Health care among forgotten issues in forgettable federal election
Charlotte Gray
CMAJ 1997;157:57-8
[ en bref ]
Charlotte Gray is a CMAJ contributing editor
© 1997 Charlotte Gray
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In brief
The recent federal election evoked little more than yawns among Canadians. Health care had been expected to take centre stage during the campaign, but this never happened. Instead, the politicians concentrated on national unity. However, the returning Liberal government did draw a line in the sand as far as health care funding is concerned.
En bref
Les récentes élections fédérales n'ont guère su tirer plus que des baillements aux Canadiens. On s'attendait à ce que les soins de santé occupent l'avant-scène scène pendant la campagne, mais cela ne s'est jamais produit. Les politiciens se sont plutôt attardés à la question de l'unité nationale. Le gouvernement fédéral s'est malgré tout engagé à verser un minimum de financement aux soins de santé.
As the dust settled after the Liberal's narrow win in the June 2 federal election, party policymakers must have shaken their heads in disbelief. When they wrote their election manifestos a few weeks earlier, they knew that voters' number-two concern, after job creation, was medicare. According to a CMA poll, 56% of Canadians expected health care in their province to deteriorate. Canadians were worried that universal health care was threatened by provincial cuts, and they wanted the federal government to ensure its survival. Yet during the 5-week campaign, health care never emerged as an issue that could sway voters -- despite strong efforts by organizations such as the CMA to focus on it.
This was puzzling, because party leaders all wanted to own the issue when the writ was dropped. From the start, Prime Minister Jean Chrétien presented himself as the defender of medicare. The Liberals' first campaign announcement was a promise to halt further scheduled cuts in transfer payments to the provinces for health care. It meant Ottawa will pay the provinces $6 billion more than budgeted over the next 5 years for social programs.
Yet the disdain with which this announcement was treated, both in the media and by the opposition parties, gave a taste of how quickly medicare had become yesterday's flavour. The promise was a one-day wonder which didn't even attract major press coverage. The other parties rushed to point out that the provinces will still be getting nearly $7 billion less annually in federal funding for social programs than they did 4 years ago.
Reform leader Preston Manning, no slouch when it comes to manufacturing sound bites, called Finance Minister Paul Martin "the Dr. Kevorkian of Canadian health care" and told a Calgary audience that "more damage has been done to the medicare system by the federal government, particularly the finance minister, than by anybody else." The Liberals' other major health-related promise, for a national pharmacare program, never attracted any attention.
However, the Liberals' $6-billion promise smothered the entire issue for the rest of the campaign, since all parties now agreed that there should be no more cuts to medicare. All that was left was a competition to determine who would put the most money back in the pot. The New Democrats easily won that race with a pledge to pump $15 billion annually back into transfers, but no one took the pledge seriously because the only race the NDP were in was for official party status. Since they wouldn't have to govern, the NDP could have promised $150 billion.
Tories and Reformers were left to snarl about Liberal cuts made since 1993 and to defend themselves from accusations that they would permit a two-tier health care system. On this point, the Liberals went after Preston Manning with a vengeance in the West, where Reform began to gather strength mid-campaign. Reform has always attracted more men than women, and the Liberals knew that universal health care is particularly important to female voters. In a direct appeal to women and seniors, they broadcast a series of ads in the western provinces that quoted Manning saying he would experiment with user fees, deductibles and private delivery of health care services.
Even if they weren't debated during the 36-day campaign, everybody involved in health care knows that important questions remain about the medicare system. Since health care falls under provincial jurisdiction, Ottawa can only provide leadership and seed money for new initiatives. It cannot act unilaterally on either the pharmacare program that has been proposed or the national home-care program the NDP wants.
