Medicare is turning out to be the sleeper issues in this election as Canadians continue to say that public health care -- universal, comprehensive, publicly administered care, transferable across provincial lines -- is their most important election issue, even more important than the economy. And is the economy that Harper has based his whole campaign on -- after spending over $20 million in public funds framing the argument in his favour.
But if Medicare can become the issue in the last two weeks of the campaign, there is a good chance that Harper's Teflon will start to erode.
But for that to happen, people need to know just what Harper is likely to do with Medicare and what he has said about it in the past. People's memories are short.
The country needs a refresher course in Dr. Harper's New and Improved Health care.
Harper's first policy efforts regarding health care were undertaken on behalf of the Reform Party (I wrote a book on the party and published a Reform Watch Newsletter for four years in the mind-1990s when Harper was the party's policy director). Harper said then what he believes now: that the Canada Health Act gives the federal government too many powers and that federal funding for Medicare should be "unconditional" and, crucially, that the funding should recognize "different levels of economic development in the provinces." That's code language for opening the system to user fees, extra billing, erosion of the number and kind of services provided and the end of "portability" -- the transferability of care across provincial boundaries, and different standards of care between rich and poor provinces.
After developing the death knell policy prescription for health care for the Reform Party, Harper quit politics in frustration and joined the most viciously right-wing lobby group in the country and the source of many Reform policies: the National Citizens Coalition. The NCC was founded by Colin Brown, a wealthy insurance broker, in the aftermath of the advent of national Medicare in 1967. Its raison d'être was, at the time, exclusively to fight Medicare and open it up again to private insurance.
But it became much more -- spending millions on campaigns against Vietnamese immigration, spending laws restricting corporate funding of elections, attacks on feminism (their publications portrayed feminists as pigs with hairy chins). The NCC spent $50,000 in the 1993 election getting Harper elected in his Calgary riding.
When he quit the Reform Party in 1997 he said in a speech to the NCC: "The agenda of the NCC was a guide to me as the founding policy director of Reform. I have long supported and proudly defended the NCC and it has never given me reason to do otherwise." Never.
To get a sense of what the NCC thought of Medicare, here are a few quotes I gathered over the years:
- The February 1986 issue of the NCC newsletter, Consensus, in its feature on Medicare called for "permitting the establishment of private medical insurance schemes and private hospitals"
- Medicare is "the equal division of misery" -- June 1995 Consensus
- "Could it be that the very feature of our health care system which Canadians most often boast about -- namely, equal accessibility to all -- is one of the things that is keeping it expensive and inaccessible? If we allowed rich people to pay extra to jump to the head of the queue, or to try experimental treatments, wouldn't their money eventually result in a shorter queue and better treatment for those still waiting?" January 1994 issue of Overview, the NCC's bimonthly publication
- "In Canada you stand a greater chance of dying while waiting for a heart operation than you do of dying on the operating table." March 1994 Overview
- "More Canadians will die [if the Canada Health Act is implemented] because they can't get the life-saving health care they need, when they need it. This will turn our doctors into a bunch of civil servants." March 1984 NCC fundraising letter
- "So ... how would you like your open-heart surgery done by a civil servant?" from an anti-Canada Health Act NCC ad published in Canadian newspapers, 1984
- "As prisoners of this new oppressive system, our incomes will be inexorably eroded, year by year, by vote-buying politicians promising misinformed voters cheaper health care." Dr. William Rudd, head of NCC's medical advisory committee, in a letter the NCC mailed to 16,000 Ontario doctors in 1984
In 1994, while still Reform policy director, Harper in a speech to the NCC's Colin Brown Memorial Dinner, stated: "Universality has been severely reduced: it is virtually dead as a concept in most areas of public policy...These achievements are due in part to the Reform Party..."
The year that Harper became VP of the NCC, 1997, his boss, David Somerville, openly expressed the organization's position on Medicare: "It's past time the feds scrapped the Canada Health Act and transferred tax points to provinces to allow them to run health care as they wish as is laid out in the British North America Act." It was the philosophy behind the Reform Party's position, though the party was never quite as bold in stating it.
