The current federal election has highlighted for me the difficulty of having a truly informative debate about health care in Canada. Of course some of the difficulty derives from the nature of politics, and of the media, but even this is made worse by a lack of clarity about the nature of Medicare in Canada, and foundational legislation like the Canada Health Act. This lack of clarity makes it easier for some politicians to mislead Canadians about their real positions, and may even cause Medicare friendly politicians to unintentionally obscure the issues.
From 1980 to 1984 I was the NDP Health Critic in the House of Commons. As such, I had a role in both pressuring the Liberals to bring forward the Canada Health Act, and in the study of it after it was introduced, by what was then called the Standing Committee on National Health and Welfare. With this history in mind, I offer the following reflection.
The Canada Health Act (CHA) Is the federal legislation that governs Canada’s publicly funded health care insurance, otherwise referred to as Medicare. The key word is insurance. The CHA does not require that medical and hospital services be delivered by public or non-profit providers. It only requires that however insured services are provided, by the public or private sector, that the cost of those services be covered by provinces without financial barriers, and particularly without direct charges at the point of service for such services.
Over the years, Canadians who prefer not only public insurance for health services, but also publicly owned delivery of health services, have often conflated the two in a well meaning attempt, arguably in keeping with the spirit if not the letter of the CHA, to promote public sector delivery, and to discourage any enlarging of the role that the for-profit private sector already plays in the delivery of publicly insured services.
The challenge with this approach arises sometimes when there is a debate about Medicare. Conservative Leader Erin O’Toole repeatedly says he supports the Canada Health Act. The problem is that to the extent that Canadians have accepted the conflation of public insurance of health services and public delivery of health services, they can be falsely re-assured about Tory intentions.
For better or worse, mostly worse, there is lots of room within the CHA for expanding the privatization of the delivery of health care services that at present are publicly delivered. Which is what it seems Erin O’Toole is talking about when he touts innovations and partnerships in health care delivery, while confessing his support for the Canada Health Act. If he is elected, It is a promise he might even keep, because he no doubt knows, unlike those who conflate insurance and delivery, that the Canada Health Act doesn’t actually stand in his way. Only Canadians who wish the profit motive to be less rather than more entangled with the delivery of health care can do that.
Finally, to those of us who might be thinking that if the Canada Health Act permits the private for-profit delivery of health care services, then what’s the problem with more of it. This is where the threat of a two tier health care system enters the argument. This is because the more privatization there is, the more the infrastructure for a two tier health care system is put in place. It’s important not to let our publicly funded health care insurance plan finance its replacement by creating the infrastructure for two health care tiers, one for the general public, and a private one for those who can afford it. For those who would ultimately like to see such a system, privatizing more of the delivery of the health services in the current single public tier could well be an important step along the way.
Bill Blaikie is a former MLA and MP from Winnipeg and is a board member of the Broadbent Institute.