Unity trade-off potentially in the works

>> Will Ottawa give the provinces control over Medicare in exchange for a deal on national unity?

by PHILIP PREVILLE

Just how far will the federal government go in order to keep Quebec in Canada? If spokesperson Mike McBain of the Canadian Health Coalition (CHC) can be believed, they're so desperate for a unity deal that they're willing to give up control of Medicare--in exchange for the provincial legislatures' support of the Calgary Declaration.

"I've been told they're going to do some horse trading at next week's First Ministers' conference," McBain told the Mirror. "In exchange for support of the Calgary Declaration, Chrétien will hand over the administration of the Canada Health Act." McBain would not reveal his source, but claimed he got word of the proposed covert deal from a high-ranking provincial government official in western Canada.

Provincial officials contacted by the Mirror claimed no knowledge of any pending deal, though some would not rule it out entirely. "I would say that's totally erroneous information," said Daniel Atlin of Ontario's Intergovernmental Affairs department. Atlin said he could offer no further information on next week's meeting, as details were still being discussed. But Heidi Bonnell, assistant to Newfoundland Premier Brian Tobin, did not deny the possibility of such a deal. "In other provinces, particularly out west where support for the Calgary Declaration is weak, perhaps they see a need for a deal," Bonnell told the Mirror. "But here in our province there's no need for a tradeoff, because support for the Calgary Declaration is strong."

The topics of health and unity are on the agenda for the First Ministers' meeting, to be held next Friday Dec. 12.

The Canada Health Act details the standards that provincial health care programs must meet in order to receive federal funding. Notably, the Health Act states that Medicare's objective is "to facilitate reasonable access to health services without financial or other barriers."

Implementation of the Health Act has always been an exclusively federal responsibility. But in a January document titled A Renewed Vision for Canada's Health System, all 10 provinces proposed a "New Administrative Mechanism" which would provide for joint federal-provincial interpretation and enforcement of the Act.

According to McBain, the provinces' proposal "would mean that [OntarioPremier] Mike Harris and [Alberta Premier] Ralph Klein would be in charge of interpreting the Health Act. It would destroy Medicare and replace it with a private health system.

"The premiers know there is no public support for their position. That's why they want to make a closed-door deal. It's the only way they will get their way."

The provinces have been pushing for changes in the way the Health Act is administered due to the Medicare cutbacks and restructurings that are currently happening in all provinces. Last January in Quebec, for example, the provincial government de-insured a number of services that used to be free of charge; as a result, patients who visit a doctor now must often pay for diagnostic medication, local anaesthetics and wound dressings when they visit a doctor.

Claude St-Georges of the Coalition solidarité-santé, a volunteer organization which advocates universal access to health care, says that Quebec's de-insuring of services may already be in violation of the Health Act. "They're definitely walking a thin line," St-Georges says, "because these are the grey areas of the Health Act."

In other words, Quebec may or may not be contravening the Act--depending on how you interpret the "no financial barriers" clause. By securing joint federal-provincial interpretation of the Act, the provinces would have more latitude to make cuts to health care without facing a financial penalty from Ottawa.

Were Ottawa to allow joint administration of the Health Act, it would be an unprecedented development: never before has one government passed legislation only to let other governments interpret it. Bruce Davis, Director of Health Insurance with Health Canada, reiterated Ottawa's position that "final interpretation of the Act will remain a federal responsibility." But he admitted that by insisting upon "final" interpretation, Ottawa may be willing to accommodate the premiers' demands.

The CHC's McBain worries that Ottawa is all too willing. "We don't trust Jean Chrétien to defend Medicare," McBain says, "but I'd love to be proven wrong. The provinces are committed to gutting national standards, and they're attempting to use the Constitution as leverage."