economic Justice. Trish Hennessy is a communications consultant and watches too much Dr. Phil.