MPs have some light reading on the Canada Health Act (CHA) coming their way.
The acts annual report to Parliament is due on Feb. 15. This years report, if recent reports are a guide, will be missing key information about the growth of private, for-profit health care services. The information will simply not be there.
These annual reports should be the best way for MPs to monitor the status of our public health care system. Provinces are obliged to provide data on, among other things, the number of private, for-profit facilities and the total payments being made at these facilities.
But in page after page, for province after province, this crucial information is listed as not available.
How much money is being spent at for-profit facilities? Not available. How many private, for-profit clinics are there? Not available. How many publicly-insured services are being provided at private clinics? Not available.
Not available?
This means that governments, which in 2004 spent $91 billion of the $130 billion spent on health care in this country, are not following the reporting mechanism that the CHA demands in law. The provinces arent reporting, and the federal government is not enforcing. This should send chills up the spines of both citizens and auditors.
MPs concerned with accountability in government spending should take notice, for fiscal reasons alone. As privatization spreads, the seriousness of this lack of oversight will only make the sponsorship scandal look like a garage sale by comparison. In a single-payer system where the public system pays for private services, public money would go straight to private corporations with nobody keeping track.
We need MPs to keep track. MPs will recall that Minister of Health Ujjal Dosanjh pledged, shortly after his appointment, to stem the tide of privatization. He has his work cut out for him.
Private diagnostic and surgical clinics continue to operate in most provinces, with Quebec, Alberta and B.C. being the most active on this front. So-called public-private partnership (P3) hospitals have been approved and are in construction stages in Brampton and Ottawa, as well as in Vancouver and Abbotsford. Two major teaching hospitals in Quebec are slated to be P3s as well.
Alberta Premier Ralph Klein is campaigning for a third way, his latest code for more private, for-profit care, despite no evidence backing the claim that private delivery will lessen the public systems waiting times. The premier himself recently acknowledged that surgeries contracted-out to private clinics cost 10 per cent more. Klein often rants that the public health care system is unsustainable, but why is he now willing to pay more for a private one?
It is true that Health Canada is monitoring and investigating some provincial actions. However, the only area of the CHA that has ever been enforced are the prohibitions against user fees and extra billing, whereby small amounts of money have been deducted from transfers. The federal government fined the B.C. government $126,000 for allowing patients to pay for surgeries at private clinics in 2004.
But, notably, penalties have never been levied against a province for contravening one of the principles of the act (universality, accessibility, public administration, portability and comprehensiveness). No province has been taken to task, for example, for limiting comprehensiveness by de-listing an insured service.
In the past, Cabinet had the final say on violations of the act and approved dollar-for-dollar reductions from transfers. A new process, established in April 2002 and re-affirmed in September 2004, takes non-compliance issues out of the legislative and public realm and into the backrooms. Legislation loses out to politics the politics of chequebook federalism.
Federal and provincial/territorial relations are now foremost in any consideration of health care, and these have been reduced squarely to haggling over money. How the money is to be spent, through public or private delivery, is simply not on the table, as Canadians saw with last falls open meeting between Prime Minister Paul Martin and the premiers. The provinces will spend federal dollars as they see fit. The federal government will just hand over the cash.
The fact that only the federal government can enforce standards across the country led CUPE and others to take the Minister of Health and the federal government to court for the lack of monitoring, enforcing, and reporting on compliance with the CHA. Last fall, Mr. Justice Mosely of the Federal Court said our legal challenge raised matters of important public policy, but concluded that its parliamentarians who must hold the Minister accountable.
Perhaps the best tool MPs have is the CHA annual report. MPs must press the federal government to be accountable for public spending on health care and for the services provided under the act. We need MPs to take a good look at the report tabled next week.
If the report says, again, that information on the growth of for-profit health care is not available, MPs should conclude that this is not acceptable.
Next week, MPs can hold up the annual report to the light of day. Will it be full of accurate information, or full of holes?
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Paul Moist is the national president of the Canadian Union of Public Employees (CUPE)
CUPE is Canadas largest union, with 540,000 members providing public services in communities across the country, including 140,000 members who work in the front lines of the health care system. CUPEs health care workers include nurses, technicians, laundry and housekeeping staff, porters, home care workers and emergency medical services workers.