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Provinces battle have, have-not approach to health

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Provinces battle have, have-not approach to health

January 11, 2012 - 4:35am By MARILLA STEPHENSON

Premier Darrell Dexter responds to recommendations by Dr. John Ross on emergency health care at a news conference Dec. 7 at the Middle Musquodoboit Hospital. (ERIC WYNNE / Staff / File)

The divide-and-conquer strategy has long proven to be highly successful in getting Ottawa past sensitive issues with the provinces.

So why is anyone surprised that Prime Minister Stephen Harper would use it to blow his way through the political minefield of a new health-care funding deal? Regional economic disparities, provinces that chafe under the yoke of federal control often attached to funding deals and mixed reviews of constitutionally dictated, similar-levels-of-service principles have been fertile ground when it comes to brewing discontent among the provinces.

Throw any federal program on the table and one can be certain the chances of unanimous support among the provinces will be slim. Youth crime, child care, employment insurance — take your pick.

The motherlode of all issues has remained health care, decade after decade, election after election — at least until last month. The provinces were girding for battle at a federal-provincial meeting, held in December to discuss a new funding plan, when Finance Minister Jim Flaherty tossed the pigskin on the field, then left the stadium.

The new deal — not that there was any negotiating — is basically a no-strings funding arrangement that will honour Harper’s commitment to increase health transfers by six per cent until 2016. After that, increases will be linked to inflation and gross domestic product.

Nova Scotia Premier Darrell Dexter, among the half of Canadian premiers who are unhappy with Flaherty’s approach, is headed west this weekend for a premiers meeting where the federal position on health care will dominate the agenda.

Dexter, representing a small province that has the oldest population in the country, is correct to complain that funding based primarily on a per-capita formula will make it impossible for Nova Scotia to offer service levels that will be enjoyed in richer provinces.

The economies of scale that come from a larger population won’t exist and the needs of our aging population combined with high rates of disease incidence are already placing heavy burdens on the provincial system.

Provinces that will be hurt by the new federal approach are banding together in an effort to force Flaherty to reconsider the December package. Led informally by Ontario’s Dalton McGuinty, the group of mostly eastern provinces are pushing the commitment in the Constitution to relatively equal service levels and the principles of the Canada Health Act:universality and publicly funded care.

Sustainability has repeatedly reared its head in federal-provincial health-care discussions. Ottawa has in previous agreements tied funding to contentious issues such as wait times as a means to press provinces to change the way they deliver care.

As for serious structural change, it has been hard to come by. Complaints remain that there is too much administration, too much kowtowing to the demands of a labour- and physician-controlled systems that have been slow to evolve.

The federal position represents a hands-in-the-air withdrawal that will leave provinces to sort out their priorities, with little likelihood of a unified front. Indeed, the Harper Conservatives are counting on this.

Dexter is fighting the good fight on the formula question but there is restructuring work to be done.

Simply cutting funding to numerous health authorities, even as costs for labour contracts continue to climb, specialist-driven care continues to dominate and wait times issues are massaged into submission, is not the only answer.

The restructuring of the emergency medicine system with a so-called collaborative care approach was a major first step for which the Dexter government must be congratulated. But it can’t stop there. Proactive health care that shifts the focus to a patient-centred approach long before expensive, ongoing specialist care is needed must be the new model.

But that doesn’t help for folks who are already sick. Falling down on frontline care for those who need the system now, and who will need it in the decade ahead, will be unacceptable to most Canadians.

Dropping the ball and shifting the focus to squabbling provinces may seem like a fine political strategy for the still-new Conservative majority right now. But they should proceed with caution and listen to provincial concerns about equitable care.

That’s because health care, as previous federal governments have often learned the hard way, is an issue that can come back to bite when political leaders least expect it.

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