Voter beware

He hasn't often been considered by the media to be one of the Cons' weaker ministers - and indeed is being talked up as a possibility to clean up the mess Gordon O'Connor has made of Defence. But Tony Clement has managed to be the culprit in a least a couple of seeming question period gaffes which haven't managed to win media attention. And he may have topped them all in another exchange with Penny Priddy to finish off the spring session:

Ms. Penny Priddy (Surrey North, NDP):
Mr. Speaker, there has been tainted carrot juice, spinach laced with e-coli, dog food that leads to severe health issues and death. Now we find that ordinary Canadians have been exposed to counterfeit toothpaste and other personal hygiene items. Canadians are quickly losing confidence in imported foods and personal items.

With bad trade deals and understaffed inspectors, the government does not seem to grasp the severity of the issue. Releasing warnings to the media is not enough.

Why has the minister not taken the Consumer Products Association's advice and made importers responsible for the contents of their goods?

Hon. Tony Clement (Minister of Health and Minister for the Federal Economic Development Initiative for Northern Ontario, CPC):
Mr. Speaker, this is indeed a serious situation. The hon. member is talking about the possibility of tainted toothpaste which has been available in the marketplace.

I can tell the hon. member that in fact we do have inspectors and investigators who are on the scene and who are busy analyzing the products to see whether there is any kind of health hazard. That is what we do. We are responding to this situation. Indeed, we do have staff who are involved in the counterfeit situation as well. They monitor to ensure that we have a response if counterfeit products do appear on our shelves.

The best advice I can give until that investigation is complete is buyer beware.

Once again, it's surprising that Clement seems to have managed to escape much attention for what strikes me as an alarming statement. After all, Canadians concerned that unsafe products have found their way onto store shelves can only have all the more reason to worry now that the minister responsible has made it clear that in his view, it's their responsibility to figure out whether they've unwittingly bought harmful products.

Of course, it could be that the opposition is largely holding its fire from Clement in hopes that he'll still be available as a juicy target when they need one later on. And it seems likely that if actually moved to the Defence portfolio, he'd give Gordon O'Connor a run for his money in headline fodder.

But it's hard to see how that potential for future attacks justifies letting the Health Minister off the hook for saying that Canadians are on their own when it comes to product safety. And it seems likely that if Canadians knew just how far the Cons' laissez-faire philosophy seems to go, then voters wouldn't hesitate to start wondering how quickly they can trade Clement and his ilk in toward a different government.

False responses

The story didn't make the headlines out of yesterday's Question Period. But it's worth highlighting that Tony Clement has explicitly taken the side of the False Creek patient-funded clinic in claiming (with little basis) that it doesn't violate the Canada Health Act:

Ms. Penny Priddy (Surrey North, NDP):
Mr. Speaker, the False Creek Urgent Care Centre in B.C. is back in business, charging patients hundreds of dollars for basic medical services that should be free. This American style clinic is the exact opposite of what Canadians expect from our health care system. It should be illegal, but the clinic has found a loophole that allows it to stay in business.

Every Canadian has the right to free, universal health care when they need it most, regardless of whether or not they are carrying their chequebooks. Will the Conservatives take action today and put an end to clinics that charge patients for medically necessary urgent care services?

Hon. Tony Clement (Minister of Health and Minister for the Federal Economic Development Initiative for Northern Ontario, CPC):
Mr. Speaker, nothing could be further from the truth. Indeed, we are reviewing the situation of this clinic, but upon first blush by the minister of health of British Columbia, it is violating no laws in British Columbia, violating no principles of the Canada Health Act...I see no double standard in that.

So let's see what the Canada Health Act actually has to say. First, let's look at the definition of "insured health services", whose importance will become clear shortly:

“insured health services” means hospital services, physician services and surgical-dental services provided to insured persons, but does not include any health services that a person is entitled to and eligible for under any other Act of Parliament or under any Act of the legislature of a province that relates to workers' or workmen’s compensation;

In effect, any and every medically-necessary service rendered to an "insured person" (i.e. resident of the province) is included within the definition, except where payment is provided for under other legislation.

Which is important on a look at one of the Canada Health Act's five core principles, being that of comprehensiveness:

9. In order to satisfy the criterion respecting comprehensiveness, the health care insurance plan of a province must insure all insured health services provided by hospitals, medical practitioners or dentists, and where the law of the province so permits, similar or additional services rendered by other health care practitioners.

The emergency services provided by the False Creek clinic are plainly "insured health services" provided by medical practitioners, and equally plainly not covered by B.C.'s health insurance plan. Which would seem to make for a glaring violation of section 9 of the Canada Health Act.

