LETTER TO THE EDITOR: Premiers’ stance worrisome


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Absent in the ongoing debate regarding funding of health care between the federal and provincial/territorial governments is the lack of openness on the part of the premiers regarding their objectives and intentions.

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Absent in the ongoing debate regarding funding of health care between the federal and provincial/territorial governments is the lack of openness on the part of the premiers regarding their objectives and intentions.

The consistent and focused objectives of the federal government are relatively clear: a pan-Canadian health-care system publicly funded through federal and provincial taxes, administered by the provincial governments as constitutionally prescribed, accessible to all regardless of ability to pay, comparable services in all provinces, portable coverage from province to province.

Additionally, the federal government has been clear in statements and offerings of additional monies to the provinces to improve the system that exists and to institute a broader definition of and commitment to more comprehensive health-care services. These include but are not limited to long-term care, mental health care, home care, dental care, child daycare, personnel issues (certification, recruiting, compensation, working conditions) and effective and efficient health-care delivery systems.

Included as a condition in the federal government’s position — one that is an anathema to provincial premiers — is that funding agreements must include agreed-to definitions and descriptions of health services, of health indicators and performance measures and reporting systems to evaluate use of funds and determine the effectiveness and efficiency of health-care systems in all its dimensions.

Provincial premiers have made it clear that their objectives in negotiating with the federal government begin and end with federal monies. They want more federal health-care funding and no conditions as to how and for what federal health-care monies will be spent.

That appears to be the only point of unity among the premiers or as far as they are willing to take their imagination and responsibility.

Individually or collectively, they have not offered any vision of what kind of health-care system they are recommending or considering. They have not given any indication that they, individually or collectively, do not agree to the principles that guide the current health-care system. They have given no indication they have any principles in mind that will guide them in designing and implementing an alternative system. Nor have they suggested or indicated whether they support a pan-Canadian system or 13 separate provincial systems.

This behaviour by the provincial premiers should be concerning to all Canadians. In essence, provincial premiers are asking, demanding of Canadians that they place their trust in them in designing and implementing a health-care system using federal and provincial taxes collected from Canadians. In essence, premiers are expecting, demanding Canadians to make a choice between a relatively clearly articulated public health-care system or a “blank cheque” offered and signed by Canadians with no comprehension of what their systems might or will look like.

To some extent, the position of the premiers reinforces the federal government’s concerns that the implementation of a pan-Canadian health-care system based on the principles of being publicly administered, universal, accessible, portable and comprehensive is in jeopardy.

This may or may not be true. It may or may not be true that the premiers, individually or collectively, have a vision for their respective provinces. Absent of any sharing and openness by the premiers regarding their intentions, objectives, there exists a great void that will be filled by speculation based upon past and current behaviours of the premiers regarding their responsibilities for implementing and managing an effective and efficient health-care system. Their silence offers no comfort or assurances to Canadians that they know what they are doing.



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