For health policy wonks, 2011 ended not with a whimper, not with a bang but with a wallop. Federal Finance Minister Flaherty thumped the federal government’s 2014 Accord ‘offer’ on the table. A special kind of offer, in fact a fait accompli: there’ll be no negotiation, no debate, no to-ing and fro-ing. This is what you’ll get. And what you get is a temporary (up to 2017) continuation of the existing 6% annual increase in federal health funding to the provinces and then a lottery increases in line with growth in the economy. So the psychopaths on Wall Street get to decide not only how to wreck the American and indeed the world economy, but also (indirectly) how much the provinces will get from the federal taxpayer.
We don’t know yet whether there’ll be a new Accord with high sounding rhetoric about how the federal government, provinces and territories will work together on addressing any health policy issues, but Prime Minister Harper has said there’ll be ‘no strings attached’ to the new deal. But just what does ‘no strings’ mean? Presumably the five Canada Health Act conditions remain. Health minister Aglukkaq still talks about provincial accountability though both inside parliament and outside so there’s a bit of a disconnect in the federal rhetoric still.
So is ‘no strings attached’ a good thing? Is it reasonable that there be no debate about how to improve health care in Canada at this once-in-a-decade opportunity? No re-jigging of what Medicare means, say addressing the lamentable state of home care or the lack of a national Pharmacare scheme?
The supporters of ‘no strings’ will say this gives the provinces the autonomy they need to set their own priorities for their own health care needs. But it has been said that Medicare has replaced the railroads as a unifying force in Canada. How much diversity is a good thing? If we have too many provincial separate paths, when will Medicare cease to have a meaning or ability to act as a unifying force?