The area where Canadians tell pollsters they want Ottawa to stand firm is the enforcement of national standards. The Liberals showed they were determined to enforce the Canada Health Act (CHA) in 1996 when they reduced Alberta's transfer funds until the province stopped letting doctors charge user fees. But how aggressively will Ottawa pursue this policy, at the risk of antagonizing Ralph Klein's government? During the election, then federal Health Minister David Dingwall warned he would penalize Alberta again if it allowed a new private hospital to operate in Calgary.
This tough-guy stance didn't go down well with either Klein or Dingwall's colleagues because Ottawa simply cannot afford too many battles with the West, particularly after the losses the Liberals suffered there June 2. The most lasting effect of Dingwall's braggadocio was the guarantee that he would not be returned to the health portfolio, but that point became moot when he was trounced in his Nova Scotia seat.
The Reform Party manifesto spoke more about respecting provincial jurisdiction in health care than on trying to achieve national standards. "We would respond to what the provinces would wish in terms of any amendments to the health care act," Manning remarked. Although reopening the CHA would inevitably mean the fragmentation of medicare, he evaded any debate about the impact of this promise.
The only fresh idea on enforcement of the 5 principles enshrined in the CHA came in the Progressive Conservative's election manifesto, Let The Future Begin. The Tories said they would try to convince provinces to enter a "Canadian covenant" in which provinces would commit to agreed national standards in return for the transfer of all the tax points for health care funding from Ottawa. But Jean Charest never managed to explain this concept in a way that caught the public's imagination. Certain political phrases have what New York Times columnist Russell Baker calls a MEGO effect -- "My Eyes Glaze Over" -- and "Canadian covenant" is a MEGO phrase par excellence.
So health care never emerged as a major issue in the campaign, although some argue that the election itself had a MEGO effect. In 1997, it appeared people had more important things to worry about than federal politics.
By campaign end, national unity had emerged as the major issue. It was an albatross for the governing party and a potential vote getter for 2 regional parties, Reform in the West and the Bloc Québécois in Quebec. Chrétien had to defend himself on both flanks: the Bloc accused him of being antidemocratic, when he suggested that a simple majority for the Yes side would not be a wide enough margin in the next referendum, and the Reformers accused him of being too sympathetic to Quebec's concerns, at the expense of the West.
Manning's 1993 vow to stop letting Quebec dominate the national agenda had completely dissolved by 1997, for as the election approached the Reform leader realized that the only way he could galvanize Western alienation was to raise the spectre of more concessions to Quebec by French-speaking federal politicians. It was a successful strategy in that it allowed Reform to win enough seats to form the Official Opposition, but it was unsuccessful in that it once more kept Reform shut out of Ontario. Manning did not make the hoped-for inroads in Central Canada that would allow Reform to become more than a regional party.
In the immediate aftermath of the vote, the Canadian punditocracy was busy analysing what the vote means for Canada's political future. Most voters no longer cared, for several other events had touched them deeply. They included the cross-country outpouring of sympathy for victims of the Manitoba flood, the final broadcast of CBC Radio's Morningside with Peter Gzowski, the opening of Confederation Bridge (the "Span of Green Gables") to Prince Edward Island and the 150-m race between Donovan Bailey and Michael Johnson. At least 1 of these events triggered damp eyes or a momentary gasp in most Canadians, and none had a thing to do with politics.
The candidates handing out leaflets and making speeches until they were hoarse evoked a much sourer reaction. Voters wondered why we were having an election only 3 years after the last one, and what difference would it make when the result seemed to be a foregone conclusion.
In the end, however, the election has drawn a line in the sand as far as health care in concerned. Party leaders, federal and provincial, may continue to duck and weave on fundamental issues such as what Canadians can expect from our national health care system and how it might be reformed without being damaged, but the health care budget itself is now untouchable.
The deep cuts Paul Martin made in the Liberals' first mandate have come to an end, even if their impact continues to ripple through the system. With their new mandate, the Liberals will desperately try to rebuild confidence in their ability to protect a government program that remains more precious to more Canadians than Morningside, Donovan Bailey or Anne of Green Gables put together.
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