Harper essentially repeated this policy on many occasions and in different formulations.
In his leadership material when running for the leadership of the Alliance Party, it is stated clearly again: "Harper also believes that our health care will continue to deteriorate unless Ottawa overhauls the Canada Health Act to allow the provinces to experiment with market reforms and private health care delivery options. He is prepared to take tough positions including experimenting with private delivery in the public system."
On January 24, 2001, Harper and a number of other right-wing Albertans wrote the famous "firewall letter" to Premier Ralph Klein, urging him to take on the federal government on Medicare (and other issues) even to the point of biting the bullet re: penalties for violating the Canada Health Act.
They called on Klein to: "Resume provincial responsibility for health care policy. If Ottawa objects to provincial policy, fight in the courts. If we lose, we can afford the financial penalties Ottawa might try to impose under the Canada Health Act. Albertans deserve better than the long waiting periods and technological backwardness that are rapidly coming to characterize Canadian medicine. Alberta should also argue that each province should raise its own revenue for health care -- i.e., replace Canada Health and Social Transfer cash with tax points, as Quebec has argued for many years."
Harper's attack on Medicare in 2001 never let up. In a speech to the Canadian Institute of Plumbing and Heating on June 27 Harper, still President of the NCC, attacked the appointment of Roy Romanow's Commission into the future of Medicare: "Thus the federal government needs the Romanow Commission to separate itself from its own irresponsible legacy in the health care debate. But it needs the Commission for an even worse reason -- to make itself look essential in an area where it is largely an obstacle.
So why is the federal government going to spend millions of taxpayer dollars to run an inquiry into the health-care system? The answer is likely so that it can insist upon finding a 'national solution' -- precisely the opposite of what the system needs.... To the extent it leads us in a philosophical debate about 'national values' in search of a non-existent 'national solution', the Romanow Commission is not only useless but dangerous, distracting Canadians and delaying tough, real choices at the provincial level."
The real solution, Harper told the plumbers, lay with the provinces: "...what we clearly need is experimentation -- with market reforms and private delivery options within the public system. And it is only logical that, in a federal state where the provinces operate the public health care systems and regulate private services, that experimentation should occur at the provincial level."
He told CBC Newsworld on Dec 4, 2001: "One of the things that we suggested specifically was that the Alberta Government take on the Canada Health Act."
For those who think that Harper has mellowed on Medicare, think again.
Until he was recently forced to talk about it (and "pledge" to keep increasing federal funding by 6% a year) Harper virtually never spoke about Medicare -- either in the House of Commons, in public forums, or in media interviews. It was as if there was no such thing as Medicare -- or the billions of federal dollars that help fund it. Harper for the past five years has often gone literally months -- sometime half a year or more -- without uttering the obnoxious term Medicare. It is, for Harper, anathema -- it is the very symbol for Harper of what is wrong with Canada.
He even ordered Leona Aglukkaq, his Health Minister, not to attend the meeting of the Canadian Medical Association last August -- breaking with a tradition that goes back twenty-five years. Aglukkaq had "pressing and conflicting business" -- watching Harper announce funding for upgrades to the airport in Churchill, Man. This bizarre behaviour speaks to the man's visceral hatred of public Medicare.
He will do whatever it takes to destroy it. If he gets a majority he will, as have similar libertarian politicians, move quickly to undermine Medicare. How quickly and exactly how he will do this is open to debate. He would not try to simply repeal the Canada Health Act outright. But he could just continue what he has been doing for five years -- refuse to enforce it. He could amend the Act gradually while assuring Canadians that they will all have access to health care. He could provide extra funding for provinces willing to "experiment" with private solutions.
He already said in the English language leaders' debate that his plan for "alternative delivery service" was not privatization -- a blatant lie, as that is virtually a definition of what privatization is. This is why he pledged to keep increasing funding: that largesse will eventually, under Harper's plan, got to for-profit providers.
It could be argued that Harper has stayed in politics to ensure a single legacy: it will be he who goes down in Canadian history as the Man who Killed Medicare.
This article was first posted on murraydobbin.ca.