The election cometh: CMAJ polls the federal parties

CMAJ 2000;163(10):1323

[News & analysis in PDF]

Would you amend the Canada Health Act (CHA)? In what way?

New Democratic Party — We believe that ensuring equal access to health care across Canada requires legislative change in a broader legislative framework. The CHA does not have to be opened up to achieve the legal changes that would allow real innovation and reform of health care. We share Monique Bégin's view that strong laws are required to protect against a parallel, for-profit system. In response to Liberal inaction against Alberta's Bill 11, the NDP proposed a ban on public funds being used to subsidize for-profit hospitals. Every other party in the House of Commons voted against our motion.

Canadian Alliance — Yes, we would amend the CHA to entrench 5-year funding agreements negotiated with the provinces to ensure that the federal government lives up to its responsibility to provide stable, predictable funding. We would also be prepared to work with the provinces if they collectively decided that amending the CHA would lead to better health care for Canadians.

Progressive Conservatives — The Progressive Conservative Party would amend the CHA by adding a sixth principle to medicare: stable and predictable funding for health care. We would guarantee a commitment to stable federal funding through appropriate legislation so that provinces can better plan to meet the health care needs of our growing and aging population. In addition, a Progressive Conservative government would immediately restore the cash portion of the Canada Health and Social Transfer to at least 1993–94 levels.

Liberals — The Liberal Party is committed to upholding the principles of the CHA, which are broad and flexible enough to allow for innovation while building on the strengths of our single-payer system. A national effort to renew and strengthen medicare is presently under way with all provincial and territorial governments. All governments across Canada believe that the status quo is no longer an option. Furthermore, with respect to improving the federal government's enforcement of the CHA, Health Minister Allan Rock recently announced an increase of resources for administering the CHA. An increase of $4 million, which would bring the total resources to $5.5 million a year, will enable Health Canada to be proactive in fulfilling its responsibilities in this area. We are also improving the CHA information system so that we will have the information we need to uphold the principles of medicare.

Alberta and other provinces have experimented with variations on the all-public financing and administration of health care in Canada. As prime minister, would you encourage or discourage more experimentation in this area by the provinces and territories?

New Democratic Party — Canada's NDP supports innovation in health care, but does not confuse innovation with privatization. We do not encourage for-profit "experimentation"; rather, we encourage real reform such as home care and disease-screening programs, such as BC's work on breast cancer detection. The federal Liberals encouraged privatization by deregulating drug approval, encouraging corporate research and helping to spawn Bill 11 in Alberta by agreeing to a 12-point deal with Mr. Klein in 1996. This deal provided historic permission for doctors to practise in both a public and for-profit system concurrently, a key building block for a parallel, private health system.

Canadian Alliance — The goal of all governments must be to provide quality health care at affordable cost. Everyone recognizes that constructive change to the current situation is required. Thus, we would encourage innovation within the parameters of the CHA.

Progressive Conservatives — The Progressive Conservative Party believes that accessible health care is a core value of Canadians. It is too central to our way of life to be held hostage to the political demands of the moment. We believe that we need an approach that will secure the future of health care — a system that respects the principles of the CHA and that will give provinces and the people they serve predictability and stability. Provinces have the know-how and the mechanisms to assess the needs of their populations, to set targets for the mix of services they want to achieve and to set priorities accordingly.

Liberals — The minister of health has been very clear in expressing his opposition to Bill 11 and the direction it takes. We believe that the right direction to take is to reinvest in and support the public system. The Liberal government has profound concerns about the possible implications of Bill 11, since it could lead to violations of the CHA. Consistent with the recommendations of the auditor general, we have increased by more than $4 million our CHA enforcement capacity. We have also been watching the situation in Alberta very closely and will continue to do so. The government of Canada will be there to protect the principles of the CHA if, in practice, any violations do occur — either in Alberta or elsewhere.

What is the federal role in Canadian health care?

New Democratic Party — Partner and protector. Health care was founded on an NDP vision supported by federal and provincial governments. Though the Liberals harmed this partnership, health care is a unique issue in which the federal government has both the right and the responsibility to assert vision. We will continue to fight for new national programs, real national standards and meaningful enforcement of the CHA. Without a national plan and vision, there is no guarantee of equal access for families in all communities and with all incomes. The federal role is made more important by trade agreements. Increased privatization threatens to lose Canada's tenuous NAFTA exemption for health care, which is based on the public provision of health care.

