As you meet in Winnipeg to discuss the future of Canadas health care system, I am writing to remind you that Canadians are watching your actions closely to ensure that the promise of the first ministers agreement is fulfilled. Canadians expect the health ministers to implement policies and programs to strengthen and enhance public health care.
Your meeting, the first since the agreement reached on September 11, is key to establishing the ground rules for the future.
The $21 billion allocated to health over the next five years, while welcome new dollars, are not sufficient to make up for previous cuts to the Canada Health and Social Transfer. The fact that none of the new money will be applied to the base of the CHST until next year means that todays problems including hospital re-directs, cancer care or waiting lists for diagnostic treatments are unlikely to be fixed. With large surpluses at both the federal and provincial levels, Canadians will not be satisfied to wait until next year.
I encourage each of the provinces to put a priority on spending for health care rather than spending on tax cuts. Polls have consistently shown that Canadians do not want tax cuts as much as they want improved health services.
In the longer term, how the money is spent is critical. Money should be spent on providing care to patients. That is what Canadians want and expect. They do not want health care dollars to end up in the pockets of private corporations in the form of profits. Instead, they want programs which deliver home and community care, acute care services, long term care, palliative care, assistance with the high cost of prescription drugs, and health promotion programs to their loved ones. In a time of swelling surpluses, it is not too much to demand.
In your deliberations over the next days, I ask you to consider actions that will stop and reverse the privatization of health care. I ask you to allocate more money for all types of health care starting with a re-investment in acute care. I ask you to rebuild the public health care system and expand it to include a home and community care program with national standards and guidelines, and a national drug plan to deal once and for all with the skyrocketing costs of drugs. A workable national health information system must also be developed to provide information which benefits patients and has the necessary fire walls to ensure privacy. Health information systems should not be designed to assist drug and insurance companies with their corporate business strategies.
I know that you will be considering primary care reform during your meeting. It is crucial that these reforms not play into the hands of those who wish to introduce managed care through HMOs similar to those in the United States. Primary care should not be about rostering (requiring you to sign up with a particular provider) and capitation (providing funding to the provider based on the number and type of people signed up). These approaches provide the basis for American style for-profit health care and reduce choice and access by restricting the point at which an individual can enter the system.
Rather, primary care should be about providing health care to Canadians where they need it and when they need it on a not-for-profit basis. There are many sound principles on which a made in Canada primary care program should be based. Programs should employ multidisciplinary teams of health care providers (physicians, nurse practitioners, registered practical nurses therapists, social workers, counsellors, nutritionists, optometrists, dentists, etc.) located in one easily accessible site, 24 hours a day and 7 days a week. They should be allocated global budgets in order to provide the services most appropriate to the community they serve. Democratic governance structures should be put in place to ensure that primary care meets the needs of the community.
All health providers should be paid a salary rather than be paid on a fee-for-service basis. People should be treated as whole persons within the context of their families, communities and workplaces. Primary care centres should be the lynch pin of continuity in an individuals health and social well-being. The primary care centre should be integrally linked to acute care, long term care, home and community care, dental care, eye care, pharmacies, and social services.
Some of these primary care locations already exist in community health centres across Canada. The challenge now is to secure the principles of this model and to establish them in the appropriate institution or location within each community. For example, an existing community health centre may already be the appropriate location or, if the local hospital is the hub of health care in a community, then it would be appropriate to have primary care located in and affiliated to the hospital. New facilities will have to be developed where they dont already exist.
Finally, I implore health ministers to be cognisant of the serious trade implications of their decisions. Opening up areas of Canadian health care to private provision of services will open the doors to international for-profit corporations under NAFTA. Health care is not a commodity to be bought and sold in the marketplace. Provision of health care services are most efficiently and effectively delivered within a publicly funded and publicly delivered system. Wrong decisions on these matters will have disastrous consequences.
For some time, we have heard promises that there would be public debate and input at critical points in the process of rebuilding our health care system. Unfortunately, consultation with the public has never happened. Rather, first ministers, health ministers and bureaucrats have made the decisions behind closed doors without consultation and seemingly without paying attention to the desire of Canadians to strengthen our public health care system. Moreover, the recommendations of an acknowledged group of experts in health economics and policy, the National Forum on Health, have been ignored. The recommendations made by the National Forum on Health are consistent with the positions I am presenting to you in this letter. They should not be passed over a second time.
It is time to listen to Canadians about what they want in a health care system and stop listening to nay-sayers who have no vision and are narrowly focused on the bottom line.
Had we listened to those people in the 1940s, a hospital insurance act would never have been proclaimed in Saskatchewan, a national Medicare program would never have been enacted in 1966, and the Canada Health Act would never have been passed in 1984. Had we listened to those people then, we would not now have a public health care system worth fighting for. If we listen to them now, we will not have a public health care system in the future.
Over the next days and months you will be shaping the future of our health care system. Canadians will be watching and holding you to account.
c.c.Prime Minister of Canada
Provincial or Territorial Premiers
CUPE National Executive Board