Dalton McGuinty can’t play Captain Canada to rescue medicare

TorStar.com – news/canada/politics
Published On Sat Jan 14 2012.   By Martin Regg Cohn, Queen’s Park Columnist

Dalton McGuinty joins his fellow premiers in Victoria on Sunday for a special summit to cure health care’s ills across Canada. But McGuinty’s mind will be elsewhere.

Fresh from his special guest appearance at the Liberal convention in Ottawa — where he renounced any federal leadership ambitions — Ontario’s premier will once again perform a delicate dance:

He must resist playing the role of Captain Canada rescuing medicare, avoiding any prime ministerial pretensions on the West Coast. And he dare not overdo his customary talk of fostering “national standards” for health care lest he lapse into the archetypal central Canadian patronizing other provinces.

But there is another reason for McGuinty to be more muted over the next couple of days of posturing with the premiers: The Great Game isn’t what it used to be.

The world has changed since 2004, when the provinces engaged in high-stakes negotiations with Ottawa that culminated in an accord to boost health care funding by 6 per cent annually for a decade. The premiers were caught off guard last month by federal Finance Minister Jim Flaherty unilaterally fixing future transfers at a rate decreed by Ottawa alone.

Flaherty’s diktat has sucked the air out of the premiers’ conferences because there is little left to fight about — except amongst themselves. A split has emerged between western premiers who deemed Ottawa’s offer reasonable and those who denounced it as wretched. Now federal Health Minister Leona Aglukkaq is trying to pick up the pieces, but the process is in limbo.

“This is a bit of an existential moment in the federation,” complains one official. “The feds are taking this goodbye-and-good-luck approach and yet still want to keep a foot in the door.”

Despite their internal divisions, the show must go on in Victoria. Yet McGuinty knows perfectly well that the real action isn’t at the conference table, comparing notes with premiers who are at cross-purposes.

The focus should be back home in Ontario, where the province’s finances are in a precarious state and the health sector is on a knife’s edge.

At $47 billion a year, the health bill takes up an unhealthy 42 per cent of Ontario’s spending. That’s why McGuinty has long made medicare a touchstone of his speeches, demanding that Ottawa sign another accord with national standards and clear objectives (like shorter waiting lists).

Now Ottawa is following its own script. Yet Queen’s Park tirelessly (and tiresomely) repeats its boilerplate denunciations of bad faith federalism.

It’s time to move on. Victoria can serve as a clearing house for “best practices” and interprovincial brainwaves on innovation, but it won’t provide any panaceas.

Like it or not (and I say this as an arch-centralist), the terms of the debate have shifted. The more interesting conversation is taking place back home, where the biggest brains are turning their minds to the bigger problems.

McGuinty needs to get out in front of the funding challenges in his own backyard: highly paid doctors, a poorly integrated health care system, modest community care and meagre home-care programs.

A report on Ontario’s public services, coming soon from influential economist Don Drummond, makes health care its major focus. Drummond points out that virtually all the major providers (doctors, nurses, pharmacists) are remarkably united with the big players (the Ontario Hospital Association and community care groups) in recognizing that delivery cannot continue as before — because funding cannot continue as in the past.

Drummond’s report will set the table for another major debate on front line challenges for health care in Ontario, free from pan-Canadian policy abstractions — and distractions. There is a perfect storm brewing on Ontario’s shores, and yet the stars are in alignment.

A draft of Drummond report’s is now in the premier’s office. McGuinty must know that Ontario will have to find its own way, and that the real work begins once he finds his way home from Victoria.

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