The Ottawa Citizen and Vancouver Sun
April 27, 2004
Liberals softening stance on Medicare rules: critics
By Mark Kennedy
OTTAWA -- The Martin government has signalled it will adopt a softer approach to enforcing the Canada Health Act and is open to further private-sector delivery of health care, a move that has critics outraged.
The change of tone has come in recent days from Health Minister Pierre Pettigrew, who has been charged by Prime Minister Paul Martin with helping lay the groundwork for a federal-provincial deal this summer on reforming medicare.
Pettigrew's comments are music to the ears of premiers such as Alberta's Ralph Klein, but they have already sparked outrage among critics who allege the federal Liberals are quietly abandoning their responsibility to protect Medicare in order to appease provinces.
"It's massive deception," Mike McBane of the Canadian Health Coalition said Monday.
"It looks like the feds are prepared to make a trade-off with the provinces. They're looking short term. They need a health care deal and they're willing to give up enforcement of the act so that provinces will sign onto a deal that passively privatizes the system over time."
McBane's criticism came after Pettigrew said last week the federal government must change the way it ensures that provinces adhere to Medicare's rules.
Traditionally, the federal government has had the sole power, withholding fiscal transfers from provinces that break the act.
Still, it's a power that has rarely been used and the auditor-general has been critical of the federal government for failing to live up to its obligations.
But Pettigrew indicated he agrees with provincial complaints that too much power rests in federal hands to interpret the act.
"My view is that the existing enforcement mechanisms just don't work," he said. "There has been incoherence in our enforcement of the Canada Health Act. Incoherence is a polite word. It's arbitrary."
Pettigrew has suggested the provinces themselves should have a hand in developing the rules.
"Leaving the enforcement exclusively in the hands of the federal cabinet does not really guarantee us the best possible enforcement," he said. "I think we should be developing, along with the provinces, certain mechanisms in which we would make sure that the Canada Health Act is implemented."
In another apparent shift, Pettigrew said he does not have a position on whether private MRI clinics violate medicare, and he is open to discussing with the provinces how they should be used within the public system to give patients equal access to diagnostic services. That could potentially mean private companies would deliver the services on behalf of the public system and keep a share of the profits.
In the Commons on Monday, New Democrat MP Yvon Godin blasted Pettigrew for espousing privatization policies that are no different than those of the Tories.
But Pettigrew rejected that allegation, saying he is "looking for ways" to better enforce the Canada Health Act's five principles "in cooperation with the provinces."
For months, critics have been suggesting Martin's rise to power late last year could only spell bad news for Medicare.
The first clue seemed to come within days of Martin's taking office in December. The B.C. legislature had just recently passed a bill prohibiting private clinics from charging user fees. The bill was initially introduced because the province said it was being pressured by Health Canada to enforce the health act.
Then, in mid-December, Premier Gordon Campbell said it would not be necessary to proclaim the provincial bill -- which would have given it legal effect. Now that Martin was in power, he said, "it may well turn out that we don't need it at all."
Also disconcerting to critics was the fact that lobbyists in the Earnscliffe Strategy Group, the Ottawa-based lobbying firm with close links to the prime minister, are representing the private health care sector.
And they reacted with alarm recently when Martin's government appointed an advocate of more health privatization to a senior post in the Finance Department.
The Canada Health Act is not enforceable
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