In arriving at this deal both levels of government hoped to deflect criticism that they have mismanaged and underfunded the health care system. This is especially important for the governing Liberals, for whom this will be a key election issue (page 1029). But we should have no illusions: the transfer of money from our federal left pocket to our (largely) right provincial and territorial pockets will have little effect on the underlying problems facing medicare in this country.² The injection of cash is a political solution to a political problem.

Health care professionals and patients have seen the problems with our health care system up close. Bed shortages, emergency room crises, delays in introducing new technology and impossible demands on home care and long-term institutional care have become all too familiar since the mid-1980s, when the Conservatives, and then the Liberals, curbed transfer payments to the provinces.³ In the presence of an oppressive debt and under political pressure to deal with the deficit, the federal government had little choice but to slash its largest source of expenditures: health care. The provinces and territories, in the same situation, had no room to manoeuvre around the shortfall in federal funding. It is a credit to patients, health care professionals and health care managers that the system survived.

And, almost inadvertently, it may have even been strengthened. Hospitals, which suffered the bulk of the cutbacks, have had to seek alliances with community physicians, home care programs and other community resources. The barriers between different levels of care have started to come down, to the benefit of patients and health care professionals.