The role of the federal government is to provide cash transfers and research to facilitate the delivery of health care by the provinces and territories – not to dictate to them what services they should provide.
Federal Health Minister Leona Aglukkaq delivered that unequivocal defence of Ottawa's hands-off policy toward medicare in a speech Monday to the Canadian Medical Association general council meeting in Yellowknife.
"Decision-making about health care is best left to the provincial, territorial and local levels," she said. "As federal minister of health, I will not dictate to the provinces and territories how they will deliver services or set their priorities."
Ms. Aglukkaq said the federal government has provided long-term stable health funding in the form of the Canada Health Transfer – $27-billion this year and rising to $40-billion annually by 2019 – and given the provinces and territories the "flexibility to focus on areas of their priority." She also pointed to more than $1-billion annually in funding for health research and data collection provided to the Canadian Institutes of Health Research and the Canadian Institute for Health Information.
But physicians and opposition politicians alike rejected the minister's position and repeated earlier complaints that Ottawa is abdicating its leadership role in health care and fostering regional inequities that undermine medicare.
"There's a piece missing," said John Haggie, CMA president. "What Canadians have told us is … they would rather like some standards, equity and equitability across the country." He said the federal government has a role delivering health care to aboriginal people, the RCMP and the armed forces, as well as in public health and international health.
Further, Dr. Haggie said, Ottawa has an essential oversight role, ensuring that similar care is available across the country "whether it's Yellowknife or Corner Brook … and that void was never addressed by the minister."
The CMA also released polling data that not-too-subtlely rebuked Ms. Aglukkaq's position that Canadians are happy with the federal government's approach to health care.
Only 37 per cent of those polled believe Ottawa's role should be limited to funding while leaving delivery of care to the provinces. By contrast, 85 per cent of respondents said the federal government "should play a leading role in protecting and strengthening the health-care system." However, those surveyed were divided on who should take responsibility for improving the health system, with 50 per cent saying the federal government and 46 per cent the provinces/territories.
The telephone poll of 1,044 adults was conducted by Ekos Research Associates Aug. 3-9, and has a margin of error of 3 per cent, 19 times out of 20.
Opposition politicians and advocacy groups were also quick to condemn the Health Minister's position.
Libby Davies, health critic for the New Democratic Party, said the argument that Ottawa is merely respecting the provinces' constitutional jurisdiction on health care is a cop-out.
"Flexibility is a code word for lack of action, lack of leadership," she said. "The federal government's role is not just to provide money, but to ensure there is equity and fairness."
Hedy Fry, the Liberal Party health critic, accused the minister of "clever wordsmithing" to try to gloss over the fact that the "federal government is clearly abdicating its responsibility." She said the provinces and territories have always been responsible for delivery of health care, but Ottawa also has a clear role to level the playing field.
The hands-off approach is leading to the balkanization of the health system and the undermining of medicare, Dr. Fry said.
Robert Woollard of Canadian Doctors for Medicare accused Ottawa of abandoning national standards and turning its back on low-income groups who are being hurt by growing inequities in access to care. "The minister can't even pronounce the word 'equity,' " he said.
Ms. Aglukkaq seemed to anticipate the criticism, saying: "There's been a lot of negative, over-the-top rhetoric from individuals and organizations about the federal role in health care." She insisted the government was on the right track.
The Canadian Medical Association represents Canada's 76,000 physicians, residents and medical students. The group calls its annual general council meeting the "parliament of Canadian medicine."