Volume Ten, Number One   January 2005   www.columbiajournal.ca

The National Health Care Summit: Good and Bad

Colleen Fuller

Sometimes it seems that Canada’s health care system has evolved into little more than a battleground, with patient care hanging by a thread above the fray of federal and provincial squabbles about Constitutional jurisdiction and funding. So the cease-fire achieved at the end of a three-day summit among the country’s first ministers in mid-September was certainly welcome.

But was the agreement good or bad for Canadians? The answer is yes--it was good and bad. Here is a brief rundown.

1. The Good

The premiers and Paul Martin reached a ten-year deal that will see $41 billion in federal cash transfers to the provinces and a plan to reduce wait list – and that promises to put the country’s health care system on a more secure footing in the coming decade. It will also move Ottawa towards a 25 per cent federal contribution level – and a step closer to the goal of re-establishing health care as a national (instead of provincial) program with national contributions at 50 per cent.

One of the most important achievements didn’t involve the provinces at all. Prior to the health care summit the federal government met with leaders from the Assembly of First Nations, the Inuit Tapiriit Kanatami, the Métis National Council, the Congress of Aboriginal Peoples and the Native Women’s Association of Canada.

Ottawa and the Aboriginal leaders agreed to a plan that will allocate $700 million over five years to implement “specific measures to close the gap between the health status of Aboriginal Peoples and the Canadian public.” The plan includes $100 million for an Aboriginal Health Human Resources Initiative designed to recruit and retain aboriginal health care workers. The success of this agreement will obviously depend on how much control Aboriginal people will exercise over the money, but it’s a good move in the right direction.

Another exciting development, which occurred in the days leading up to the health summit, was the successful efforts of the Canadian Federation of Nurses’ Unions and the Canadian Health Coalition to convince the provincial premiers to endorse a National Pharmacare Program. The proposal called on the first ministers to “upload” the costs of pharmacare from provincial to federal jurisdiction. As the CFNU pointed out, most of the policies, which determine the cost of prescription drugs in Canada--the federal government enacts such things as drug patents and drug approvals. But Ottawa downloads the impact its policies and regulations have on the cost of drugs to the provinces and private payers. Over the past decade public spending on drugs has tripled to $7.6 billion, while private spending has reached $12 billion.

The first ministers also agreed to provide certain home care services in the public health plan by 2006, including short-term home care for two weeks, short-term care in community mental health homes for two weeks and end-of life care, with a further strategy for home care by Dec. 31, 2006.

Another plus was that Ralph Klein left the summit early.

2. The Bad

Despite the consensus among provincial premiers, backed by a majority of Canadians in public opinion surveys, Martin and health minister Ujjal Dosanjh (along with the drug industry) gave the Pharmacare plan a thumbs down. They claimed it would cost too much money – but the point is that Canadians cannot afford NOT to have a national program. Despite their predictions about a $12 billion price tag, a national program that covered only safe, effective and affordable drugs, using the essential medicines list recommended by the World Health Organization as a starting point, is completely within the realm of possibility.

Instead of putting all 5,000+ drugs currently on the Canadian market into a national drug plan, we need an arms-length committee of progressive non-industry experts and consumers to determine which drugs should be covered. The WHO list is a good starting point and, in addition to tough bargaining with the drug industry on drug prices, Canadians could significantly reduce the amount of money we’re spending on medicine.

Fortunately, the first ministers did agree, at the end of the summit, to form a task force to develop and implement a national pharmaceutical strategy by June 2006. This gives us time to organize a mass movement in support of a national program.

The deal also left out some of the most urgent issues identified by Canadians – the privatization of health care services and the push by Big Business to put its nose firmly in the public insurance trough; the lack of accountability by privatizing and delisting provinces; and the continued failure of the federal government to enforce the Canada Health Act. There also was no mention at all of long-term care, a glaring oversight.

The failure to address privatization was scandalous, especially given the overwhelming evidence that private for-profit delivery of health services lowers the quality of care, increases the rate of death especially among the most vulnerable, and costs significantly more money. The premiers and the Martin government had an opportunity to provide strong leadership on this question, but instead we were treated to belligerent premiers insisting that they wanted federal dollars with no strings attached.

British Columbia is one of the most grievous offenders when it comes to Canada Health Act violations, so this issue is an urgent one for us. We got no relief at the summit table on this issue.

We will have to continue fighting on that and other issues, but we did make some significant progress this summer on the health care front. There is more money from Ottawa, which should enable the provinces to re-invest in long-neglected areas of social service. We put pharmacare on the national agenda and it will be hard for Ottawa to remove it. The fact that there was a summit at all is a direct result of our fight to defend Medicare in the first place. We’ve made progress – take a deep breath before the next round.