Canadian Health Coalition

Council of the Federation (2012)

A Medicare supporter greets premiers in Lunenburg, N.S.

Council of the Federation (July 26-27, 2012)

Montreal Gazette (July 28, 2012)
Editorial: Baby steps toward co-operation on health care

Globe and Mail (July 27, 2012)
Editorial: Premiers’ health-care report is just the start of what’s needed

Globe and Mail (July 26, 2012)
Premiers forge own health-care path

Council of the Federation (July 26, 2012)
Health Care Innovation Working Group Report and Communique

Chronicle Herald (July 26, 2012)
Premiers: Ottawa to cut health funding by $36b over 10 years

Globe and Mail (July 26, 2012)
Provinces to bulk-buy generic drugs in bid to cut health costs

CBC News (July 25, 2012)
Protesters send message to premiers over healthcare

Toronto Star (July 25, 2012)
It’s time to protect, strengthen and extend public health care
Op-Ed by Maude Barlow and Michael McBane

CBC News (July 25, 2012)
Canadians lack confidence governments can solve issues
Survey suggests lack of confidence in governments’ ability to fix health care

CBC News (July 25, 2012)
Busload Halifax-bound in support of Medicare

(L-R) Maude Barlow (Council of Canadians), Dr. Robert Wollard (Canadian Doctors for Medicare),
Michael McBane (Canadian Health Coalition) & Ken Georgetti (Canadian Labour Congress) hold press conference in Halifax

Montreal Gazette (July 28, 2012)
Editorial: Baby steps toward co-operation on health care

MONTREAL – This week’s commitment by the premiers meeting in Halifax to have their provinces work more co-operatively in the field of health care, particularly to help reduce drug costs, is to be applauded, even though co-operation is long overdue.

Canada’s population is aging; its health-care costs have already spiralled upward to more than $190 billion a year, and there’s no upward end in sight for future operating costs.

The premiers announced at their Council of the Federation meeting that their first step toward co-operative action will be to implement a cross-country plan to buy generic drugs in bulk, starting in 2013.

It’s something the provinces, who have exclusive jurisdiction over health care, should already have been doing. The fact that they haven’t speaks to some systemic inefficiency in having so many different governments in charge of health care in this country. However, going forward one can only hope that this bulk buying will foster even more inter-provincial planning in health care.

In preparation for this week’s meeting, Saskatchewan Premier Brad Wall and Prince Edward Island Premier Robert Ghiz commissioned a report on how to deliver health care more efficiently. Economizing on prescription drugs through bulk buying turned out to be the most obvious actionable measure available. In 2010, Canadians spent $30.6 billion on prescription drugs, or almost $1,000 a year per capita. To put that $30.6-billion figure into perspective, Ottawa’s health transfers to the provinces this year add up to $27 billion.

Another factor that will influence the financial side of health care in the future is the plan by the federal government to tie the rate of growth in health-transfer spending to the provinces to overall economic growth from 2016 onward. Until then, transfers will increase by 6 per cent – well ahead of inflation, and enough of a fiscal cushion to give the provinces time to explore ways to work together more co-operatively.

This is the backdrop against which the premiers have to do their own provincial planning. On the whole, the Wall-Ghiz report, which proposes a variety of ways to improve value for money, represents a solid basis for future planning. As far as control of drug costs is concerned, a few classes of drugs account for the bulk of drug spending, according to a study published this year. For one of them, angiotensin-converting enzyme inhibitors, used primarily for high blood pressure, the cost doubled between 1996 and 2006, to reach $965 million. With drugs accounting for a rising proportion of overall health-care costs, the provinces have good fiscal and financial reasons to more actively control growth in drug spending.

Premier Jean Charest says Quebec already has an agreement with drug companies whereby those companies in Quebec must match the lowest drug prices offered anywhere else in the country. Charest said for that reason Quebec isn’t really joining the new co-operative pan-Canadian buying plan so much as the other provinces are putting together a new interprovincial model based on the Quebec lowest-cost-anywhere model. It is a subtle distinction, one that irritated host Nova Scotia Premier Darrel Dexter, who said, “This was supported by all premiers.” But with a provincial general election coming, Charest presumably felt he needed to assert Quebec’s jurisdictional independence, even from its provincial neighbours.

