01/27/2012 11:57 EST | Updated 03/28/2012 05:12 EDT

Without Universal Health Care, Who Are We?


If Canadians were being honest with themselves, they'd admit that socialized health care in this country is a myth. Our system is not a national one, it is governed by each province separately - the only "national" thing about Canadian health care is the financial assistance provided by the federal government ("assistance" being the operative word here - the feds only assist in the funding, they don't pay the whole thing). Even the terminology of Canadian health care -- "transfers" -- implies a decentralization of power from the centre to the edges. And, increasingly, private health care is creeping toward acceptance.

Tommy Douglas isn't the father of socialized medicare in Canada, he's the father of public health care in Saskatchewan, an idea that the other provinces, over time, appropriated, resulting in a web of provincial health plans that covers the entire country, but varies, often widely, from province to province.

A national health care plan, in theory, would offer the same level and quality of health care to every Canadian, via a central body. Our system isn't designed to do that: the Canada Health Act doesn't govern the ways in which health care is distributed, it only sets out broad guideline under which provinces qualify for funding of their individual health care mandates.

The problem, then, with the Harper government's announcement in December that it would tie health care funding to economic growth starting in 2018 isn't that doing so may destroy national medicare, it's that it will increase the inequity among provincial health plans.

When you leave health care in the hands of the provinces and territories, each with its own mandate priorities and concerns, not to mention financial outlooks, performance is guaranteed to differ. A December 2011 report by the Frontier Centre for Public Policy ranking health care performance by province is but the most recent proof: Ontario, New Brunswick, and British Columbia, the report states, are "well ahead of the other provinces" when it comes to health care. The report actually separates the provinces into two "tiers" -- the aforementioned three in the first, and the remaining seven in the second, with Quebec, Saskatchewan, and Nova Scotia at the very bottom of the list.

Talk about two-tiered medicine, the "he who shall not be named" of universal health care advocates in this country. The disparity from province to province proves we don't need a private system to produce tiered medicare. It's already here.

It is true the Harper plan will only exacerbate the inherent unbalance within the system. Poorer performing provinces will receive less funding than better performing ones. And even the latter group will lack funding certainty -- economic ebbs and flows guarantee that the money coming in will vary over time. That means that the quality of health care will be constantly changing. The Harper government's efforts to achieve cost-certainty will relegate provincial health care to a state of constant uncertainty. And uncertainty is the last thing anyone wants when it comes to health care.

But there is an inherent sensibility to the Conservative plan -- that is, it is understandable once you dismiss the notion that Canada operates a national socialized health care system. Bear with me here: The federal government's mandate is to oversee national governance and fix national problems. Health care, as set out in the Canada Health Act, is a provincial matter. At a time when there is a national issue that requires serious attention - deficit reduction - why should the feds spend money on provinces' health care problems?

And yet, one worries what Harper's health care edict will do to the collective Canadian psyche. If we are indeed on the road to more privatizing of medical care -- a process that, perversely, might actually offer more health care equity across the country -- Canadians are destined to lose one of the key pillars -- if not the key pillar -- on which our identity rests. Because, even if it is mostly a myth, socialized health care forms the base of our national character; it's what separates us from our neighbour to the south. It gives us a common cause, a shared pride in our Canadian humanity -- it shows that we think it's important to care for each other.

We have no military power. We are not a major player in international diplomacy. We are, in general, an afterthought -- a nation with a bland reputation built on good hockey, great beer and, now, oil that may be more trouble than it's worth.

Without the myth of national medicare, what defines Canada?