|
"Starting 2003 with a good plan for health care"
Notes for an address
by the Honourable Stéphane Dion
President of the Privy Council and
Minister of Intergovernmental Affairs
Faculty of Law
University of Victoria
Victoria, British Columbia
January 22, 2003
Check against delivery
From a federal-provincial relations viewpoint, the year 2003 is starting off
at a lively pace. The Prime Minister of Canada, the Right Honourable Jean
Chrétien, will meet with his provincial and territorial colleagues on February
4 and 5 to agree on an action plan, with increased funding, to improve health
care in Canada . It will be a very important meeting, because we all know how
much Canadians want more accessible, higher-quality health care.
Our governments need to come to an agreement. Not counting today, there are
12 days left to properly prepare that meeting. Yesterday, the federal Health
Minister, the
Honourable Anne McLellan, gave a speech in Ottawa in which she set out
the objectives the Government of Canada hopes to achieve together with the
provinces and territories. Also yesterday, I had an excellent meeting with my
counterpart from British Columbia, the Honourable Greg Halsey-Brandt.
Tomorrow, premiers and territorial leaders are meeting in Toronto. These
preparations will continue intensively until February 4.
I would like to explain the four reasons why I am optimistic about this
First Ministers’ Meeting, and why I anticipate Canadians will be
satisfied with the work of their government leaders.
1. Our first ministers agree on making health their priority
Our first ministers all know that enhancing health care is the priority of
the hour, the main concern of Canadians. Our first ministers know that
solidarity in the face of illness is a sacred value for Canadians and that
access to high-quality care is an essential dimension of their quality of life.
Our first ministers have seen the overcrowded emergency wards and are aware of
the long waiting lists for operations. I am sure they find it unacceptable that
here in Canada, sick people are lined up in hallways rather than having the
privacy their condition requires. Also, with Canadians’ greater welfare in
mind, they will reach a fruitful agreement on February 5.
2. Our governments agree on respecting the principles of the Canada
Health Act
Regarding Canadians’ right to accessible health care, I detect a
philosophical consensus among our first ministers, and this, in spite of their
ideological differences. They all say they support the five principles set out
in the Canada Health Act: public administration, comprehensiveness,
universality, portability, and accessibility. As Premier Gordon Campbell said on
January 25, 2002, in his capacity as chair of the Provincial-Territorial
Premiers’ Meeting: "We are all committed to the Canada Health Act."
Moreover, our governments agreed in April 2002 on a mechanism to prevent
and resolve disputes which could result from the interpretation of the
principles of the Canada Health Act. To be sure, that philosophical
consensus does not prevent our governments from having different viewpoints. But
I am convinced they all support the principle of justice whereby access to
health care in Canada ought not to depend on the size of the patient’s wallet.
3. The federal government has some financial flexibility
The third reason for my optimism is the crux of the matter: money. For you
know the good news: the Government of Canada has sufficient flexibility to
inject more funding, notably because of the exceptional performance of the
Canadian economy, which grew by 3.5% in 2002, whereas private-sector economists
instead forecast a 1.1% growth. Imagine how different things would be if our
first ministers were set to meet in a few weeks’ time to talk about federal
budget cuts, rather than reinvestments. Let’s not forget that elsewhere in the
industrialized world, in the United States, Europe, Japan, national governments
are facing major deficits.
Of course, when it is a question of money, agreements are rarely reached
easily. At the meeting of finance ministers last December 17 and 18, the
provincial ministers reiterated their desire for a major federal reinvestment in
health to the tune of $24.7 billion over the next four years. That amount is
$4.6 billion (or 30.7%) more than the increase suggested in the Romanow Report
for the period 2003-2004 to 2005-2006. Federal Finance Minister John Manley
has clearly repeated on numerous occasions that it will be very difficult for
him to find such an amount, because even though health is the priority, other
legitimate and pressing needs also require additional spending. In addition, Mr.
Manley has stressed the need to respect the Government of Canada’s financial
framework and to take into account the uncertainties of the international
situation.
If the economies of the United States, Europe and Japan were growing at a
rate as impressive as ours, if they were creating jobs at the same rate we are,
rather than showing signs of weakness, and if the governments of those countries
were running surpluses comparable to ours, rather than grappling with
substantial deficits, Mr. Manley would certainly be looking to the next budget
year with greater optimism. But in light of such an uncertain international
situation, all Canadians can congratulate him on his prudence. I am sure the
premiers and territorial leaders are aware of that.
4. Our governments have everything they need to reach agreement on the
objectives for reform
Acquired experience is the fourth consideration that justifies my optimism.
Our governments have already been there: they concluded an agreement on health
at the First Ministers’ Meeting in September 2000. In the months
leading up to that agreement, the provincial and territorial governments were
calling for increased funding from the federal government, which, for its part,
wanted that funding to be accompanied by a plan for change. No money, no plan,
repeated the provinces; no plan, no money, replied the Government of Canada.
