The Canada Health Act at 25: Time to Come to Its Defence

It’s an event I missed, but I wished I’d been there: the 25th anniversary of the adoption of the Canada Health Act. André Picard in The Globe and Mail didn’t forget though, and on Thursday wrote about a celebration in Saskatoon sponsored by Canadian Doctors for Medicare.

While Medicare has its roots in the Depression when Tommy Douglas led the way with a provincial hospitalization plan, the whole Canada-wide program was firmly anchored when the CHA was passed in 1984. It sets out criteria for provincial programs, and allows for penalties when they’re not followed: the Feds can deduct money from the funds the federal government gives to the provinces to support health care. The hitch is, as Picard points out, that federal governments of whatever stripe have not been very keen on applying the sanctions. Between 1984 and 2004, a total of $8.7 million was deducted although during that same period, public spending exceeded $1.1 trillion, Picard writes.

This is not because provinces haven’t breeched the act. Recently, in fact, they’ve been nibbling at the “free” part of the plans by allowing the charging of extra fees, particularly in private clinics. A report by the Canadian Health Coalition last October showed 89 possible violations in five provinces, yet nothing has been done to investigate the problems.

“The federal government - under the Conservatives as well as the Liberals - has abdicated its responsibilities under the CHA,” Picard says.

The only good thing in the picture, to my mind, is the talk at the recent NDP convention about the importance of expanding and strengthening Canada’s health system and to keep it public. Indeed, that pledge was Jack Layton’s culminating point in his closing speech last Sunday. Resolutions from riding associations calling for action to defend the health system were approved in preliminary sessions but didn’t make it to the floor for debate because of time limitations. They are supposed to go to the NDP National Council for consideration. Let’s hope they do and that the NDP takes up the cause vigorously. As Picard says, no other political party is doing that.

For the record, here are the five basic standards mandated by the CHA:

Public administration: The provincial health insurance plan must be administered on a non-profit basis, and audited;

Comprehensiveness: The provincial health-insurance plan "must insure all insured health services" provided by hospitals or physicians;

Universality: All insured health services must be provided on "uniform terms and conditions;"

Portability: Insured health services must be paid (at a rate set by the province) even if a patient is treated in another jurisdiction;

Accessibility: The provincial health-insurance plan must provide "reasonable access" to services and provide "reasonable compensation" to medical practitioners.