Monday, September 01, 2014

On healthy proposals

Paul Wells seems quite disappointed not to have received more attention for his recent piece on Thomas Mulcair's speech to the Canadian Medical Association. So let's take a closer look at why the angle Wells took didn't seem like much of a revelation - and what might be more significant in Mulcair's plans.

At the outset, I don't see much basis for surprise that after consistently and rightly criticizing the Cons for their health-care funding choices, Mulcair would follow up by saying he'd act differently if he had the power to do so. Which means that the headline promise highlighted by Wells is best seen as the flip side of the NDP's oft-used policy currency, not some significant new discovery. 

Now to be fair, we may not be able to take for granted that a party's opposing a policy in opposition represents a commitment to reverse it while in government (see: cuts, GST, and their omission from subsequent opposition party platforms). And indeed the Libs are following that same pattern when it comes to Harper's health-care slashing: they won't hesitate to criticize the Cons' funding cuts explicitly and implicitly, but they apparently don't want to commit to doing anything differently.

But it's hardly news that the NDP has questioned the combination of cuts to anticipated health care spending, and the Cons' less equitable distribution of the money they'll deign to put into the health care system. And Mulcair is calling only for a return to the exact level of increases already offered by past Libs and Con governments alike - which, even if continued, still figured to do little more than restore the federal government to half of its past role in funding the existing health care system.

In other words, if we've defined a "big directional policy announcement" downward to the point where incrementally-increased federal funding qualifies (particularly if accompanied by no expectation of associated policy outcomes as suggested by Wells), that would say far more about how little we've been trained to expect from our federal government than about any drastic impact from Mulcair's speech.

Fortunately, it's not clear that Wells has any basis to suggest that Mulcair's plans don't involve some meaningful policy choices beyond turning on the funding taps slightly more:

Or for those who want part of the speech in writing, here's Barbara Sibbald's report from the same speech:
An anticipated budget surplus in 2015 should be used to cancel proposed cuts to health care, maintained Mulcair.

While money may not be the solution for problems facing health care, it is "definitely a necessary precondition," he said. "Mr. Harper, it's time keep your word to protect Canadian health care."

In keeping with an underlying theme of the annual meeting, Mulcair pointed to seniors care as a primary health care challenge and later told reporters that he favours a Royal Commission on physician-assisted suicide. The NDP is the only federal party with a national strategy for seniors care, including a policy on aging and palliative care.

In his speech to CMA, he quickly moved on to other challenges, criticizing federal cuts to refugee health as "cruel and thoughtless."  

He also decried the "awful" state of some First Nations' reserves and food security in Canada. "It's totally unacceptable… that 800 000 children go to school each day without having eaten." The NDP is the first federal party with a pan-Canadian food strategy.

On the topic of military health, Mulcair slammed the government for shutting down nine Veterans Affairs service centres this year and pledged to reopen them if elected. 
So no, Mulcair isn't talking about handing over more money to the provinces while otherwise following in the Cons' laissez-faire footsteps. Instead, he's treating increased funding to the provinces as only a "precondition" to systemic improvement - pointing specifically to Libby Davies' report which discusses how federal investments can be used to change health care delivery for the better by agreement with the provinces.

Meanwhile, Mulcair also highlighted a far more significant role for the federal government in meeting its own responsibilities. And he connected health funding to a number of other related issues which the Cons tend to keep in their own silos, reflecting the NDP's recognition that public health necessarily involves more than hospitals and doctors' offices alone (including a direct mention of studying the social determinants of health).

Which is to say that while restored transfer payments may reflect bigger headline numbers, they're far from the only departure from the philosophy of Canada's federal governments, in some cases dating back several decades or more. And if there's a clear point of distinction we should draw from Mulcair's speech, it's the NDP's belief that the federal government can and should play a positive role in creating a healthier society.

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