Putting Money Where Her Mouth Is

Recently, Health Minister Jane Philpott informed the province of Quebec that she intended to enforce the Canada Health Act. Tom Walkom writes:

The Canada Health Act is the federal statute governing medicare. It lists the standards provinces must meet if they are to receive money from Ottawa for health care. And it gives the federal government the right to cut transfers to any province that doesn’t meet these standards.

In particular, it imposes a duty on the federal health minister to financially penalize any province that allows physicians operating within medicare to bill patients for extra, out-of-pocket fees.

However, the federal government has only rarely penalized provinces which allowed extra billing:

Compared to the billions the federal government spent on health transfers over the period, these penalties were pittances. But they did make the point that medicare is indeed a national program.

And in every province except B.C., where the issue has morphed into a constitutional court case, the extra-billing problem was apparently resolved.

There, Dr. Brian Day has launched a court case, claiming that extra billing is a practice that is protected under the Charter of Rights and Freedoms. If the case succeeds, medicare -- as a defining Canadian institution -- will be finished. Someone has to meet the challenge head on. That task has fallen to Philpott.

But it's imperative that Justin Trudeau stand behind her by providing the money to defend medicare. Originally, medicare was a 50/50 proposition. Half of the costs were to be born by the provinces and half by the federal government. In 2013, CUPE released a report on Healthcare spending. The fifty-fifty split was ancient history. According to the report,

the federal government covers only one fifth of provincial health spending, where it used to cover half – and it wants to scale back further. The 2004–2014 Health Accord provided stable funding after deep cuts in the 1990s. It has brought the federal government’s cash share of provincial health spending up to 20 per cent1 from a low of 10 per cent in 19982 and part way to its original 50 per cent share. The current federal government wants to reverse this progress. 

The "current federal government," of course, was the Harper government. When Stephen Harper headed the National Citizens Coalition he advocated dismantling medicare. These days, Dr. Day has taken Harper's place.

Minister Philpott has signalled that the line has been drawn. But, if she is to succeed, the prime minister is going to have to put money where her mouth is.

Image: The Canadian Press