The collapse of negotiations between the provinces and Ottawa over health-care funding brought home just how little ownership the federal government retains in medicare.
Our publicly operated, universal health service was meant to be a joint collaboration. The federal government promised to reimburse half the cost if the provinces would take care of delivery.
That no longer holds: The provinces still deliver, but Ottawa now pays just 22 per cent.
However, that is only part of the story. In recent months, Health Canada has taken a series of steps to direct attention away from medicare.
First, Health Minister Jean-Yves Duclos announced funding for a new dental program, called the Canada Dental Benefit.
No serious effort was made to build any kind of program management around the new “benefit.” The federal government is simply mailing cash to families who qualify. The five-year cost is estimated at $9 billion, money Ottawa couldn’t find for medicare.
Then Carolyn Bennett, federal minister of mental health and addictions, offered $5 million toward the management of chronic care.
Like the dental benefit, in itself this is commendable. Yet it does seem the federal government is more interested in funding high-profile new services for which it will get all the credit, rather than sharing with the provinces the harder task of rescuing medicare.
This attempt to direct attention elsewhere became apparent when Duclos met with the provincial health ministers.
Yes, he allowed, there might be more federal money (though he wouldn’t say how much), but only if the provinces agreed to establish both a national human resources strategy, and a national health database.
Duclos had to know these are both non-starters. Canada already has a fully functioning hospital database.
What we don’t have is a country-wide electronic health record, and with good reason.
In 2001 the federal government established Canada Infoway. This arm’s-length agency was supposed to link the medical files of 400,000 health-care providers and 38 million 91原创s.
That was always a bridge too far. Two decades later, after billions have been spent, the project is still unfinished.
And this is by no means the only systems failure the federal government has been involved in.
In 2005 Ottawa attempted to set up a new nationwide public health system called Panorama. The objective was to manage infectious outbreaks.
But when when several provinces tried to deploy the software, more than 11,000 defects were found. One review concluded that the system was suffering from “a pandemic level outbreak” of flaws and glitches.
In 2011 Ottawa rolled out an automated payroll system known as the Phoenix Pay System. It was intended to serve all federal employees.
Years later, and still not completed, Phoenix had either overpaid, underpaid or failed to pay nearly 80 per cent of the country’s public servants.
The federal Auditor General called the building and implementation of Phoenix “an incomprehensible failure of project management and oversight.”
One reason for these repeat washouts was that they attempted too much. As a systems specialist at McMaster University put it, “massive centralized systems almost always fail.”
Duclos had to know this, but it didn’t stop him walking out of the meeting when the provinces rejected his proposal.
All in all, if the federal government wants to sustain medicare, it should focus on the immediate issues of greatest interest to 91原创s — shortage of family physicians, crippling wait times for surgery and insufficiency of mental-health resources.
Then we could have a meaningful discussion about how to save our country’s health-care system, instead of the shadow boxing we’ve just been treated to.
