System stretched to the limit, new president of doctors' group says

VALERIE LAWTON
OTTAWA BUREAU

OTTAWA—The federal government is putting people at risk with plans to cut spending on an already stretched-to-the-limit public health-care system, the Canadian Medical Association said yesterday.

Dr. Sunil Patel, the new president of the doctors' organization, said it was clear even before the SARS crisis hit that Canada was paying far too little attention to public health and emergency preparedness.

"SARS and other emerging threats have clearly illustrated the dangers of being complacent," Patel told the House of Commons finance committee.

"This summer we paid a tragic price for our collective complacency," he said.

Warnings about the poor state of the public health system have gone unheeded by all governments, he told MPs. "Instead of addressing the issue, things went from bad to worse."

And now government spending estimates suggest that worrying trend could continue, Patel said. Those documents show expenditures on public health dropping to less than $308 million in 2005-2006 from $433 million in the current fiscal year.

The CMA argues that's a major mistake and is instead calling for $1.5 billion in new federal spending on public health initiatives over the next five years.

"This is a small price to pay relative to the massive personal and financial costs of another SARS outbreak," Patel said.

The CMA argues the government's top public health priorities should be creating a communications system that would allow immediate dissemination of crucial information to health officials during emergencies, as well as greater investment in emergency medical supplies.

Health Minister Anne McLellan said her department, like others, has been forced to trim budgets for programs, but predicted the SARS experience will mean money is put back into public health spending.

"That will be decided in the future, but I have every confidence that the dollars will be there," she said in a brief interview yesterday. "Everybody is quite clear that we need to invest new dollars, all three levels of government, in rebuilding our public health infrastructure."

While acknowledging SARS put a strain on the system, she insisted Canadians have not been left in danger because of underfunding.

"We have one of the best health-care systems in the world, with pretty much the healthiest people in the world, who live the longest," the minister said.

Patel also criticized federal and provincial governments for squabbling over setting up a national health council to monitor health policy and accountability.

A $2-billion special health fund that was part of a federal-provincial accord last year is holding the new council "hostage," he said.

Federal officials are questioning whether the surplus will be big enough to provide the $2 billion, and some provincial health ministers have told the CMA they won't co-operate with the health council plan if they don't get that cash.

The accord said the $2 billion would be distributed only if the federal surplus was large enough, but some provinces, including Ontario, have already allocated the money.

Yesterday in Renfrew, Ont., provincial Liberal Leader Dalton McGuinty said he will "fight like hell" to get Ontario's share of federal health-care dollars in light of reports that Ottawa may be looking to renege on $2 billion for the provinces.

"There is all kinds of speculation about federal money these days, I don't believe that speculation but I will tell you one thing, I will fight like hell to get our fair share of health-care funding," McGuinty said.

Later in Kitchener, Ont., he said: "Nobody has received any word from anybody in a position of authority who is prepared to attach their names to what the federal government is going to do on this score. But I'll tell you this much the feds are going to have to come to the table with more health-care dollars."

Ontario would received $771 million of the health transfer, but the $2 billion has never been a sure thing, even though Ontario and other provinces have included the money in their plans to boost health-care spending.

Prime Minister Jean Chrétien said it's unclear whether the money will be available and warned provinces not to count on it.

"If they're spending money they don't have, it's like buying a Rolls Royce right away, but if you don't have the money to pay for it, that's another problem," Chrétien said as he left a cabinet meeting. "Listen, they signed the deal. They should have read the terms before doing it."

CMA chief executive William Tholl told MPs that health is the top priority of Canadians.

"We need to service the health-care needs of Canadians before we service the debt," said Tholl, who urged the federal government to make the $2 billion available only to provinces willing to sign on for the health council.

The planned health council continued to attract new controversy yesterday as the federal government released details about the nomination process for the new body's 27 members.

The council will include a chairperson, 13 expert and public representatives and 13 government representatives representing Ottawa, the provinces and territories. Each government can nominate up to four potential candidates to fill the public positions, with ministers of health choosing from this pool.

The federal government is proposing Michael Decter, deputy health minister in the Ontario government of Bob Rae, chair the council.

Mike McBane of the Canadian Health Coalition said this process dooms the health council to failure because it leaves governments with too much power.

"It's designed not to have any independence," he said. "It's designed to be unwieldy and it's designed to ensure no governments are held to account."

McBane noted that Roy Romanow, who led a commission on health care, had called for an independent health council. He argues a panel of respected Canadians should have been established to determine the council's membership.

With files from Richard Brennan.