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Medical Association Journal
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Health care got short shrift in an election about nothing
As the dust settled after the Nov. 27 federal election, many Canadians were left asking, "What was that about?" Some columnists started calling it "the Seinfeld election" because, like that sitcom, it was about "nothing." Prime Minister Jean Chrétien's political opponents charged that it was about power and the Liberals' determination to hang on to it at all costs. Newspaper editors insisted it was about a fundamental clash of political philosophies: traditional Liberal support for government services versus the tax-cutting individualism of the Canadian Alliance. In this sitcom, the Bloc Québécois, New Democrats and Progressive Conservatives had walk-on roles.
Even as far as specific issues were concerned, this was a Seinfeld-type election. Public opinion never gelled around tax cuts, industrial subsidies, welfare reform or government corruption. Although it seemed that finally, in the year 2000, Canadians were ready for a serious debate about how health care should be reformed, the issue never caught fire. There was more excitement about abortion and creationism than about access to MRIs, and candidates probably faced more questions about abortion than about their party's intentions on medicare reform.
The Liberals were never grilled on what had happened to their 1997 promises regarding pharmacare and home care. Instead, we followed an Internet campaign to rename Alliance leader Stockwell Day "Doris" and parallel campaigns to brand him a racist homophobe and Chrétien a crook. It was such a strange election that the name of Barney the Dinosaur came up more often than that of Tommy Douglas, the father of medicare.
Nobody would have predicted this when the election was called. For months Gallup had been asking Canadians what the country's most important problem was, and in the days immediately after the election was called 46% of respondents said health care. One reason for the Liberals' decision to go to the polls only two-thirds of the way into their term was that they had just secured agreement with the provinces on future health reforms in return for restored transfer payments.
Liberal strategists were eager to position the party as the defender of the Canada Health Act. In contrast, the Canadian Alliance intended to portray itself as a party that would put enough money into public sector health care, while being brave enough to consider new delivery models. The Tories and the Bloc both went after Chrétien for massive health funding cuts in the 1995 budget. New Democrat leader Alexa McDonough was equally eager to make this a health care election: for 5 weeks, even when nobody else was talking about health, she scarcely spoke of anything else. No one listened. Why?
In the hurly-burly of the campaign, health care proved too complex for the bumper-sticker style of debate. Despite efforts by groups like the CMA, which created national advertising and Internet campaigns in an attempt to launch a serious debate on health care, the media concentrated on the parties' frat-boy antics.
However, even if there was a Seinfeldesque feel to this campaign, there was also a lot going on beneath the surface. Party strategists and most voters recognized that health care was subliminally crucial in this election. As much as anything, the Liberal–Alliance clash was about federalism versus devolution. The Liberals are adamant that the feds have a role to play in providing health care and that Ottawa should continue as guarantor of the 5 principles of the Canada Health Act. An Alliance government would recognize the provinces' primary responsibility for delivering health care and curtail Ottawa's policing powers.
Alliance-type medicare would look very different from the Liberal version. Liberals are still open to the idea of new programs, even if their plans for home care and pharmacare ran aground. The Alliance would leave any such initiatives to provinces and to provincial budgets.
The Liberal victory put the public health care system back on life support as a national program. But now that the battle of the sound bites is over, the government can no longer duck the public–private debate as it managed to do after its 2 previous victories. The system needs structural reform. What solutions are available? What would the introduction of nurse practitioners, the delisting of some services, the privatization of particular institutions and reliance on copayments and user fees actually involve? Which of these alternatives might strengthen public health services? Which would undermine them?
None of these questions was answered in an election in which the voter turnout of 62.8% was the lowest since Confederation. With this type of campaigning, it is a record made to be broken. — Charlotte Gray, Ottawa
Copyright 2001 Canadian Medical Association or its licensors |