And the apparent violations don't stop there. Here's the first part of the accessibility principle:

12. (1) In order to satisfy the criterion respecting accessibility, the health care insurance plan of a province

(a) must provide for insured health services on uniform terms and conditions and on a basis that does not impede or preclude, either directly or indirectly whether by charges made to insured persons or otherwise, reasonable access to those services by insured persons;

(b) must provide for payment for insured health services in accordance with a tariff or system of payment authorized by the law of the province;

It should be apparent that the False Creek billing system both isn't on uniform terms and conditions to those applied elsewhere, and isn't one "authorized by the law of the province".

So we have two sections of the Canada Health Act apparently violated - and that's dealing solely with the "principles" part of the act (which Clement appears to have deliberately referred to) rather than the sections which specifically deal with extra-billing and user charges. For added fun, the prohibition against user charges is violated even more clearly:

“user charge” means any charge for an insured health service that is authorized or permitted by a provincial health care insurance plan that is not payable, directly or indirectly, by a provincial health care insurance plan, but does not include any charge imposed by extra-billing.

19. (1) In order that a province may qualify for a full cash contribution referred to in section 5 for a fiscal year, user charges must not be permitted by the province for that fiscal year under the health care insurance plan of the province.

Of course, Clement himself holds the only available means of holding B.C. accountable for the current Canada Health Act violations going on within the province. And Clement has left no doubt that in addition to having prejudged the outcome when it comes to the False Creek clinic, he has zero interest in allowing his department to do its job by holding violators accountable.

That said, the fact that there may be no formal means to force Clement and his department to carry out much-needed enforcement doesn't end the matter. Yesterday's response offers just one more example of the Cons being entirely happy to take the side of privatized health care even while claiming to support the Canada Health Act. And if Canadians are informed of just how dishonest the Cons are being on the health file among others, that can only help the chances of preventing them from holding office for long.

More medical negligence

The story surprisingly seems to have been overlooked following Tuesday's Question Period. But Tony Clement has apparently backed off even the Cons' meek initial response to Quebec's plan to facilitate health care double-dipping, leaving any enforcement of the Canada Health Act to the same provincial government which has already indicated its intention to allow patients to pay their way to the front of the line:

Ms. Penny Priddy (Surrey North, NDP):
Mr. Speaker, public health advocates are worried about a wait times plan in Quebec that will have far reaching effects. The new legislation would create a new industry in Quebec: for profit hospitals being paid for by public money. The health minister must immediately take steps to protect our public medicare system. What action has he taken so far?

Hon. Tony Clement (Minister of Health and Minister for the Federal Economic Development Initiative for Northern Ontario, CPC):
Mr. Speaker, as the Prime Minister indicated during the election campaign and as we have indicated as a government, we support the Canada Health Act and the principles of the Canada Health Act which include universal accessibility and universal coverage.

I had a conversation with my Quebec counterpart this morning. He is investigating the situation involving a Montreal clinic. I have every confidence that the Government of Quebec will support the Canada Health Act and universal accessibility.

In case there's any doubt, that's the same Quebec counterpart who's himself responsible for the legislation which formed the subject matter of Priddy's question. Which means that in addition to failing to respond to the question (though in fairness, the diversion was atypically from one relevant issue to another), Clement's answer signals that the Cons are perfectly content to let the provinces have the sole say as to whether or not their health-care schemes meet federal standards.

And that would be bad enough if the problem was merely the Cons' dereliction of duty. But then there's also the question of whether there's any reason for "confidence that the Government of Quebec will support the Canada Health Act". So let's take a look at what Couillard's office has had to say as to what standards it's concerned about:

When asked whether such fees were legal, an aide to Health Minister Philippe Couillard responded that the new law will resolve the question.

"Under Bill 33, accessory fees will be outlined in detail - what can be an accessory fee and what cannot," said Isabelle Merizzi.

In other words, Clement is entirely willing to leave the enforcement of federal standards to the judgment of a provincial government which (a) doesn't even consider those standards to be relevant to the question of what is and isn't legal, and (b) is itself responsible for one of the two likely breaches of federal law in question (and indeed the one which Clement was asked about initially).

Needless to say, any continued neglect by the federal government can only damage single-payer health care in Canada - both by allowing private funding to take a larger role, and by signalling to provinces that they can ignore the Canada Health Act with impunity. Which means that Priddy, the NDP and anybody else who values universal accessibility should be doing everything possible to highlight the danger both in Couillard's legislation, and in Clement's complete refusal to do anything other than pass the issue off to the source of the problem.