Mulroney’s prescription for Canadian healthcare is not reform

Retired politicians often get their best press when they’re showing up their successors.

Former Progressive Conservative Prime Minister Brian Mulroney recently prodded current Prime Minister Stephen Harper to concentrate on the “big ticket items” and set up a   “blue ribbon panel of distinguished Canadians” to fix the financing of Canada’s burgeoning healthcare budgets. Click on: http://www.theglobeandmail.com/news/politics/ottawa-notebook/mulroneys-advice-to-harper-do-something-big/article1879648/

“We are facing a genuine, genuine problem of quite enormous dimensions,” Mr. Mulroney says. “We have a pretty good system here, but obviously the financing is completely out of whack.

“Someone has to provide some unbiased, thoughtful but effective leadership in the thinking on this,” he says. “Without some new thinking and some visionary approaches, health care is going to consume 70 to 75 per cent of provincial budgets.”

Classic Brian Mulroney.

Before teeing up for another favorable reference to his big ticket accomplishments, however, Mulroney could have acknowledged Harper’s radically different political circumstance. Mulroney himself went big on free trade with the US and introduced the Goods and Services tax in a majority parliament, after winning an electoral majority without reference to either issue. Indeed, in the election Mulroney was either silent on these latent issues or postured as a red-Tory nationalist.

While not always first to those issues that call for boldness, Mulroney has every right to offer bold advice and to be listened to carefully. Once committed to act, great projects did bring out in Mulroney great talent and resolve. Unfortunately, his advice on this occasion is not bold and, indeed, could lead to less change, not more.

Red Tories, like Mulroney, reflexively send big problems to Ottawa. They are the same as liberal Democrats in the US.  Once they see that a significant problem growing in every province in the country, they look for a federal response. However, in the case of healthcare costs Ottawa may, in fact, be the worst place to turn for effective solutions.

Fundamentally, the principal national challenge—universal access across Canada--has been long resolved. The federal government—through equalization payments and per capita health grants to the provinces—provides incentives and support to ensure each province maintains universal and portable healthcare services.

That federal contribution has grown with the growth of provincial costs and there is broad agreement that Ottawa maintain is share.

The provinces are almost entirely responsible for the delivery of those services and, as important, have the competence and political responsibility to manage the individual provincial systems.

In Ontario, for instance, the Ontario government operates a $47 billion health system and pays for approximately 80 % of the costs. A new national vision might end up simply increasing the federal share to above 20 % and, thereby, relieve the province of a fraction of the political and managerial challenge of keeping the system affordable and up to date.

Recent federal silence on changing the status quo, however, hasn’t necessarily been a bad thing. It’s now clearer in people’s minds that the provinces are actually responsible. And governments in Quebec, Ontario, Alberta and elsewhere are implementing and testing new ideas.

Other than re-opening demands for $billions more from Ottawa, Mr. Mulroney’s blue ribbon panel could actually distract the provinces and only confuse the public about who is accountable.