Poll after poll tells us that, for the majority of Canadians, the most pressing issue of this election is health care. Unfortunately, there is so much confusion around this issue that Canadians may not feel that they have the information they need to make the best voting choice. The time to demand clarity is now.
There are basically three concerns.
The first is federal funding. Between them, the Mulroney Conservatives and the ChrÃ©tien Liberals cut almost $11 billion of federal funding from the health care file, bringing the federal contribution down to its lowest level in four decades. Without an increase in federal funds for health care, the federal government has almost no power to influence how the provinces deliver health care.
On this question, the Liberals have pledged $3 billion more in general funding over two years and $4 billion to reduce waiting times. The NDP has promised to increase federal funding until it covers 25 per cent of health care costs in two years. The Conservatives have been vague, promising only to “ensure adequate funding.”
The second concern centres around whether or not to expand medicare to cover areas such as home care, pharmacare and primary care, community-based care that includes nurse practitioners, which could relieve much pressure on over-burdened hospitals.
On this question, the Liberals have promised to “lay the foundation” for a national home care program for full inclusion in medicare; phase in a plan for prescription drugs; and work with the provinces to increase national access to primary care. The NDP has promised to work immediately to include a full drug plan, home care plan and primary health care plan within medicare. The Conservatives have not committed to primary care or home care and have only promised to work with the provinces to improve access to prescription drugs.
The third concern, and perhaps the most important, centres on the privatization of health care delivery. While all parties support public funding of health care, there are real differences between them over the growing practice in some provinces of allowing the delivery of health services to be done by for-profit private companies. (This should not be confused with private, not-for-profit services delivered by most family doctors in Canada.)
This issue is crucial because, under the rules of existing and proposed trade agreements, creeping privatization will kill medicare. The only way an exemption for any public service such as health care can be maintained in these agreements is if the delivery of the service is done as a public service on a non-profit basis. Quite simply, the more for-profit services we have, the more rights we give to private American health care corporations to set up business in Canada.
On this question, the Liberals have promised to enforce the five principles of the Canada Health Act and set up an expert panel to resolve disputes over violations of the Act. The Liberals have no clear policy against public-private partnerships, the mechanism of choice to deliver for-profit health care in several provinces; however, they have put in place a Parliamentary Secretary with special emphasis on public-private partnerships. They are also aggressively promoting trade agreements such as the General Agreement on Trade in Services that put public health care at risk.
The NDP is against all forms of for-profit delivery and would reverse existing provincial private sector initiatives. As well, it opposes trade in social services and would roll back the 20-year trade-related patenting rights of the big drug companies, giving Canadians access to cheaper generic drugs once again.
The Conservatives support the for-profit health care programs of provinces like Alberta and British Columbia. Leader Stephen Harper said in the House of Commons that private delivery of health care is “a natural development” and until recently, headed the National Citizens Coalition, which was founded to fight medicare.
The architects of medicare were clearly opposed to private health care. Their five principles promised Canadians health care that is universal, accessible, publicly administered, comprehensive and portable. To ensure that provinces complied with these principles, they added two “conditions” under which the federal government should withhold funding to the provinces — extra billing and user fees.
At the time they didn’t anticipate that the principles could be undercut by a third practice — that of private for-profit delivery of health services. But this omission could bring down the whole program and open the door to American-style private medicine which denies many millions affordable coverage and adequate care.
What Canadians need, and what we must demand now, during this election, is a third condition of medicare that would ban the practice of for-profit delivery of health care and ensure this most important social program is here for the next generations.
This is indeed a crucial election. The very future of health care is on the line. Ask the right questions of your candidates. And vote carefully.
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