Where should progressive decentralists stand on Medicare in Canada? Should we resign ourselves to the much-dreaded vision of a patchwork of provincial systems, or should we insist that universal health care trumps the virtue of dispersing political power far and wide?
Stephen Harper has contended recently that health is solely a matter of provincial jurisdiction, that he wants the federal government to provide transfer payments with no strings attached. I will admit that I like the idea of fewer federal standards imposed on the provinces. Just because I happen to favour a fully public health care system with no user fees — and I do — that does not mean that I should be able to force all my preferences on Manitobans or Nova Scotians. But there is a difference between fewer federal standards and no federal standards whatsoever. To receive quality medical care wherever you are and regardless of your ability to pay ought to be considered a basic human right. This could potentially manifest itself in many diverse forms in the provinces, but Harper is making it ever more apparent that he is unwilling to protect so minimal a right at all.
Furthermore, while I believe in decentralization of decision-making within limits, I also believe in centralization of funding. In a country with regional economic disparities, robust federal funding is necessary to ensure that all provincial governments have the ability to implement health care systems of their choosing, and to respect the basic rights of their residents. Some might argue that having one group of people provide the money while another decides what to do with it is a recipe for unaccountable spending, and there is some validity to that. But let us not overstate this concern. Provincial governments are, after all, accountable to provincial voters. It is a little known fact, but there happens to be a sizable overlap between provincial voters and federal taxpayers, and they have an interest in ensuring that their tax dollars are well-spent. As far as I’m concerned, substantial federal spending on provincial projects optimally combines the principles of decentralization, equity, and accountability.
And what does our Prime minister have to say on the subject? Harper has unilaterally announced a plan according to which federal health transfers to the provinces will continue to increase, but at a lower-than-accustomed rate. On top of that, he has decided to change the funding formula to an equal per capita allotment for every province. Previously, poorer provinces had received more funding per person than rich ones on the grounds that their revenue-raising capabilities were more limited. Under the new formula, however, the rich (i.e. Alberta) will get richer at everyone else’s expense.
So does the recent series of health care announcements by the Harper government pass the — okay, my — progressive decentralist test? The answer is an emphatic “no.” The funding that Harper promises is neither sufficient nor fair, and it is unclear just how close he will come to sacrificing the human right to health in the name of provincial jurisdiction. Too close for comfort, we may reasonably project, given his well-established distaste for social programs.
Dr. Harper’s cure, in other words, appears far worse than the disease. Back to the prescription pad!