Finally, we got both: an action plan that has yielded excellent results and $21
billion in increased federal funding over five years, including $1 billion in
funding for medical equipment and a further $800 million in funding for
transition costs involved in implementing major primary health care initiatives.
Since the agreement in 2000, our country’s health ministers have met on
several occasions to ensure implementation of that plan. They have also worked
hard to develop performance indicators so as to make government actions more
effective, transparent and accountable to the public. Several governments have
commissioned studies, such as the Fyke Report and the Romanow Report, to
guide them in their reforms. The conclusions of those reports are fairly
convergent. It is possible to build on these achievements to reach a new
agreement among our first ministers by February 5.
It is in building on all of these joint achievements that Minister Anne
McLellan has identified a number of key areas of reform the Government of Canada
wants to invest in specifically. Ms. McLellan has strongly insisted on the
need to develop an action plan tailored to the situation of each province and
territory, which will give them the flexibility they need in terms of
implementation. She said she wants to assist the provinces in attaining shared
objectives and help them be accountable for them to the public.
In fact, the provincial and territorial governments are pursuing objectives
which correspond to the six core elements that Ms. McLellan set out
yesterday and which must be the focus of health care reform.
The main points of Ms. McLellan’s announcement yesterday can be summarized
as follows:
-
primary health care - ensuring that 50% of Canadians are under the care
of multi-disciplinary health care organizations within the next five
years;
-
home care - providing coverage for a core set of home care services;
-
pharmaceuticals/catastrophic drug coverage - ensuring that no Canadian
should have to face undue financial hardship for needed drug therapy;
-
diagnostic/medical equipment - addressing the shortage of
medical/diagnostic equipment;
-
health human resources - our health ministers must continue to work
together to better plan, train and ensure the supply of health care
providers across the country; and
-
information technology - advancing the use of electronic health records
and telehealth, particularly for rural and remote communities.
As well, all governments agree on strengthening their public accountability.
For the first time, in September 2002, health ministers of the 14 governments,
including the Government of Canada, simultaneously released a report to their
constituents on a set of jointly defined performance indicators. Some of those
indicators are well developed and can already be put to use; others are still
being prepared and need refining. More needs to be done to enhance the scope,
comprehensiveness and quality of the indicators and the reports. I am sure the
next agreement by first ministers will further strengthen that cooperation.
I am encouraged by the initial reaction of some provincial governments to
Ms. McLellan’s speech, particularly on the subject of the flexible
approach she intends to develop. In his own inimitable style, Alberta’s
Premier Klein is quoted in today’s National Post as saying:
"... if someone gave you the money and said you can do what you
want with the money, but you have to spend it in a particular area’, in other
words a home improvement’, I would say yes".
I also completely share the assessment made by the New Brunswick Minister of
Health, Elvy Robichaud, also quoted in today’s National Post:
"We are not far apart and I think when the Prime Minister and premiers
meet, we will be able to reach an agreement".
Conclusion
Total health spending (private and public) in Canada was $112 billion in
2002, according to the latest report by the Canadian Institute for Health
Information, released last December 18.1 That
represents 9.8% of our GDP, one of the highest percentages of all countries.
That is a lot of money. Additional federal funding will have an impact only if
it helps to fund reforms that will have structuring effects. Improving our
health system is not just a question of money. We need clear objectives.
Fortunately, our governments have everything in hand to reach agreement on
setting those objectives. First, they have the will to succeed, because they all
know how much of a priority health is for Canadians. Second, they agree on a
fundamental philosophical orientation, because they all support the five
principles of the Canada Health Act. Third, the financial flexibility to
reinvest in health care is there, even if it is not as substantial as we would
like.
Finally, our governments have strengthened their partnership following the
September 2000 agreement on health care. Primary care reform, home care,
accessible catastrophic drug coverage for all Canadians, improved access to
medical/diagnostic equipment and services, strengthening health human resources
planning and management, better use of information technology to improve care:
these objectives were identified yesterday by the federal Health Minister and
are shared by all her counterparts.
At his press conference at the beginning of the year, on January15,
Prime Minister Chrétien stated: "Health care and the
preparation of a successful first ministers meeting is a top priority for me. I
will work cooperatively and in partnership with other first ministers. I expect
the same cooperation and partnership from them. Canadians deserve no less. This
is the time for action, not for rhetoric."
For the four reasons I have just set out, I am convinced that those wise
words by the Prime Minister of Canada will be echoed favourably by his
provincial and territorial counterparts.
-
Canadian Institute for Health Information, National Health Expenditure
Trends, 1975-2002, summary report released December 18, 2002, p. 2.
|
