ca
http://umanitoba.ca/outreach/evidencenetwork/archives/4929
We call our system single-payer to distinguish it from systems where governments own and operate almost all aspects of the delivery system. In the late 1940s, for example, the government of the United Kingdom took over the ownership of all hospitals when it introduced the National Health Service (NHS). Far from an ideologue, Douglas never intended the government to own or control all aspects of delivery as long as there was accountability for public funding back to elected legislatures. This brings me to the third essential dimension, what I will call the Douglas-Diefenbaker-Pearson legacy; and that is the federal-provincial nature of universal medicare in Canada. This is a system in which the provinces are responsible for managing their respective system, while the federal government is responsible for providing the provinces with the incentive to adhere to a few common standards. This is no micro-management. Moreover, not one of the five principles of the Canada Health Act prevents the provinces from being more entrepreneurial in the delivery of higher quality and more timely health services. Even under the current system, provinces cannot be forced to comply with national principles, such as portability; instead, they are induced to do so by federal cash transfers and the possibility of their partial withdrawal. But surely this is the minimum we should expect from the provinces for the billions of dollars they receive in federal health transfers. Without this minimal federal role, the terms of access to health care will vary from province to province and portability will become a sham. This is precisely what we are in danger of losing, as successive federal governments provide cash transfers for health care with little or no concern for ensuring the integrity of the principles of the Canada Health Act. On this, more than ever, we need Douglas vision, leadership and balanced understanding of our federation more than ever. Rather than go backwards to a time before medicare, we can focus on the more important business of reforming the health delivery system so that it will improve the quality of life for all Canadians, not just a privileged few. Gregory Marchildon is an expert advisor with EvidenceNetwork.ca. He is also a Canada Research Chair and professor, Johnson-Shoyama Graduate School of Public Policy, University of Regina, and former executive director of the Romanow Commission.