Democracy Gone Astray

Democracy, being a human construct, needs to be thought of as directionality rather than an object. As such, to understand it requires not so much a description of existing structures and/or other related phenomena but a declaration of intentionality.
This blog aims at creating labeled lists of published infringements of such intentionality, of points in time where democracy strays from its intended directionality. In addition to outright infringements, this blog also collects important contemporary information and/or discussions that impact our socio-political landscape.

All the posts here were published in the electronic media – main-stream as well as fringe, and maintain links to the original texts.

[NOTE: Due to changes I haven't caught on time in the blogging software, all of the 'Original Article' links were nullified between September 11, 2012 and December 11, 2012. My apologies.]

Wednesday, August 01, 2012

The provinces and health care: coming to terms with a new reality

Canada’s provincial and territorial premiers met last week in Halifax for their annual Council of the Federation summer meeting.

In the past, these meetings have been big on barbecue and light on substance, but this year, things were different. This was the first formal opportunity for the premiers to respond to the federal government’s December 2011 unilateral announcement on the future of health care and social programs funding.

Last December, Finance Minister Flaherty announced he would continue the Martin Accord’s six per cent annual escalator for health care to 2017, three years beyond its planned expiry date of 2014, after which transfers will grow at the rate of nominal GDP, but never falling below three per cent annually.

At the time, some premiers complained about this federal “cutback” in future funding, but their outrage foundered on the federal tactic of front-loading its commitment, which was virtually impossible to spin as a cutback. As far as the future is concerned, with the economy struggling to reach two per cent in annual growth, it continues to be difficult for the premiers to argue that an automatic six per cent increase in transfers every year in perpetuity is a God-given right.

Last week, the premiers produced a report that totaled up the federal “cuts” to health and social transfers. It’s an impressive sounding number, but it’s really just pretend money — the difference between what they would have received under the old Martin Accord formula projected out ad infinitum, and the new one. Left unacknowledged by the premiers was the well-documented fact that several provinces have already managed down their year-over-year increases in health care spending to the two-to-three per cent range. The reason, of course, is that the provinces can no more afford six per cent annual increases in health care spending than the federal government can, but that won’t stop them from asking.

The other issue on display last week is the essential problem the provinces and territories face on health care: the only really federal involvement they crave is an open federal purse. As much as they cloak it in calls for “federal leadership” in health care and demands that the federal government “come to the table and negotiate” or “take the lead on innovation,” they belie their true motivation with equally stout declarations that “we are the level of government that actually delivers health care.” And that, of course, is precisely Stephen Harper’s point. Imagine the federal government these days trying to tell any province how to organize primary care, recast cancer care in a particular direction, or take diabetes care on a new route. The feds would be told to take a flying leap.

At the heart of the federal government’s health care funding decision last December was the Prime Minister’s rejection of the old approach to federal-provincial conditionality, in which the federal government would turn over billions of dollars to the provinces “on condition” that they would take certain steps to improve health care. As he reviewed the results of the first few years of Mr. Martin’s “ten year fix,” Mr. Harper was not impressed, because few of the promised goals and objectives had actually been met. So much for Mr. Martin’s commitment to using federal dollars to “buy change.”

While the premiers took some time last week to criticize Mr. Harper for his unilateralism, they also indicated they are not about to impose such an approach on themselves. They received the report prepared by Premiers Wall and Ghiz proposing several ways they could co-operate in pushing health care innovation. Time will tell how truly innovative these ideas prove to be, but one striking feature about the report is worth noting. All of its recommendations are voluntary, making the point yet again that there are few “right” or “wrong” answers in health care, and that at the end of the day, it is the provinces and not the federal government who organize and manage Canada’s health care system.

Original Article
Source: ipolitics
Author: Geoff Norquay

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