Harper and the subtle erosion of medicare

Thomas Walkom:

As the Canadian Medical Association Journal reported last month, at least five provinces (including Ontario) are turning a blind eye to private clinics that break the law.

Some defy the federal Canada Health Act by charging patients for medically necessary services. Others ignore provincial laws aimed at maintaining the integrity of medicare — such as those that prevent physicians from operating both inside and outside the public system.

Harper’s federal government has been even more remiss.

Medicare exists as a national program for only two reasons. The first is money. As long as Ottawa gives cash to the provinces, it can require each recipient to operate a provincial medicare program that adheres to the Canada Health Act.

The second is enforcement. The Canada Health Act permits (and in one case requires) Ottawa to withhold money from provinces that break the rules.

Most of the time, Ottawa prefers not to confront recalcitrant provinces. Still, between 1984 and 2006, the federal government levied penalties averaging about $400,000 a year.

Since Harper came to power, however, federal medicare penalties have shrunk to about $84,000 annually.

This, presumably, is what Harper was referring to when, in last week’s televised English-language debate, he talked of giving the provinces free rein in medicare.

... medicare requires a federal government willing to enforce the Canada Health Act. If, in the name of allowing provincial experimentation, it chooses not to do so, the system simply atrophies.