Canadian Alliance — Under Canada's Constitution, provinces are responsible for delivering almost all health care. In addition to its direct responsibility to provide health care to military personnel, the RCMP and federal prisoners, the federal role is therefore to facilitate interprovincial coordination, provide independent information, support provinces through block-funding transfers and equalize provincial disparities to ensure that all Canadians receive quality health care.

Progressive Conservatives — There is a need for a strong federal role in health care. National leadership is vital in this vision of a health system that is prepared to meet the challenges of tomorrow as well as today. While there is a need for an immediate injection of money into the system, it must go hand-in-hand with a clear plan of action that would focus on the ends that we want from our health system, not just the current debate on means, and that will build on the foundation of the core principles of the CHA as well as the many strengths of the system.

Liberals — From a constitutional or legal perspective, the 2 major bases for federal activity in the health field are its spending power and its criminal law power. The federal spending power allows the federal government to have a policy presence in areas where it does not have constitutional power to regulate directly. To date, the government's ability to support the principles of the CHA has rested entirely on its spending power and the conditions it places on its cash grants to the provinces. To maintain public health and safety, the government of Canada also has the authority to use its criminal law power. Thus, for example, federal health-related activities occur through criminal sanctions against unauthorized use of narcotics (the Narcotics Control Act) and the control of hazardous products. Other legal bases for federal intervention with respect to health have been supported by the "peace order and good government" clause in the Constitution, and the federal powers to regulate trade and commerce between provinces. Federal authority extends to entering into agreements on international health care matters and to health concerns of people entering Canada. Also, the federal government has explicit responsibilities for providing health care to Aboriginal peoples, military personnel and veterans, and public servants. Finally, it should be remembered that the federal role in health care includes the licensing and regulation of drugs and medical devices and health research. The government of Canada has nearly doubled its contribution to health research over the past 2 years and officially launched the Canadian Institutes of Health Research (CIHR) on June 7, 2000, revolutionizing the way health research is done in this country. This strong role and commitment to CIHR will allow Canada to keep its best and brightest scientists and remain internationally competitive in today's knowledge-based economy.

What is your vision of medicare for the future? What is the appropriate balance of responsibility between the individual and the state in achieving health?

New Democratic Party — The NDP's vision goes beyond more money and beyond hospitals. While these are crucial, true reform requires a broader approach, including drug- and community-based care, and a plan to stop privatization of both care and research. We believe in encouraging healthy lifestyles, but we also believe that poverty, housing and pollution are health issues not solved by massive tax cuts. By fighting causes of disease — including reversing tobacco tax cuts — we aim to prevent illness before it reaches health professionals' offices. We will fight for a public system that assures equality of access and standards across Canada.

Canadian Alliance — My vision for today is to see a government helping its citizens to achieve better health in addition to caring for those who are ill. In the future our aging society will increase the cost of health care to society. My vision for tomorrow is to arrive at an appropriate division of health care costs between generations, while maintaining our strong tradition of compassion for the sick and needy. Given the demographics of an aging population, more emphasis must be placed on preventive medicine, which places a degree of responsibility on individuals to ensure their wellness.

Progressive Conservatives — My vision is one of a revitalized health care system, one with stable long-term funding and one that provides Canadians coast to coast with a system that is people oriented, empathetic and offers a caring response to human needs. Health care in the new millennium must continue to rest on the twin pillars of access and quality. To achieve those goals we would work with the provinces and health professionals to develop national standards for a Canada-wide health-info system to bring a greater level of accessibility and accountability to the health care system. A Progressive Conservative government would work with the provinces to ensure that new technologies, such as information technologies and telehealth, form part of a modernized health system. In addition, we would encourage the development of a "Wellness Agenda" that stresses health promotion and disease prevention.

Liberals — The first ministers have signed an agreement that is very clear on our vision of health care. Our vision, shared by the provinces and territories, is for quality, publicly funded health care for Canadians, health care that is cost-effective and fair. Our vision includes timely access to an appropriate and integrated range of services for Canadians. The vision means that health care is available to all Canadians, based on their needs and not on their ability to pay. Our vision recognizes that we must report regularly to Canadians on how our health care system is performing. Our vision is for a health care system that is forward looking and that focuses on health promotion and prevention. Our vision confirms all governments' commitment to the principles of the Canada Health Act. And, our vision respects provincial jurisdiction and commits us to working together, cooperatively, to improve health care for Canadians.

Copyright 2000 Canadian Medical Association or its licensors