The Canada Health Act is often considered a third rail of Canadian politics. Politicians who dare speak of reforming, let alone repealing, it are labelled radical at best or anti-Canadian at worst. We are stepping into that breach by arguing it is time to replace the act with a more responsive series of provincial laws. This will strengthen accountability and allow provinces seeking more autonomy in Confederation, like Alberta, to lead and not leave.

In the current situation, provinces blame Ottawa for insufficient funding, Ottawa blames provinces for poor delivery, and citizens are left trying to determine which level of government is responsible for which failure in a system both claim to run but neither fully controls.

Universal public health care is a fundamental part of Canada’s political culture. But the Canada Health Act is not the paragon of public health care its defenders make it out to be. It is a funding statute with narrow scope and weak enforcement. In practice, it does not guarantee timely access, cover all important services or hold governments responsible when care models break down. Defending quality health care in Canada means kicking our dependence on the Canada Health Act and insisting on a higher level of accountability and decentralized authority than the legislation can provide.

Canadians started down this path decades ago.

Federal transfers have already become more decentralized

Under prime ministers Jean Chrétien and Stephen Harper, Canada moved toward a more decentralized, mature model of fiscal federalism. Reforms to major federal-provincial transfers increasingly recognized that provinces have different priorities, socio-demographic pressures and approaches to delivering public services. The federal government’s role became less about directing provincial policy or establishing one-size-fits-all national programs and more about ensuring that Canadians, wherever they live, benefit from a fair distribution of federal funds and comparable levels of service.

 Chrétien and Harper reforms were all good things for a more decentralized Canada – and they gave all provinces, including Alberta, more autonomy over their own programs. Reducing conditions on federal transfers in areas of provincial jurisdiction is one way in which Alberta has found a way to lead, not leave Canada. This spirit of open federalism was abandoned during the years Justin Trudeau was prime minister. But the underlying logic remained reflected in equalization. Have-less provinces continue to receive equalization payments without any federal conditions on how the money must be spent. We trust provincial governments to make those decisions, and we empower legislatures, citizens and courts to hold those governments accountable for the........

© IRPP - Policy Options