Medicare: It’s Decision Time

Decision Time for Medicare

“The uncertain future of medicare does not come from public opinion.  By a wide margin, most Canadians want health insurance according to the five principles that identify medicare.  There is little on which the public will is so clear. Medicare’s troubles are rooted in our federalism, in the political difficulty of providing what people want when that requires the collaboration of federal and provincial governments.”

So argues Tom Kent in Medicare: It’s Decision Time, released today by the Caledon Institute of Social Policy, an Ottawa-based think tank.

Mr. Kent is one of the architects of Medicare and other major social programs created in the 1960s.

The report lays much of the blame for medicare’s woes on the federal government.

“Yet even as deficiencies began to grow, discontent to mount, it was provincial politicians who got almost all of the blame.  Federal politicians cut their financing but managed to go on blithely claiming to be the dedicated defenders of medicare against the evil axis of provinces, doctors and assorted reactionaries.”

Kent argues that Ottawa must act now to save medicare, in “committed partnership” with the provinces: “The creation of Canada-wide medicare required a federal initiative; so does saving it by modernizing it.”

A key proposal is that the federal government boost and stabilize its financial support by cost-sharing 25 percent of provinces’ medicare expenditures.

Federal funding for medicare would be identified as coming chiefly from “indulgences and pollutants, especially those that contribute to the need for health care.”  These include taxes on tobacco, automobile and industrial emissions and alcohol.

Another source of federal funding would be a limited after-use charge on medicare services, graduated to income and administered through the income tax system.

Kent calls for a new Canada Health Act that “would fully maintain the existing principles of medicare but define them more precisely.”

“The principle of accessibility would be defined to mean prompt access to health care of the quality made possible by contemporary technology, including primary care efficiently delivered by community-oriented team organizations.”

“The principle of comprehensiveness would be defined to embrace a full range of preventive care, emphasizing early diagnosis at all ages and giving priority to services that help to foster the mental and physical well-being of children.”

The report also proposes the creation of a federal-provincial agency for health policy.  It would serve as a “mechanism for regular consultation and collaboration” and “conduct investigations and make recommendations over the whole range of medicare principles and practices.”

Kent’s proposals are directed in part to the Romanow Commission, whose forthcoming report he sees as crucial to the future of medicare.

“If that report is soft, if it cautiously offers a range of options, the Chrétien government can be expected to make a soft response, a combination of grand declarations and uncreative tinkerings.  The way thereafter will be downhill.”

“If, however, Mr. Romanow is true to his Saskatchewan antecedents, to the wishes of most Canadians, to the logic of social justice in the public policy of Canada, he will make a strong report.  It will define, firmly and clearly, how to strengthen medicare by modernizing it.”

ISBN – 1-55382-018-5