On healthy choices

There's little doubt that the consensus on continued boosts to the federal government's health transfer from 2014 onward takes at least part of the health-care debate off the table. But notwithstanding that basic level of funding, there are still some highly significant points of distinction between the parties - and it's worth pointing those out in advance of the debate which will pit their visions against each other.

First, there's the question of how any given party will influence health-care costs. And while one would think that any reasonable perspective would involve trying to minimize costs to ensure the maximum possible return on federal funding, there's a radical difference in philosophies in the area where the federal government can most directly affect the prices available.

Not long after taking power, the Cons started inflating brand-name prescription drug costs with needless giveaways to the pharmaceutical industry. And they're now promising a free trade agreement with Europe that would inflate costs by billions more - eating up at least some chunk of the continued federal funding increases, along with plenty of private money.

In contrast, the NDP has fought against those types of giveaways at every turn, and promises to use national purchasing power to look for billions in possible savings. Meanwhile, for those looking for a party to go in both directions on drug costs, the Libs are both promising a national purchasing plan, and backing the CETA-linked giveaway.

The second area worth pointing out is the role played by the federal government in enforcing the Canada Health Act. Here, the Cons have taken an entirely laissez-faire view, ending all federal enforcement so that any accountability based on the principles of universal medicare relies solely on provincial self-reporting. Which makes sense given their general attitude that the federal government doesn't have any direct role to play in health care.

While the Cons work to render the Canada Health Act irrelevant, there's also a difference of view between the NDP and the Libs as to what to do with it. The Libs have paid at most occasional lip service to the idea of making changes to deal with innovations in private health care, while the NDP has long been pushing to strengthen the Canada Health Act to deal with double-dipping and other means of using public money to subsidize private health care.

Finally, while the parties have come to agreement on the escalator clause, it's well worth noting that there are some other substantial platform planks that involve separate investment in health care. The Cons have offered up a minimal amount of funding to move doctors and nurses to rural areas; the Libs have money booked for a similar program as well as a Canadian Brain Health Strategy and a tax credit for home care; and the NDP's platform includes funding to train and recruit doctors and nurses, dedicated transfers for home care and long-term care, and money for prescription drugs and mental health services.

So even if the transfer to the provinces looks to be locked in for 2014 and beyond, there's still plenty to choose between Canada's federal parties on the health care front. And the choice should be clear for anybody who wants to see the federal government take the lead in making better health care more accessible to Canadians.