OTTAWA — There is a deficit of political leadership in health care, especially at the federal level. Prime Minister Stephen Harper stated in a year-end interview recently that he had no idea how to secure the future of health care in Canada. Instead, he said it is up to the provinces to find “solutions.”

Harper’s recent unilateral, non-negotiable decision on the future of federal health financing stunned provinces. It seems the federal government intends to limit its role to signing blank cheques with no strings attached and no accountability. If rumours on the Hill are true, once the current arrangement expires Harper may replace cash transfers entirely with tax credits.

The Harper government has set in motion a strategy that will lead to the unravelling of Canada’s national health system. All Harper has to do is nothing. By abdicating the essential federal responsibilities in health care, the system will fragment on its own into 14 separate pieces.

In order to understand the implications of abandoning federal responsibilities in health care, it is important to identify what they are, especially since the Harper government never misses an opportunity to say that health care is a provincial/territorial responsibility.

The federal role in health care is very clear and well described on Health Canada’s website.

The federal government is a funder, and transfers more than $40 billion a year to provinces and territories for health care. In addition to health-care cash transfers, the four most important federal duties in health care are: 1. guardian of the national standards in the Canada Health Act; 2. regulator of pharmaceuticals, medical devices and food; 3. health-service provider to First Nations and Inuit communities; and 4. catalyst for innovation and best practices.

First, as guardian of national standards, the federal minister of Health is supposed to ensure that provinces and territories are in compliance with the Canada Health Act and are not allowing queue-jumping, extra-billing or user-fees for medically necessary services. The act also says no Canadian should face a financial barrier to care — regardless of where they live or work. Increasingly flagrant violations of the law are occurring and are well documented. The federal government plays dumb as patients and the sick are exploited or denied access to essential services while wealthier Canadians jump the queue.

Second, as a regulator, Health Canada is responsible for health protection, including the safety of products (food, pharmaceuticals, medical devices, natural health products, consumer products, cosmetics, and chemicals). When the federal government performs these duties poorly, the consequences for Canadians and their health-care system are dire. Currently, the federal government is fighting multi-billion dollar lawsuits for regulatory negligence. Poor regulation of drugs is making people sick and killing thousands of Canadians annually. This regulatory negligence also puts enormous strain on provincial and territorial health-care resources.

Third, as a service provider, the federal government is the fifth-largest in the country. Health Canada provides basic primary care services in approximately 200 remote First Nations communities, home and community care in 600 First Nations communities, and support for health promotion programs in Inuit communities across four regions. Where is the federal plan to adequately meet the health-care needs of aboriginal people in Canada? Also missing in action.

Fourth, Health Canada is a catalyst for innovation, a funder, and an information provider in Canada’s health system. It works closely with provincial and territorial governments to develop national approaches to health system issues and promotes the pan-Canadian adoption of best practices.

The narrative of the Harper government — that health care is not its responsibility — is simply untrue. If there is indeed no federal role in health care, why does the federal minister of Health have 12,000 employees and an annual budget of $4-billion? Harper’s abdication of health care is also at odds with the values of the vast majority of Canadians. A Nanos poll released in December shows support for public health care in Canada at 94 per cent.

It is time for the federal government, on behalf of all Canadians, to perform its legal duties and get back to the table with provincial and territorial counterparts and work together to secure the future of health care in Canada. With Canada’s growing and aging population, federal leadership is needed more than ever.

An excellent place to start is better regulation and management of pharmaceuticals. It is perverse for the federal government to encourage excessive growth of pharmaceutical costs and abusive marketing practices, and then pass the bill on to provinces, territories, employers and individual Canadians.

You can’t tell the provinces and territories that health-care sustainability is their problem when it’s federal policies that allow the pharmaceutical industry to drain billions of dollars out of their health-care budgets.

The Health Council of Canada observed that advances in pharmaceutical management policies are integral to overall health-care renewal, since drugs are the second-highest spending area in the Canadian health-care system. The reality is federal pharmaceutical management is a failure that threatens the integrity and sustainability of all aspects of the health-care continuum, including primary, hospital, home, and continuing care.

A groundbreaking study done by Marc-André Gagnon concluded that a universal public drug plan would save Canadians up to $10.7 billion annually. The dramatic cost savings are achieved primarily by just four measures, including eliminating subsidies, bulk purchasing, more rigorous assessment of “new” drugs, and improved prescribing practices.

Politicians can no longer hide behind the excuse that a universal drug plan is too expensive. It would not only save taxpayers billions annually, it would save lives and provide medically necessary medicines to every Canadian in need — many of who currently have no coverage.

Canadians can’t afford not to have a pharmacare program. Nor can Canadians afford the current deficit in federal leadership in health care.

To paraphrase Tommy Douglas, our parents and our grandparents worked and fought and suffered to get us medicare. We’re not going to let anybody take it away, including Prime Minister Stephen Harper.

Michael McBane is national co-ordinator of the Canadian Health Coalition in Ottawa.

This article was first published in The Hill Times and reprinted on with permission.