Exit stage right

Issue: BCMJ, vol. 46, No. 3, April 2004, Page 110 Editorials

For two days in February, Canada’s first ministers met in Vancouver to discuss common concerns and develop strategies to deal with the bad news indicators that kept leaking out of Ottawa’s back rooms. This was advertised as a meeting with a “broad brush stroke” agenda, but apparently little other than federal transfer payment reductions and the probable impact that the announced reductions would have on publicly funded medical care were discussed.

It seems that our new PM had his political table set by a predecessor bent on spoiling the feast, as virtually every day he and the rest of us were witness to one malodorous mess of decaying, unbelievably expensive patronage after another. The spin-off from all this bad news has been a parade of pronouncements that there is a universal spending freeze on, that transfer payments would have to be scaled back, that some lofty heads were going to roll, and that the PM was really mad (and I suspect checking the polls every night before turning out the lights). At the time of writing, the final word on how big the transfer payment reduction will be hadn’t been officially proclaimed, but it looks like all the provinces are going to have to deal with the spectre of a significant reduction when compared to last year’s federal transfer monies.

The reactions of the individual first ministers have been interesting and quite predictable. The have-nots are doing a lot of hand-wringing while the leader of the haves has been threatening to abandon the Canada Health Act (CHA) altogether and go it alone. To my mind, Mr Klein is merely giving notice that there is more intention than indecision in the announcement and I suspect that at the next week-long meeting this coming summer, Alberta will announce their exit date. The rest of the haves have suggested that the feds increase the transfer funds up to the level recommended by the Romanow Report, but if anyone reading this believes that Ottawa is going to commit to a 25% share of the cost, I have some medication for you. Given that the transfer payments stay the same or, as advertised, are decreased, the expected implosion of publicly funded medical care in this country by 2012 is most likely an overly optimistic time line.

The rapid expansion of privately provided medical care in BC in the past few years is likely to become a tsunami in the next 5 to 6 years with the daily barrage of medicare bad news reporting by all of our national news outlets coupled with the recent front page proclamations by Canada’s first ministers. I wonder how long Mr Klein and Mr Campbell are going to wait before announcing their intention to include private enterprise in the long-term solution equation. Part of this will almost certainly be driven by the Supreme Court’s decision in the Chaouli case, but this decision will only affect the component of the CHA that concerns itself with access to care in a reasonable period of time. The final and most important political decision that needs to be made is the decision to allow third party co-insurance carriers to sell their product to Canadians and finally allow all of us to access the same kind of expedient care we have come to expect, as pointed out by Dr Oetter on these pages last December, for our pets.


James A. Wilson, MD. Exit stage right. BCMJ, Vol. 46, No. 3, April, 2004, Page(s) 110 - Editorials.

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