Even so, Quebec should not shy away from working with the rest of the country to save money on health care or, as the Wall-Ghiz report also recommends, to establish benchmarks for best practices for costly medical interventions. The more closely the provinces work together, the better health outcomes will be for all Canadians, and the better off Canada will be politically as well.

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Globe and Mail (July 27, 2012)
Editorial: Premiers’ health-care report is just the start of what’s needed

With an aging population and spiralling health-care costs, Canada’s premiers are wise to begin looking for innovation and change in this sector, rather than wait for the money to run out. The proposals unveiled Thursday at their annual meeting are really just the start of what will be needed.

Canada ranks higher than most other countries in health spending, and while federal transfers will continue to grow by 6 per cent annually until 2016-17, they will thereafter be tied to the rate of economic growth.

With an aging population and spiralling health-care costs, Canada’s premiers are wise to begin looking for innovation and change in this sector, rather than wait for the money to run out. The proposals unveiled Thursday at their annual meeting are really just the start of what will be needed.

Canada ranks higher than most other countries in health spending, and while federal transfers will continue to grow by 6 per cent annually until 2016-17, they will thereafter be tied to the rate of economic growth.

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Globe and Mail (July 26, 2012)
Premiers forge own health-care path
By Jane Taber

Canada’s premiers are taking the lead on health-care reform without direct leadership from Ottawa, a departure from the way the country’s cherished but increasingly expensive system has long been managed.

On Thursday, the premiers took their first steps to make health care less costly and more efficient, announcing a plan to save provinces millions of dollars on prescription drugs by purchasing generics in bulk.

But these changes are only the beginning, premiers told The Globe and Mail at a conference in Halifax.

“This is a process, not an event,” said Saskatchewan Premier Brad Wall, who co-wrote a report on health reform with Prince Edward Island Premier Robert Ghiz.

Mr. Wall and Mr. Ghiz said they are responding to a lack of leadership from Ottawa and that the provinces are determined to pursue change on their own.

“We decided, as provinces, we don’t need the federal government. … We run the health-care system,” said Mr. Ghiz, adding that the “only thing” the federal government does is “provide a cheque for about 20 per cent of the costs. ”

By acting alone, the premiers are answering Ottawa’s call to action. Late last year, Prime Minister Stephen Harper granted provinces more autonomy to reshape health care as Ottawa moves to end 50 years of using its funding power to coerce provinces to adopt national standards.

Mr. Harper essentially asked provinces, with some federal guidance, to do as they see fit in their own jurisdictions while inviting them to co-operate in establishing national benchmarks for delivering health services.

The next step, Mr. Wall said, is to explore more bulk-purchasing options, including equipment. He said the provinces will also work together to reduce medically unnecessary testing, citing evidence that suggests up to 20 per cent of some medical imaging is not required.

At their meeting – which was nearly overshadowed by sparring between Alberta and B.C. over the proposed Northern Gateway pipeline – the premiers were critical of Ottawa for not negotiating a new health accord. But some premiers said they will simply fill the leadership void.

“We deliver the health care. … They said they didn’t want to talk health care with us,” Mr. Ghiz said of Ottawa.

Federal Health Minister Leona Aglukkaq, however, congratulated the premiers on their report, adding that bulk buying generic drugs is within the premiers’ “purview to make decisions of that nature to manage how they deliver health care.”

Ms. Aglukkaq defended the federal government’s role in the health-care debate: “We have played a huge leadership role.”

Some health-care advocates are concerned the federal government is not at the table. Michael McBane, the national co-ordinator of the Canadian Health Coalition, said the premiers were being too polite.

“They are treading water because they don’t have a federal partner,” he said, adding that the federal government has more responsibility than financing.

And some premiers do not believe the health report goes far enough. Ontario Premier Dalton McGuinty said it was a good first step, but that Ontario is “going a little further and perhaps moving a little quicker than they are considering in this report.”

On generic drug costs, he said, his government has already saved Ontario residents more than half a billion dollars annually.

