Enclosed is the text of a letter sent by
Prime Minister Jean Chrétien
to Premiers and Government Leaders

January 23, 2003
Ottawa, Ontario

Dear Premier:

I thought it would be useful as we prepare for the First Ministers’ Meeting on February 4-5, in Ottawa, to set out my perspective on what we must accomplish together.

In September 2000, all First Ministers agreed on a vision, principles and action plan for health care renewal. All governments have made significant new investments in health care since then to improve access to quality health care services in an accountable and sustainable public health care system. Real progress has been made.

Since we last met, a number of important reports have been issued including Romanow, Kirby, Clair, Fyke, Mazankowski. I am struck by the similarities in their recommendations on the priorities for reform, particularly a consensus in the areas of primary health care, home care, catastrophic drug coverage, access to diagnostic/medical equipment, and information technology and electronic health records. These reports see these initiatives - which build on the September 2000 Agreement - as an integral part of our overall health care system and as fundamental to ensure the sustainability of health care for Canadians for the years to come.

There is agreement that while new money is essential, money alone will not solve the problems of our public health care system. Money must buy meaningful change so that Canadians can have timely access to quality health services now and in the future.

Health care renewal is the single most important priority of the Government of Canada and of Canadians. It will require substantial new investments from both levels of government. The Government of Canada will do its part. But you and I both know that Canadians and their governments have to balance other priorities as well that require additional financing and which cannot be ignored.

We must also manage our affairs in such a way as not to put at risk the hard won fiscal achievements and structural reforms of the past decade. We all must recognize that we have fewer resources than we have demands on our systems. None of us should create unrealistic expectations about the amount of new money that governments can allocate to health care or other important priorities. Having said this, we can devote a significant amount to health reform. Indeed, we can devote enough to make a real difference - enough to achieve fundamental reform, higher quality care, more timely access and sustainability.

Canadians expect new investments to produce better outcomes. They also expect transparency and accountability for the many billions of dollars all governments invest in health care. That is something we must deliver.

I am sure that you will agree with me that our electors want to see the Prime Minister and the Premiers working together in partnership rather than trying to score political points against one another. Canadians want us to agree on a way forward on health care renewal - a way that we began to develop in September 2000, and which has been highlighted by the various Task Forces, studies and Commissions of Inquiry which have reported since then. Canadians want an agreement on a collaborative partnership amongst governments, not a "deal" or a "compromise" where the press speculate on political winners and losers. An agreement on a collaborative partnership will strengthen public confidence in the political process, and most importantly in the health care system. A "deal" or "compromise" with winners and losers only adds to cynicism about the political process and does nothing for health care reform. Therefore, all of us as First Ministers have a responsibility to be very careful about our public statements in the next two weeks. We have to be careful about the expectations we create. I have always been of the belief that underselling and outperforming is the best approach to public policy. It is particularly important in health care renewal.

My colleague, Anne McLellan, Minister of Health, yesterday circulated to all health Ministers a draft of an accord which I hope all First Ministers will be able to agree to on February 5.

I believe the text captures the principal recommendations on which there has been convergence in the Reports and Studies and Task Forces which have reported over the last two years. It incorporates the views of stakeholders and the Canadian public. It builds on the good work of our health Ministers and finds its foundation in the September 2000 Agreement of First Ministers. It re-affirms our collective commitment to the five principles of public medicare in Canada and sets out an action plan for fundamental health care renewal and reform. It includes new financing and enhanced accountability provisions. Based on the consensus among experts reflected in the various reports, I am persuaded that these reforms will help us to manage overall cost pressures on the health care system. If we can agree to this plan, I am certain Canadians will be well served.

Agreement by all First Ministers to the plan for health care renewal will mean a substantially increased federal investment for health in a sustainable and predictable way over the next five years and beyond, the details of which I will put on the table when we meet.

I look forward to our meeting in two weeks. If you have comments or suggestions, in the meantime, it would be most productive if you could call me directly.

Yours sincerely,

[Original signed by the Right Honourable Jean Chrétien]