In Brad Wall’s deal, clues for medicare’s future

Posted on in Health Policy Context – Opinion
Jan. 20, 2017.   GARY MASON

Provinces holding out from signing a health-care accord with the federal government were dealt a significant blow this week when yet another jurisdiction announced it was breaking from the pack and inking a side deal with Ottawa.

The fact that it was Saskatchewan, led by Premier Brad Wall, a vocal adversary of the Justin Trudeau government, was particularly meaningful. Mr. Wall is the most senior first minister in the land, who has years of experience reading federal tea leaves.

With New Brunswick, Nova Scotia and Newfoundland and Labrador already having abandoned hope that the provinces, in the form of a united front, might pressure Ottawa to sweeten its health-care offer, it seemed only a matter of time before others began seeing things the same way.

But few imagined that of those steadfast in their insistence the federal Liberals bend to their will – a powerful group that includes B.C., Alberta, Ontario and Quebec – it would be Saskatchewan to next surrender in the standoff. The province wanted a pan-national deal as much as anyone but as Health Minister Jim Reiter correctly pointed out: “That ship has sailed.”

Lost in the murmur the move created was reference to a clause in the agreement that has the potential to be a groundbreaking development in the way we view medicare in this country.

Saskatchewan is in the early stages of an experiment involving private-pay health care. Faced with a backlog of people needing MRI scans, and with dwindling provincial resources as a result of a downturn in oil prices, the health ministry proposed using private clinics to assist in dealing with its dilemma.

Last year, it began allowing people to pay for an MRI out of their own pocket. In return, the private clinic that performed the procedure had to provide an MRI at no cost for someone on the public waiting list.

Since the beginning of March, 2016, 501 scans have been purchased, meaning an equal number were done for free for people on the public roll. From the end of February of last year to the end of July 2016, the number of patients waiting for public MRI services decreased to 6,181 from 6,900, according to the government.

While the initial results are promising, even impressive, it may not matter.

The federal government has held a dim view of Saskatchewan’s MRI plan from the beginning. That is why mention of a one-year reprieve Ottawa was purportedly giving the province to prove its two-for-one MRI system was working seemed so significant.

Ottawa has since disputed this interpretation of the pact, insisting the MRI program defies the principles of the Canada Health Act and needs to end. Saskatchewan is adamant that the one-year amnesty was part of the agreement.

Why wouldn’t the federal government give Saskatchewan the chance to prove its case?

Ottawa says the national health act is meant to ensure Canadians have reasonable access to medical care based on need, not on the ability to pay. Well, first of all, that premise is violated every day in this country. The fact is, two-tier health care already exists. It happens when people can’t afford prescriptions that others can. It happens when people take advantage of extended health-care plans others don’t have. It happens at the dentist’s office that many can’t afford. It happens when you are a member of a group exempted under the act and allowed to attend private clinics.

On the surface, Saskatchewan’s MRI plan would appear to be helping people get quicker access to the care they need. In some cases, the reduction in waiting times could literally be saving someone’s life. It could be reducing a person’s pain by months.

And federal Health Minister Jane Philpott, a physician, knows this.

The world has changed dramatically since the concept of universal health care was first introduced decades ago. It’s even changed substantially in the 30-plus years since the Canada Health Act was passed into law.

Provinces have responsibility for delivering health care in a new, much more complex and difficult world, yet Ottawa insists on imposing conditions and restrictions that are mostly rooted in politics, not concern for patients.

Saskatchewan should be able to press onward with its MRI experiment, be able to make the case that it is helping, not hindering people.

Not allowing it to continue would be in violation of the right every Canadian holds to get the health care they need, as promptly as they can get it.

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