November 10, 2011
on its Review of the progress in implementing the
2004 Health Accord
We believe the future of health care in Canada can only be secured with strong federal leadership. The Canada Health Act is a symbol of Canada as a compassionate and caring community. The Act states that the primary objective of Canadian health care policy “is to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers.” (CHA, art. 3).
The Canada Health Act, in essence, is a call to care. As Tommy Douglas said: “When we are talking about medical care we’re talking about our sense of values. Do we think human life is important? Do we think that the best medical care which is available is something to which people are entitled, by virtue of belonging to a civilized community?”
Roy Romanow wrote in his final report entitled ‘Building on Values’: “Canadians view Medicare as a moral enterprise, not a business venture”. The ethical imperative of the Act – reasonable access to health services without financial barriers – is obviously not a business proposition. In fact the legal principles of the Canada Health Act are in blunt opposition to the legal principles that regulate the market.1
A public, not-for-profit system based on the Canada Health Act, puts government at the service of the people and not at the service of private enterprise. Health care is supposed to be delivered solely on the criterion of the need of patients, without regard for their ability to pay, their socio-economic status or where they live. The Act is supposed to protect Canadians from markets in health care that fragment services and avoid “unprofitable” populations, “unprofitable” regions and “unprofitable” services. The Act also offers the best guarantees of cost effectiveness and sustainability.
Access to health care based on need and not ability to pay is a core social right in Canada. The iconic status of the Canada Health Act and the Medicare system; Canada’s health- related obligations under the Universal Declaration of Human Rights, the International Covenant on Economic, Social and Cultural Rights and other international human rights treaties ratified by Canada; domestic commitments under section 36 of the Constitution Act, 1982; and Canadian Charter of Rights and Freedoms guarantees of security of the person and equality all support the existence of a right to publicly funded health care. In the words of Roy Romanow: “Canadians consider equal and timely access to medically necessary services on the basis of need as a right of citizenship, not a privilege of status or wealth.”2
The Canadian Health Coalition is a public advocacy organization dedicated to the preservation and improvement of Medicare. Our membership is comprised of national organizations representing nurses, health care workers, seniors, churches, anti-poverty, women, students and trade unions, as well as affiliated coalitions in 9 provinces and one territory. The CHC was founded in 1979 following the SOS Medicare conference in Ottawa organized by the Canadian Labour Congress and attended by Tommy Douglas, Emmett Hall and Monique Bégin.
The 2004 Health Accord represented a major reinvestment by the federal government and stabilized the health care system following deep cuts in 1995, which seriously compromised access to care. Significant progress has been made as a result of the major re-investment by the federal government, in the first 10-year accord – wait times are improving, more Canadians have access to primary care.
The success of the 2004 Health Accord is the reduction in wait times. Wait times for a significant number of surgeries and diagnostics have decreased. In fact, over the duration of the Accord, across Canada our publicly-funded health system has expanded to include a newer generation of technologies for cancer care, diagnostic scans, communications technology and wait list management. We have seen a dramatic increase in the number of elective surgeries, diagnostics, and better access to cancer and cardiac care. On some key health indicators, Canada is showing well. Our life expectancy has increased. Frequency of and mortality from heart attacks have declined. Stroke rates have declined. And cancer survival rates have increased. Our progress shows that with investment and support, our public health care system continues to improve and serves Canadians well.
But our health system is also contracting. In a number of provinces, rehabilitation services such as physiotherapy are being cut, delisted and privatized. More and more, longer-term care is subject to user fees and two-tier access, yet progress on a national home care strategy has been derailed. Similarly, progress on Pharmacare – identified as a priority in the 2004 Health Accord – has stalled, while drug costs continue to escalate faster than any other health care expenditure.
While our successes have come from expansion and improvements in the public non-profit health system, the Canada Health Act is not being enforced. In British Columbia, in particular, where a significant for-profit health care industry has emerged, clinics are openly charging patients fees for medically necessary services in contravention of the Act. The provinces with the most for-profit clinics (Quebec and British Columbia) are experiencing more violations as the clinics maximize their profits through extra-billing and user charges. In fact, our research has found that the majority of private for-profit clinics in Canada are selling access to health care, promoting two-tier health care, despite the Act’s prohibition of user fees and extra-billing. These clinics have not improved access. In fact, they have demonstrably reduced access in our local public hospitals and worsened human resource shortages in the public system while selling two-tier health care, regardless of medical need. The impact of for-profit privatization has not been adequately assessed, nor addressed, by the federal government, despite the reaffirmation of the principles of the Canada Health Act in the Accord.3
The biggest impediment to progress in implementing the 2004 Health Accord has been the withdrawal of the federal government from the essential role of national coordination in health care policy. There is a deficit of political leadership in health care, especially at the federal level. The Harper government never misses an opportunity to say that health care is a provincial responsibility and to avoid accountability for its important roles in health care, including: using federal spending power to achieve health objectives for the good of all Canadians, aboriginal health, food and drug safety, and enforcement of the Canada Health Act.
Developing national approaches on health system issues and promoting the pan-Canadian adoption of best practices and innovation is the glue that keeps Medicare together. This role cannot be performed by provinces and territories alone. As a result of the vacuum in federal leadership, the health care system is fragmenting more than ever, into 14 separate systems operating independently from each other. This fragmentation undermines the core principles of the Canada Health Act, especially comprehensive coverage and portability between provinces and territories. Lack of federal coordination and guardianship means that more and more Canadians lack access to comparable health services in primary care, prescriptions drugs, home care, rehabilitation and longer-term care.
A renewed 10-year plan is needed, with stable and adequate funding, including the 6% escalator, in order to maintain the momentum, expand the innovations, and address unmet needs of Canadians including continuing care and Pharmacare. It is essential that the federal government perform its roles and duties in a renewed health accord. This includes:
a) working closely with provincial and territorial governments to develop national approaches on health system issues;
b) promoting the pan-Canadian adoption of best practices and innovation; and
c) actively enforcing national standards and compliance with theCanada Health Act.
Accountability and Enforcement of the Canada Health Act
Medicare belongs to Canadians. They pay for it and are the shareholders. Medicare should be accountable to the public, but currently it is not. Federal guardianship is necessary to ensure that public funds are used to protect and strengthen Medicare. In the 2004 Accord there was a significant increase in public funding for Medicare, funding that should have been accompanied by more accountability, not less. Canadians need to follow the money -$41 billion a year – and insist on a better accounting for how the money is spent. Weak accountability mechanisms facilitate privatization. It is no coincidence that the governments with the most resistance to meaningful accountability are the ones leading the way in transferring the delivery of insured services to commercial, private for-profit corporations. Proponents of privatization in health care delivery do not want public funds accounted for or traced, but this is what public administration and real accountability requires.
Please continue reading…Health Accord Negotiations pg. 2
2 Romanow Commission, Final Report, p. vi.<
3 Ontario Health Coalition, “Eroding Public Medicare: Lessons and Consequences of For-Profit Health Care Across Canada”, October 6, 2008.