I find it shocking that yesterday, on the same day that the Canadian Medical Association reported that 87% of Canadians believe that the federal government should pay more attention to health care, the federal Minister of Health said in a public speech that “Decision-making about health care is best left to the provincial, territorial and local levels”. I fear that this demonstrates a lack of understanding of the core principles of the Canada Health Act as well as a denial of the important role that all levels of government must play to ensure the conditions necessary to enable health for all. The Canada Health Act is in fact the glue that holds together the very system of Canadian medicare. Without federal leadership, including conditions on the Canada Health Transfer, equitable access to essential health services would no longer be guaranteed.
Having worked as a physician in Canada and abroad for almost 30 years, I am convinced that the foundational strength of our modern health care system rests on the principles that been clearly elucidated in the Canada Health Act. On those principles we need solid national consensus. And we need courageous leadership from our federal government to uphold these principles. For this reason, I am firmly opposed to the notion that the Canada Health Transfer would proceed with “no strings attached”. The provinces must receive the funds with some conditions to ensure that health care provision will remain fair, accessible and universally insured.
In a recent opinion piece and in wake of the Council of the Federation meeting in Halifax, Adam Radwanski suggested that consensus-building is not the key to health care reform. But there is a role for consensus on core principles and this is one of the important roles of the federal government. We have room for both standardized agreements and experimental innovation in health care. They are not mutually exclusive. I say: Consensus on core principles and creative diversity on potential new solutions.
There are many areas where it makes sense to improve our collaboration and integration. The Council of the Federation discussions included the sensible idea of the provinces making bulk purchases of generic drugs as discussed at the Council of the Federation. There are many other areas where we could save money and provide better care by finding some cross-country consensus. Issues like routine childhood vaccination schedules and electronic health records are just two areas I mention to start the list.
The most common arguments against consensus are that it stifles creativity; abandons the opportunity to learn from comparisons; and denies market-driven motivation to innovate. But I believe that a well-rounded approach to health care reform includes:
- Consensus on the core principles (Canada Health Act)
- Conformity when it is prudent (e.g. Provinces bulk purchases of generic pharmaceuticals)
- Creativity for the purpose of innovation and taking advantage of our diverse perspectives and circumstances
Of course the provinces and territories should dream, innovate and learn from each other. Different regions and communities should indeed experiment with delivery models; with the mix of providers; or with best strategies for disease prevention. But let us not throw away the important 3Cs of consensus, collaboration and conditions (that is, “strings attached” to financial transfers). I’ve been learning from Canadian patients since I started medical school in 1980. I get the sense that they’d like providers and policy makers to agree on a few things that really work, and then stick with these core concepts so we have some health care anchors to keep us steady through the seas of constant change. And clearly they’d like the Government of Canada to “play a leading role in protecting and strengthening the health care system”.