Not too long ago, Canadians were challenged by their political leaders to discuss the future of their country. While not all dialogues were productive, there was at least a sense of engagement, if not genuine discussion. However, after the failure of the Charlottetown Accord and the unexpected result of the 1995 referendum in Quebec, we became wary of national conversations since their outcome was unpredictable.
Despite this uncertainty, conversations are important elements in political discourse. Without them a nation cannot develop a national consensus around key issues. Over the years, Canada has had broad consultations on major issues that helped chart the direction of the county. For example, the decisions to deal with our fiscal crisis in the mid 1990s and to enter into a free trade agreement with the United States were both products of a multiyear and active conversation where the pros and cons were vigorously debated at the political and community level.
Similarly, today, there are many issues that need a national consensus. One of them, however, urgently requires serious conversation. Canada is at the crucial crossroads with regards to the future of our health care. The increased demand for health services due to an aging population, the relentless rising costs of health care, and the expiration of the health accord in 2014 are all forcing policymakers to make some vital decisions.
At present, our national health care system is publicly funded and our benefits are limited to hospital and physician care. The costs for these services have been rising by six percent per year and will accelerate as our aging baby boomers reach their mid ’60s. These costs are shared between the federal and provincial governments, with the provinces contributing over 70 percent.
Not only are costs growing for the two levels of government, the fiscal capacity of the provinces is limited during the current economic slump. For example, in early December the Ontario government announced an $18.7-billion deficit for this fiscal year – and a forecast return to surplus no earlier than 2017. And Quebec’s finance minister is trying to deal with reports that his province will eventually “hit a wall” because government spending is so outpacing economic growth.
In addition, recent actions by the federal government suggest that it does not yet appreciate the gravity of the fiscal situation. Last month, federal Treasury Board President Stockwell Day expressed the hope that attrition within the public service would account for all the imminent belt-tightening that is needed to meet future spending. And, at a recently concluded federal-provincial meeting the federal government signaled its future spending intentions by arguing that it wants to reduce spending increases to the cost of living (approximately two percent per annum).
It is not surprising that governments have been reluctant to be proactive since the issue is highly charged and the answers are not obvious. But this is also a classic case of relentless cost increases colliding with the governments’ inability to pay for its share under the current costing regime. This situation cries out for some clear response.
While the federal and the provincial governments dither, the Canadian Medical Association (CMA) has undertaken a bold initiative and has launched an e-conversation with Canadians (see www.healthcaretransformation.ca/en).
With a membership of more than 74,000 physicians from across the country, the CMA has a huge stake in the outcome of the consultation. However, it has stayed clear of advocacy, at this time, by asking three crucial questions:
- The law underpinning our system – the Canada Health Act – dates back to the 1980s. It covers only doctor and hospital care. Do you think it should be broadened to include things like pharmacare and long-term care?
- It is important for citizens to feel they are receiving good value for their health care. What would you consider good value?
- Patients and their families play an important part in their health care. What do you think Canadians’ responsibilities are, now and in the future, in regards to their health?
At this early stage, the exercise has had only limited success in attracting much public participation so it is difficult to judge its potential effectiveness in stimulating a national conversation. Moreover, the CMA is only one player in this complex policy field and there is a need to hear from patient groups and, more important from citizens, to know if they are prepared to pay more for their health care.
It is obvious that somewhere along the way the federal government will have to take public ownership of the health file and the sooner it gets into the conversation, the more time Canadians will have to express their preferences.
David Zussman holds the Jarislowsky Chair in Public Sector Management in the Graduate School of Public and International Affairs at the University of Ottawa (firstname.lastname@example.org).