Does Rock's arrival at Health Canada signal growing importance for portfolio?
Charlotte Gray
CMAJ 1997;157:439-40
[ en bref ]
Charlotte Gray is a CMAJ contributing editor.
© 1997 Charlotte Gray
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In brief
The appointment of Allan Rock as health minister caught many observers by surprise because some considered Health a step down from the powerful Justice portfolio. Not so, says Charlotte Gray, who predicts the health department will be a good-news ministry because the Liberals will push some newly available resources into it.
En bref
La nomination d'Allan Rock au portefeuille de la Santé a surpris beaucoup d'observateurs parce que certains considéraient la Santé comme un recul après le puissant portefeuille de la Justice. Ce n'est pas le cas, affirme Charlotte Gray, qui prédit que le ministère de la Santé sera un ministère «des bonnes nouvelles» parce que les Libéraux y affecteront de nouvelles ressources qui viennent d'être dégagées.
Allan Rock knows what it's like to face an angry mob. Catapulted straight into cabinet when he first arrived in Parliament in 1993, he was responsible for introducing Ottawa's new controls on gun ownership. Polls said most Canadians backed the government's decision, but this majority never showed up at the public meetings where Canada's justice minister tried to explain what he was doing.
Instead, Rock faced the rage of rural gun owners, urban vigilantes and Canadian members of the US-based National Rifle Association. He was often booed so loudly that he could not make himself heard. After a Toronto meeting, his car was surrounded by angry critics and police had to be called.
Gun control was one of the most contentious issues Rock dealt with in his first cabinet job -- it cost the Chrétien government many votes in Western Canada -- but there were plenty of other fires to fight at the justice department. Many were mishandled, by both the government and the department, and put the Liberals in an unfavourable light. There was Brian Mulroney's lawsuit arising from the Airbus affair, dropped last January, as well as cancellation of the Pearson Airport deal and accusations that officials from Justice interfered in the pursuit of Nazi war criminals. Rock was on his feet many times during Question Period, defending the government's record in the face of angry Reform MPs. He met the same response when he tried to introduce legislative initiatives such as same-sex benefits.
The strain began to show on the 49-year old Toronto lawyer, who had not encountered such political thuggery in his previous job as treasurer and chief executive officer with the Law Society of Upper Canada. His boyish enthusiasm dimmed and there was talk that he would return to Toronto.
And now, he's our new health minister. His June appointment came as a surprise. Everyone knew that he wanted to get out of Justice, but during the last Liberal mandate running the health portfolio was not seen as a significant job. Neither of the ministers who held the job were impressive. Diane Marleau was regularly beaten up by the provinces and the finance department. David Dingwall, a much more combative character, did not have the subtlety to handle delicate relations with the provinces. The result: the department never had a powerful voice at the cabinet table. The clearest indication of its weakness was the way it had to swallow the rollback on tobacco taxes in 1995 as Ottawa tried to combat smuggling.
By the time Chrétien called the 1997 election, however, health care had become a priority for the Liberals. Party policymakers, seizing recommendations from the National Forum on Health, pledged an end to the cuts in provincial transfers and promised pharmacare and home-care programs. You didn't need a soothsayer to foresee that Health would be a good-news portfolio in the next government, or that plenty of potential cabinet ministers would have welcomed an opportunity to fill it.
Rock's appointment came as a surprise because he had never been mentioned as a candidate. Health care did not seem quite big enough for a former justice minister, who sits on more committees and is involved in broader issues than the health minister. And since Rock is often rumoured to be a candidate to replace Chrétien as Liberal leader, it was assumed he might look for an economic portfolio in which he could demonstrate hard-headed fiscal wisdom. Around Ottawa, Rock is regarded as a leading member of the Class of '93, the new faces who arrived in Ottawa during the 1993 Liberal sweep.
Like many members of that generation he is fiscally conservative and socially progressive. He may have established his progressive credentials a little too well at Justice, and needed a chance to round out his résumé. "He had a good stay in Justice and I felt he needed a change and he wanted a change," the prime minister explained at the swearing-in ceremony for the new cabinet. "Health is a very important and high-profile job."
The appointment triggered a mixed reaction, with the CMA among the groups praising Chrétien's selection. "He's a strong minister," President Judith Kazimirski told the Toronto Star, "and I think this signals that health is a top government priority." The Ottawa Sun, meanwhile, marked his departure from Justice with the headline: "So long, and good riddance."
Within the government, Rock is considered a highly intelligent minister who works hard and has learned a lot in a difficult job. During his early days at Justice he was frequently embroiled in too many issues and failed to establish a clear focus. Colleagues say he has a good grasp of the importance of health in interprovincial relations, and will not take the bare-knuckle, over-my-dead-body approach adopted by predecessor David Dingwall when Alberta indicated it might approve a private hospital.
He is also credible when he insists that he will fight for medicare at the cabinet table. Given that Finance Minister Paul Martin is also a born-again defender of health care and budget surpluses appear to be on the horizon, Rock should have an easier time than his predecessors wresting money for health care from his cabinet colleagues.
But will Rock be able to establish the new programs promised by the Liberals? Will he be able to design a pharmacare and home-care program that the provinces will support? These are enormous challenges. Both initiatives would see the bills divvied up between the 2 levels of government. The first hurdle will be the negotiations required to design a formula covering who pays for what. The second is whether have-not provinces will be able to take on any additional spending.
Newfoundland and New Brunswick are already struggling to fund services that reach the standards defined by the Canada Health Act, and are unlikely to embrace new programs in which it would be difficult to control costs. Ottawa has yet to develop any policy proposals to flesh out the promises behind these new programs. If Rock wants to make the health department a good-news job, he will have to work fast. And he will have to do it while mounting tension is affecting federal-provincial relations as the next Quebec referendum approaches.
"I feel a great sense of responsibility taking on this job," Rock said within hours of his appointment. One of the first issues he is likely to deal with is a request from provincial ministers to review medicare and redefine "medically necessary services." Many analysts consider this request, led by Alberta, the first step toward a two-tier system. It would lead to a list of "core" services that must be provided within the public sector and a list of "optional" services for which patients might pay the cost. Provinces also want a new enforcement mechanism, in which Ottawa will lose its unilateral power to police medicare and enforce the Canada Health Act.
During its first mandate, the Chrétien government redefined Liberalism. The economy's dire straits forced it to roll back many government initiatives in culture, regional development and public services that had been pursued by both the Trudeau and Mulroney governments. It retreated to the Liberalism of the Mackenzie King era, in which Ottawa provided help only to those facing catastrophic circumstances. Now that the deficit is almost eliminated, it wants to use its second mandate to demonstrate that Liberals still believe that some services, particularly health care, are best provided within the public sector.
Allan Rock's job during the next 4 years, then, will be to reaffirm some basic Liberal values.
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