When someone tells you it’s about values, it’s often really about money. Canada’s cultural community has played that card for years, so have the nation’s farmers. Both groups depend on the public purse for survival, and each insists that it is part of no average industry: Without us, the nation would wither. And this often works in prying lose more government funding.
So, too, with Roy Romanow’s report on health care, titled “Building on Values.” Mr. Romanow insists that medicare is not just any old government program, and most Canadians would agree. But he goes further, turning it into a talisman of Canadianism: It’s a defining feature of the country, and a critical factor in making Canadians different from their American cousins. (Which raises the question, incidentally, of what would be left of Canadian distinctiveness if Al Gore actually runs and wins the presidency in 2004 on his new plank calling for a universal, single-payer health-care system.)
But medicare is not Canada’s international calling card. No country looking to design a health-care system would use it as the model. Rather, fiscal prudence is becoming the country’s most important attribute.
Mr. Romanow would call a halt to that; a rather remarkable stance for the man who, as he himself emphasized last week, was the first provincial premier to balance the books after the 1990-91 recession. He’s now the man who would eat the surplus.
The federal government has sought to change this country’s image, from the “northern peso” affront of the mid-1990s to the “northern tiger” accolade that, while premature self-flattery, is accurate enough in headlining that Canada is moving in the right direction.
Canada is the only major industrialized nation with a budget surplus. Ottawa can’t brag about it often enough. When international publications like The Economist continued to give Canada short shrift (which was for the best through the bad years), government officials even began writing letters to London to draw attention to Canada’s new fiscal record.
The United States has turned a $127-billion (U.S.) surplus in 2001 into a $157-billion deficit in 2002. Britain expects a deficit of $37-billion next year, double its estimate of a few months ago. Germany and Japan don’t have much good to report, either.
Finance Minister John Manley, meanwhile, projects a surplus of $1-billion (Canadian) this year and $14.4-billion through 2005 (not including contingency funds for emergencies). But it still wouldn’t be enough to withstand Mr. Romanow’s view that the health-care system requires $15-billion more over the next three years, and $6.5-billion annually after that.
Prime Minister Jean Chrétien and Mr. Manley have vowed that the federal books will not be pushed back into deficit. But even if they agree to just part of what Mr. Romanow wants, there won’t be much room for other priorities — the social agenda set out in September’s Speech from the Throne, nor the additional defence spending the Prime Minister has suggested is coming. The business community also won’t stop campaigning for additional tax cuts; the Commons finance committee backed it last week, urging Mr. Manley to eliminate a capital levy which brings in $1.5-billion annually. Canada still imposes a tax on the productive use of capital. Now, that’s no tiger.
Mr. Romanow’s medicine might go down easier if it was focused more closely on reform. But his main prescription is additional money to service the public better.
There’s plenty in the report that’s worthwhile. His support for limited home care and pharmacare programs is well-reasoned. His opposition to the private provision of health care appears to be largely rhetorical. He doesn’t like it but he wouldn’t force a halt to it, so long as the services are paid for out of the public purse.
But his report still focuses more on equity than effectiveness.
The risk now is that Ottawa and the provinces are going to cook up just the kind of deal they did in 2000. Then, it was a five-year package that added more than $23-billion to the health-care pot — roughly a 7-per-cent increase in public funding.
More money, no more reform. Mr. Romanow, who was Saskatchewan’s premier at the time, seems a little apologetic about that. But the same easily could happen when Mr. Chrétien meets the premiers early next year.
It’s hard, after all, to tamper with what amounts to a state-run religion.