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Tom Mulcair: Complaint for a health system

Justin Trudeau has thrown in the towel in the fight to maintain the role of the federal government as the guardian of a public, universal, accessible and equitable health care system in Canada. This could have tragic consequences for people on the lower rungs of the social and economic ladder.

It could also harm Canadian unity, as another key feature of our health care system, portability from province to province, could also be swept away with impunity.

Let’s start with a confession: something had to change.

Tony Blair was right, there are only two categories in public administration: things that work and things that don’t. The corollary is: if what you’re doing isn’t working, then try something else.

This is the territory we find ourselves in right now. A health system where being put on a waiting list is often the only thing they can offer you.

Canadians have always been seduced by our medicare system. After all, it gave us something to brag about to our “heartless” American cousins…

I come from a very large family of ten children. My parents were both very hard working, but doctors bills were a reality that I remember them talking about. It was expensive.


When Medicare was announced, it was a relief for families like ours. In Saskatchewan, Tommy Douglas won his last election on the promise of medicare, based on prepayment, universal coverage, quality service and government administration.

Douglas himself had needed major medical attention as a child. While he was grateful to the doctor who cared for him despite his parents’ inability to pay, he wanted to ensure that health care would be available for the children, regardless of their parents’ financial situation. parents.

Saskatchewan’s CCF (precursor to the NDP) government faced a major hurdle as soon as the plan was enacted. The College of Physicians and Surgeons is organizing a doctors’ strike. Equally determined, the government brought in doctors from Britain and the United States to work under the new system. Before long, Saskatchewan doctors were back to work and accommodations were negotiated. The first health insurance system in North America was now in place. Public interest had triumphed over private profit.

A decade later, the Douglas model was introduced across Canada, thanks to an agreement between the federal government and the provinces. Unfortunately, since that time, accessibility has become a major problem that has proven extremely difficult to solve.

The original agreement provided for a 50-50 cost sharing between the federal government and the provinces.


Today it’s closer to 75-25, with the provinces paying the lion’s share. The provinces were to bring the federal government to 35%.

That’s why this week’s federal proposal is so disappointing.

What should have been $28 billion this year alone will actually be less than $5 billion. Despite fictitious figures of nearly $200 billion provided by Ottawa, the feds are only offering $4.62 billion a year for ten years.

The Ottawa press release was a masterpiece of obfuscation. Columns of characters made up in pancakes. They even tried to include pandemic-related expenses in Ottawa’s contribution!

As with the very first medicare accord, the provinces ceded some of their exclusive jurisdiction over health care. They agreed to the eminently reasonable federal request to provide transparent and objective information on things like wait times and coverage. Prime ministers rightly viewed it as essentially money with no new strings attached.

On the positive side, for the first time in decades, we seem to have been able to move beyond discussions of modalities to focus on measurable results. Results.

The problem is that with the paltry sums offered, there is little hope of real change that will save the essential qualities of the system. The pressure for greater privatization has thus set in, it must now be controlled in the public interest, but by whom?

The prime ministers seem to have read the room correctly. People don’t want fights, they want access and reduced waiting lists. Federal Health Minister Jean-Yves Duclos even channeled Pierre Poilievre over the weekend by saying the system was down. On Monday, Trudeau echoed the fact that, while avoiding his minister’s “broken” phrasing, he said Canada’s health care system just wasn’t working.

If Ottawa recognizes that this key Canadian institution is not working, why are they still refusing to honor the original agreement and pay their fair share? Is it because they have bought into the mantra that more competition, i.e. private for-profit care, is a panacea that will solve everything one way or another? !


In Canada, we seem to have a penchant for two-tier government services. When the provinces subsidize what are supposed to be private schools, workers end up seeing their taxes pay for the “private” education of the wealthiest families.

Public funds for a private service. As the public system has more and more problems, parents are sacrificing a lot to enroll their children in private schools. A vicious downward spiral in the results of the public school system.

That is the biggest fear as we talk about transferring some of the responsibility for health care delivery to the private sector.

Doug Ford sincerely believes that he will improve health care by contracting out some of the most repetitive work to private clinics. It is hoped that the economies of scale will reduce wait times and allow a decent profit, while reducing government costs. Not a safe bet but has become almost unavoidable in view of the underperformance of the public distribution system.

Amazingly, Ford’s privatization proposal, which would have been anathema to Mr. Trudeau just a year ago, which the Prime Minister now blithely describes as “innovative.”

The promises of only needing “a health insurance card, not a credit card” go no further. The real fear is that there will be two systems: one accessible to those with a little money and one for the less fortunate.

These clinics will have to be strictly regulated.

Private owners cannot be allowed to select the best patients, to better claim superior results. Smoking? Obese? Underlying condition? Sorry, you will have to switch to the public system.

The single payer will remain the government, which must therefore also remain the one-stop shop for sending patients to these private clinics. Otherwise, the toughest patients will be sent back to the public system, which will, once again, be singled out as being too expensive and inefficient.

The necessary authorization, inspection and accreditation fees must be borne by the private clinics. Unlike the tragic neglect that has led to the multiple horrors in nursing homes during the pandemic, provinces and territories will actually have to learn to apply the standards to private providers.

We have a strong emotional attachment to our medicare system because it is so egalitarian. If only. Unfortunately, it has become equally mediocre in too many areas. A good feeling is no substitute for timely treatment. Political dogma does no one a favour. We have reached an inflection point, let’s prepare for it and deal with it properly in the public interest.

When I hear politicians say that if we finally introduce drug insurance, it has to be purely public, we are in an ideological field. Quebec has, by far, the most comprehensive prescription drug coverage in Canada. It is a hybrid model where private insurance and public insurance coexist side by side. That works.

Doctrinal purity, based on an entirely theoretical model, cannot compare to a real positive result.

The same goes for health care. Like many progressives, I have fought the good fight throughout my career. Fight against the incursions of the corsairs! But if we recognize that the current model cannot be fixed, at least not at a cost that can be borne by the provinces, then we have to adapt, but we also have to get it right.

When what you’re doing isn’t working, try something else…but do it with your eyes wide open, ensuring that protecting the public is the only value guiding any private addition to the system.

Canadians deserve the best health care. Let’s see how to deliver it in fact, not in theory. It was to start with the return of an appropriate federal contribution. Now that that’s off the table, it’s time to find a cure for our once vaunted healthcare system that doesn’t kill the patient.

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