In addition, Mr. McGuinty said physician compensation should be considered closely because it represents one-quarter of all health-care costs. He has had discussions with Alberta Premier Alison Redford, who told The Globe that doctors’ salaries have an impact across the country and that the two provinces have been working closely on the subject.

Quebec Premier Jean Charest, meanwhile, said his government will have to look at the bulk-buying plan for drugs because his province has its own system.

“It’s not an adversarial approach,” he said of not endorsing the drug strategy immediately. “We want to make sure there’s an alignment of what our policies are with what the policy of the group is.”

While it is not unusual to have some animosity toward Ottawa at a premiers’ meeting, this one has seen increased tension – with many premiers not only critical of Mr. Harper’s decision to set terms on how health care will be funded but to avoid first ministers meetings altogether. The Prime Minister has convened only one since 2008.

The premiers tried a different tactic on Thursday, appealing to Mr. Harper’s focus on the economy and urging him to join them at a first ministers meeting in the fall to address the uncertain global economy and what it means for Canadians.

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Chronicle Herald (July 26, 2012)
Premiers: Ottawa to cut health funding by $36b over 10 years
By David Jackson and Paul McLeod

The country’s premiers say Ottawa’s changes to health funding will leave them short $36 billion over 10 years, starting in 2014-15.

Federal transfers to the provinces and territories will continue to grow in that time, but the premiers say that’s the extra amount of money provinces would receive if Ottawa stuck to its 2007 plan.

The Council of the Federation released an assessment of the changes Friday morning at its meeting in Halifax.

In December, federal Finance Minister Jim Flaherty said health transfers will increase by six per cent annually until 2017-18. After that, the increases will be tied to growth in gross domestic product, plus inflation.

The premiers’ report said Ottawa’s 2007 commitment also included a move to give provinces health cash on an equal, per-capita basis.

However, tying increases to economic growth, rather than the current rate of six per cent, and limiting protection to provinces to ensure they’re not worse off leads to the estimate of $36 billion less in the Canada Health Transfer.

The premiers’ estimate nominal gross domestic product growth will average four per cent nationally from 2014-15 to 2023-24.

The bottom line is less money for services the provinces are in charge of providing, said Manitoba Premier Greg Selinger, who led the working group on fiscal arrangements that was struck at a meeting in January.

“It does have a big impact on Canadians. Those resources will mean less money available for nurses and doctors and health care where people live in their communities all across the country,” Selinger said.

The difference between the health transfer arrangements would mean $900 million less for Nova Scotia over the 10 years, according to the report.

Premier Darrell Dexter said the impact would be even greater if equalization was factored in.

“The facts are pretty simple,” he said. “Two-thirds of the tax that you pay in your paycheque goes to the federal government and yet the provinces deliver 80 per cent of the services. That, clearly, is an imbalance.”

Whether the federal government is listening or not, the provinces will talk about options for transfers again in the fall.

Selinger, AlbertaPremier Alison Redford, and New Brunswick Premier David Alward will chair that meeting of provincial and territorial finance ministers.

On Thursday, the premiers agreed to bulk buy three to five generic drugs in the hopes of saving millions of dollars.

It’s the most concrete step yet towards a national pharmaceutical strategy after many years of inaction.

The premiers would not say how much they expect to save by teaming up on one big order to demand a cheaper price. Saskatchewan Premier Brad Wall estimated his province could shave drug prices by 30 per cent.

“I wish that we would have, as provinces, done this 30, 20, 10 years ago,” said Wall.

“The point is: we’re doing it now.”

Governments have been promising to create a national pharmaceutical strategy for the past decade in the hopes of saving billions of dollars in drug costs. But they’ve failed to agree on what drugs should be covered or to get doctors or insurance companies onside.

“It’s a little more complex than anticipated,” conceded Prince Edward Island Premier Robert Ghiz when asked why premiers are planning to unite on only three to five drug brands.

“We don’t want to promise something that we’re not going to deliver.”

The premiers have agreed to pick the drugs to be shared by this fall and start purchasing by April 1, 2013. Nova Scotia paid out $105 million for generic drugs last year and a further $135 million for brand name drugs.

But the plan has already hit a snag. Quebec says its universal pharmacare program might not mesh with the programs of other provinces. Quebec Premier Jean Charest said his government will do more analysis before agreeing whether to go along with the group purchase.

