8 / Canadian Government Executive // Spring 2023 CANADIAN POLITICS this division of responsibilities and fiscal capacity, we’re never going to get around this back and forth, passing the buck between the feds and the provinces. Q: What country, in your opinion, is doing this well right now? Is there any? How about Norway? Is there any other country we could learn some best practices from? It’s hard to compare to be honest, because we are a geographically big country, but population-wise, not a huge country. We are dispersed over a lot of land. We are a federal system as opposed to a unitary system. I know one thing that drives Michael Wernick crazy is when we compare ourselves to Estonia. We can’t replicate that. It is completely different world. So, I’m not sure it’s terribly useful to compare ourselves. Even if we could think of countries that we could compare ourselves to in terms of GDP or population or whatever, the fact that health care is so quintessential to the Canadian political identity, that’s a big issue. People think about this, and this is what makes us different from the Americans. We hold this program, we hold this so, so close to us, the idea that you could go to a hospital and not be seen, and you won’t be able to get the healthcare you need is like a gas light to everything we’ve ever been told about what it is to be Canadian. It’s not just about the program and the money. It’s also very dear to people. Even if we could find an administrative structure somewhere else that maybe provides better outcomes, and you could look at the money and all the rest of it, there’s still the fact that we’ve always made the promise to ourselves and each other, that you don’t have to pay for healthcare here. You don’t get to jump the line because you have money. Even if people are willing to permit more private involvement in delivery, there is no public tolerance for any kind of multi-tiered system where if you pay you get better health care. Q: Do you think the provinces are going to go for this? I think it depends. There are some provincial premiers like Doug Ford, for example, who is in a very powerful position because he won a big majority government within the last year and he’s also the premier of the largest province with the largest population. So, if Doug Ford has a problem with the deal, that’s a problem for Trudeau because so many people in Canada live in Ontario. If Doug Ford and Premier Legault don’t like the deal, that’s a big problem for Trudeau again because there’s so many people. Those are the two most populous provinces, and they represent so much with respect to the national consensus. But I don’t think it’s the end of the world for Trudeau if everybody doesn’t agree. He’s got some people who are probably going to oppose, like Danielle Smith of Alberta, like Scott Moe in Saskatchewan. If that’s the case, he can withstand Prime Minister Justin Trudeau chairs a working meeting on health care with the First Ministers of Canada’s provinces and territories. Photo by Adam Scotti (PMO), February 7, 2023, Ottawa, Ontario.
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