Merci.
I am a visiting scholar at the McGill Institute for Health and Social Policy and a political scientist at McGill University.
Ladies and gentlemen, thank you for inviting me to speak about health care, which is an important issue for me, since I have focused most of my research on it, as a political scientist, but also because of its important place in Canadian political life and the life of all Canadians.
I would like to focus on three points that I welcome you to explore further during the question period: first of all, my general impression of this 10-year agreement, with respect to the broader public debate on health care reform; then, the positive aspects of this 10-year plan; and, finally, the issues to be resolved.
On September 15, 2004, I was in Ottawa with many of you, attending the First Ministers Conference which, very late in the night, resulted in an agreement setting out the parameters of the 10-year Plan to Strengthen Health Care. What struck me, as both a political scientist and observer at the conference, was the lack of trust, among provincial and territorial representatives, of their federal counterparts—and vice versa—but, at the same time, the realization by First Ministers of the political significance of this issue. In other words, one had the impression that the political leaders had finally understood that, in spite of the constraints and problems associated with this in economic, legal and logistical terms, this was an issue of fundamental relevance to all Canadians.
The reason why the 10-year plan of 2004 is so important is that it came on the heels of a remarkable trend in Canadian attitudes about health care, from exceptionally positive majorities supporting public health insurance and the health care system in the early 1990s to a rising trend of uneasiness and insecurity about the system's sustainability.
Was there a crisis? Well, there had certainly been a squeeze on public finances that had exposed some of the weaker elements of the organization and financing of health care systems. But my colleagues and I, among them Stuart Soroka, who wrote a report on public opinion for the Health Council of Canada, have qualified this crisis as more of a crisis in confidence, one born of a growing disillusionment with political leaders in terms of their capacity and willingness to address the problems that seem to wrack the health care system.
This was something that persisted despite the myriad number of provincial health care reports and even the Commission on the Future of Health Care in Canada's report of 2002. The paradox is that most Canadians are satisfied with the care they receive but are uneasy about the future. They are also concerned about specific issues, namely, emergency room overcrowding, waits to see specialists, and wait lists for specific services.
This brings me to my second point. What has the 10-year plan done to alleviate some of these concerns? The positive aspect is that it was signed, which I guess is proof of some goodwill in some corner of this place we call Ottawa. For observers of health policy, though, the good news is that the 10-year plan was based on strengthening health care through a series of concrete measures that were accompanied by the much-needed security of multi-year funding.
I am not one of those who thinks it's only about the money, but certainly a reinvestment in health on the part of the federal government could be seen as a positive development for provinces trying to put their own financial houses in order.
The measures that were raised in this 10-year plan are not minor affairs. As the other witnesses have said, they spoke to needs as varied as human resources, home care, and public health, as well as the needs of specific populations and the more general commitment to accountability and transparency.
The emphasis on wait times was a clear message to Canadians that their personal concerns were being heard and addressed, and in the years since there has been a noticeable commitment on the part of most provinces to primary health care reform and to better management of wait times in specific areas, which can be seen, at least in part, as facilitated by the commitment of the 10-year plan in this regard.
Thirdly, and to conclude, the plan was also problematical in a number of areas. It is important to recognize that we are talking about areas that are fairly complex and quite difficult to reform and reconcile. However, the First Ministers' Plan had the benefit of at least recognizing that they are all interrelated, when it comes to health care, and that you cannot address one part of the problem without confronting the realities of another. From a political standpoint as well, I believe that recognition of the asymmetry of the arrangements made with Quebec was also appropriate. For the first time in a long time, Quebec was included in the wording of the agreement, rather than in parentheses or in a footnote, as some of my colleagues would say.
However, these same advantages may have undermined the scope and success of the plan. First of all, the political focus on waiting times seemed to strengthen the perception that waiting time is equivalent to access to health care—a perception that continued to be prevalent when the Supreme Court handed down its ruling in the Chaoulli case. And yet, it is clear that waiting times for a particular service are only a symptom of the problem—organizational or financial—and not necessarily the real problem.