The Prime Minister's Response to the Premiers and Government Leaders on Health Care

March 7, 2000
Ottawa, Ontario 

Attached is the text of a letter sent today by Prime Minister Chrétien to Premier Lucien Bouchard in response to his recent letter, on behalf of the Premiers and Government Leaders, conveying their reaction to the federal budget and requesting a First Ministers' Meeting on health care. 

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PMO Press Office: (613) 957-5555 

(Translation) 

Dear Premier Bouchard: 

Thank you for your letter conveying the views of Premiers and Government Leaders on the federal budget. 

I welcome your support for the tax cuts and your recognition of their importance for Canada's competitiveness. As you and your colleagues noted in your letter to me on February 3, it is important that governments take a balanced approach between tax cuts and new spending on key priorities. In my response to you of February 11, I repeated my commitment in this regard and I believe the budget reflects this. 

I fully appreciate the scope and urgency of the difficulties facing our health system. While these stresses are real, we need thoughtful approaches to improving a system which is still serving Canadians well. Many other industrialized countries are experiencing similar difficulties. And if there is any lesson to be learned from reform efforts in Canada and abroad, it is that there are no simple solutions, or quick fixes. We all recognize that more money for health care is not the only answer, as your Minister of Finance said so clearly last week. 

I agree with you that Canadians want a long-term commitment on the future of the health care system. They -- and all our governments -- strongly support the five principles of medicare (universality, accessibility, comprehensiveness, portability, and public administration). 

Our governments should continue to work together to address the long-term sustainability of medicare. This means improving our understanding of the pressures facing the system including demographic, technological, human resources or other factors, so that we can better plan for the future. 

Only a year ago, we First Ministers met to discuss health and social policy and renew our undertakings to work together. Prior to that meeting all Premiers and Government Leaders repeated their commitment to work together with the federal government to meet the health needs of Canadians. Our Health Ministers had already made significant progress in defining broad directions for the renewal of our health system and key priorities for joint work. I indicated that the federal government would show its commitment to the health system with a major new investment in health transfers to provinces. 

The Government of Canada has taken significant steps to address many urgent priorities of the health care system. As its fiscal capacity has permitted, the government has made repeated investments in the health care system. In 1999 there was an $11.5 billion increase in the CHST over five years, including a special trust fund that provincial and territorial governments could draw down as they see fit -- which some governments did not use last year. 

Effectively, this brings the value of the cash floor in the CHST to $15.5 billion from $11 billion in 1996. In the 2000 budget the Government of Canada has provided additional funding to address immediate and pressing health system issues, while governments continue working together to prepare the way for future long term investments. The total value of the CHST, including tax points, is expected to rise from $29.4 billion this fiscal year to $32.7 billion by 2003-04 -- its highest level ever. 

In 2000-01, the value of the CHST and Equalization will be, respectively about $1.8 billion and $1.5 billion more than when my government took office in 1993. In addition, with the strong support of provincial governments, the Government of Canada has invested $2 billion annually in the Canada Child Tax Benefit and has announced a further $2.5 billion annual increase by 2004. This helps provincial and territorial governments in the area of social assistance. 

The Government of Canada has also invested, in cooperation with provincial governments, in the development of a more effective health information system, so that we can ensure that reform in the health system is based on sound facts and knowledge, and measure our progress and keep Canadians informed. In addition, through the Health Transition Fund, our governments are working together on many innovative approaches to health system reform which will help define the directions for the modernization of medicare. 

Large investments have also been made by the Government of Canada in health promotion and protection, disease prevention, health sciences and research, which will help us address many of the major cost drivers in the health care system. 

Since we met last year and following Premiers' own meeting last summer, our Health Ministers and their officials have continued to work closely to analyze the major issues which would permit us to develop a plan to strengthen medicare. For example, they have agreed to work collaboratively on options to strengthen health human resources and improve the organization and delivery of primary care services. They plan to meet later this month and in early May. Their work is progressing well, but it is not sufficiently developed to serve as the basis for a productive First Ministers' Meeting. Canadians will not be satisfied until we provide them with meaningful solutions to the challenges facing health care and a long term commitment to strengthen the system. 

A long term commitment from governments is not simply about more money for health care. I believe the sustainability of our health system, now and in the future, depends on governments working together to accelerate the collaborative process of reform that is already underway. We should develop a plan to ensure a health system that reflects shared principles but provides for flexibility and innovation. Such a plan would require our governments to make long-term commitments, including commitments to necessary financing, which could be phased in. 

We should strongly encourage our Health Ministers to continue their work and to accelerate and intensify their schedule as necessary, while allowing sufficient time for real progress. I would suggest that we agree now to instruct Health Ministers to provide an interim report in June and, assuming adequate progress, to plan a First Ministers' Meeting in the latter part of this year with health as a key issue for consideration. 

Of course, health system reform issues have significant fiscal implications that go beyond the mandate of Health Ministers alone. So I would also suggest that we involve our Finance Ministers in the process leading to a First Ministers' Meeting. 

For my part, I can assure you of my commitment to follow this work closely and stay in touch with Premiers and Government Leaders on an individual basis. 

Canadians expect our governments to work together to strengthen medicare and we must do so. We all share a commitment to a universal, accessible, high quality public system of health care. I believe that this shared commitment will form the foundation of the necessary consensus that is required if we are to develop a common approach which addresses the needs of our health care system. 

Yours sincerely, 


(ORIGINAL SIGNED BY THE 
RIGHT HONOURABLE JEAN CHRÉTIEN)