Premiers in Canada Meet on Health-Care

OTTAWA (CP) - Canada's premiers are about to show the nation how they really feel about Roy Romanow's prescription for health-care reform.

That's not the stated purpose of their meeting in Toronto on Thursday; their aim is to agree on a common approach for health-care negotiations with Prime Minister Jean Chretien in Ottawa on Feb. 4-5.

Premiers will likely focus their public comments on how much money they need from Ottawa, but they will be forced to clarify their positions on key aspects of Romanow's royal commission report.

"It's not just about money," said Maude Barlow of the Council of Canadians.

"For us, the debate is about whether we're going to keep a public system in this country or whether we're going to go the way of the United States, allowing the death of medicare by a thousand cuts."

One key sticking point between Ottawa and the provinces is the issue of accountability.

In his report, Romanow called for billions of dollars in new federal funding to the provinces for health-care.

But he emphasized that pouring money into the system will be useless unless it brings "transformative change." He suggested that greater accountability by provinces in the spending of health money is vital to that kind of change.

Most provinces argue they are already accountable for spending, for example through their public accounts and the reports of their auditors general. They say that any additional requirements would violate their constitutional rights, since they have jurisdiction over health care.

"Provinces have always been accountable to their own populace and to their own electorate," said Ontario Premier Ernie Eves last week.

"I think there's a great deal of accountability in the system already."

Dana Hanson, president of the Canadian Medical Association, said it's time for politicians to stop bickering and put patients first.

"This is an opportunity, the best we've had in 40 years," he said. "The time is right, let's not lose it."

Hanson said he doesn't want a rerun of the federal-provincial deal two years ago, when Ottawa turned over $23 billion to the provinces without requiring them to account for its use.

"We can't have another example of September 2000 where money was poured in (without) a strict plan on how it was going to be used.

"Here we are three years later and we're saying, 'Where did the money go and is the system any better?"'

Normand Laberge, president of the Canadian Association of Radiologists, agrees that accountability is a key issue.

Laberge has had great difficulty determining what happened to a $1-billion fund for medical equipment set up in the September 2000 agreement.

His association wrote to each province asking how the money had been spent, wrote to vendors of high-tech equipment about what had been purchased and went to court using access-to-information law in its effort to track the funds.

In the end, there was still millions missing - and millions more spent on routine purchases rather than high-tech equipment targeted by Ottawa.

"How come we had to go to court to get the listing of equipment? That's how come we found lawn mowers, sewing machine, delivery trucks, pressure cookers."

Stricter accountability is also needed to ensure provinces don't divert federal money to private health corporations, said Mike McBane of the Canadian Health Coalition.

He said the public is currently not able to see some of the contracts the Alberta government has signed with private corporations.

"That's the reason accountability is so important, it's the only way to ensure public health dollars are going to care and not being siphoned off to shareholders," said McBane.

"It's really the only lever we have to keep the public health-care system in place."

Hanson noted that pressure continues on some fronts for a two-tier health system and the politicians should realize that.

"Unless (premiers) put forward a clearly articulated implementation plan, then the whole question of privatization will indeed continue to be there and may gain strength."

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