Conservatives should bring on real health system reform

Health-care spending already consumes 40-50 per cent of provincial budgets. A recent report coauthored by David Dodge for the C.D. Howe Institute shows that if current rates of increase hold it will soar from 12 per cent of GDP in 2009 to 19 per cent in 2031.

At the same time, studies by the Fraser Institute reveal that despite ballooning budgets, wait times have doubled between 2003 and 2010.

While a recent Canadian Institute for Health Information study reported that wait times for certain “priority” procedures have improved, 20 per cent of Canadians in need of those treatments still experience medically unacceptable delays.

The evidence is plain that (a) projected increases in health-care spending are fiscally unsustainable, (unless you tax Canadians into oblivion) and (b) throwing more money at wait lists doesn’t make them go away.

Clearly something else must change — and that something is the structure of our health care system.

To date, the Conservatives have evinced a mortal fear of supporting anything but the status quo — but they shouldn’t.

This election presents an opportunity to set themselves apart from the rest of the herd and craft a policy that will not only win votes, but improve the lives of millions of Canadians.

The Tories should not ignore the health-care issue, but tackle it head on. They should call the other parties’ health-care policies what they are: a bald-faced lie.

Spending more money will not fix the problem for this generation or any other. You can ride all the escalator clauses you want, but our wait lists will still end up in the basement.

Second, the Tories should propose a solution that tackles the inefficiency of our single-payer monopoly system. This should include amending the Canada Health Act to allow the provinces to experiment with health-care delivery as they see fit.

Whether that would involve allowing more private care, contracting out, or delisting would be up to provincial governments — as it should be, since constitutionally, health care is a provincial issue.

Third, the party should gradually replace the bulk of health transfer payments with the transfer of tax points. Since this is the touchiest part of the equation, in our equalization-obsessed nation, it could only be done gradually, and would likely always maintain a certain portion of federal cash, but now with no strings attached.

So bring on the health-care debate, Conservatives. The opposition’s “fixes” would fail, respecting provincial jurisidiction would play well in Quebec and the West, and no one could accuse Stephen Harper of dodging the debate.

For the Tories, it’s a winning hand — if they’re willing to play it.

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Health care is the sleeper issue that Harper can't handle

Stephen Harper is planning to cut health-care funding if re-elected.

You might think this would qualify as a controversial position worthy of spirited campaign debate. Yet, so far, the top-ranking concern of Canadians can’t even squeeze past Facebook-creeping to score a few minutes mention on the evening news.

Partly that's because it might not be true. But don’t spike the football just yet, Harper Nation. The available evidence suggests that it probably is true.

Certainly, Flaherty’s stalled budget hints that the Conservatives are at least preserving the option of trimming health-care transfers after 2014.

According to the 2004 Health Accord, transfers from the federal government rise annually at a rate of 6 per cent. It’s called the escalator clause. Now look at the March 22nd budget.

Nowhere in that big abandoned book will you find a commitment to transfer levels beyond 2014, even though the government boastfully projects budget balance by 2015-16.

Why? The federal government wants to maintain its negotiating position. Translated from government-speak, that means they’re gunning for the escalator — perhaps hoping to lower it by a couple per cent or even tying it GDP growth.

Experts call this flattening the curve. Hospitals, doctors, nurses and patients call it a cutback.

Of course, it’s possible that Harper will declare that he’ll preserve the escalator at or above its current level. But notably, he’s not actually said that.

Even more notably, 13 days deep into this election, he hasn’t yet been asked about it.

That’s baffling because, as David Dodge pointed out this week, cost pressures are rising. This debate is needed and trade-offs are inevitable.

Seven years after Paul Martin ushered in the current deal, wait times are down, public confidence is up and intergovernmental bickering has largely evaporated. Canadians would likely attach priority to maintaining this approach even at the expense of tough expenditure choices elsewhere.

It’s the sleeper issue of this campaign. Layton talks about health care but his focus is on who should lead the re-negotiations rather than what is to be achieved.

The Liberals are left with a golden opportunity. They can lead this debate, reassert their traditional trust advantage on health care and flush the Conservatives out of the bushes, possibly even exposing a position that could be dangerously discordant with voters.

So stay tuned. Harper blew the 2004 election by, in part, mishandling the hot-potato politics of health care. Who says history can’t repeat itself?