Bulk buying is one of a dozen recommendations from the health-care innovation group set up by the premiers in January and led by Wall and Ghiz. The premiers discussed their findings at the Council of the Federation premiers’ meeting in Halifax on Thursday.

Most of the recommendations involve working together to share information and strategies. All of them, even the bulk buying of drugs, are voluntary.

A caveat in the report says all provinces and territories will implement the recommendations “as they deem appropriate to their health-care system.”

Nonetheless, the provinces say the report proves they are transforming health care in Canada without the help of the federal government.

Last December, Ottawa unilaterally set federal health transfers for the next decade and declined to tie them to any performance targets. Health care falls under provincial responsibility, but the provinces say the federal government needs to work with them to ensure all Canadians get roughly the same level of care.

Ontario Premier Dalton McGuinty is urging his colleagues to join him in more tackling even more aggressive change.

McGuinty is taking on how doctors are paid in Ontario. He says governments need to overhaul the pay rates for doctors and even stop paying for some outdated procedures.

“It used to take about two hours to perform cataract surgery. Today it takes about 15 minutes to perform cataract surgery. Obviously, this means we should be paying less for cataract surgeries today than we did in the past,” said McGuinty.

The report makes a vague recommendation in that regard in a section on health human resources.

It says future work includes “examining health human resource funding and payment systems,” and that there are “further opportunities to improve the sustainability of health systems by aligning advances in technology and productivity with appropriate funding and payment practices.”

Medicare advocates and activists from other parts of the country are also in Halifax this week, holding events to highlight their call for Ottawa to stay involved in setting health-care standards.

Aboard the The Harbour Queen docked at the Halifax waterfront, the Nova Scotia Health Coalition and Council of Canadians held a news conference warning about Ottawa’s hands-off approach to health care.

“Regardless of what you hear coming from Ottawa, health care is a shared jurisdiction and it will not survive without federal leaderhip. It will splinter into 14 different directions,” said Mike McBane, national co-ordinator of the Canadian Health Coalition.

Maude Barlow, national chairwoman of the Council of Canadians, claimed Prime Minister Stephen Harper’s ultimate goal is to see more privatized health care.

She also said provinces aren’t ready to handle a new trade agreement Ottawa is negotiating with the European Union that could have an impact in areas like home care and long-term care.

As for the premiers’ plan for bulk buying several drugs, McBane and Dr. Bob Woollard, founder of Canadian Doctors for Medicare, called the premiers’ effort “baby steps.”

While the premiers are starting with up to five drugs, Wall said there are 64 Canadian generic prescription drugs that cost 90 per cent more than in the United States.

The potential impact of the bulk-buying program in Nova Scotia isn’t clear. The province spends about $105 million on generic drugs, according to the Health and Wellness Department.

The province has reduced the cost of generic drugs at pharmacies over the past year. The Health Department said Thursday that as of Aug. 1, the price of most generic drugs will be capped at 35 per cent of the price of the equivalent brand name drug, saving the province $7 million a year under the Pharmacare program.

The report also calls for common standards in treating cardiovascular disease and diabetes-related foot ulcers.

The report says there are conflicting guidelines for treating heart disease, while a greater focus on preventive care for people with diabetes can prevent up to 85 per cent of foot amputations.

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Globe and Mail (July 26, 2012)
Provinces to bulk-buy generic drugs in bid to cut health costs
By Jane Taber

Provinces will begin bulk-buying several different generic drugs as part of the first steps Canada’s premiers are taking to make health care less costly and more efficient for Canadians.

The initiative was introduced Thursday at the Council of Federation, the annual gathering of premiers, as part of a report on health care co-authored by Saskatchewan Premier Brad Wall and Prince Edward Island Premier Robert Ghiz.

A national competitive bidding process is to be initiated by this fall, according to the recommendations in the report. It says this will “result in lower prices taking effect by April 1, 2013.”

However, premiers are not clear exactly how much the savings will be. And although all of the premiers endorsed the report, it is not incumbent on the provinces to adopt the measures.

Ontario Premier Dalton McGuinty noted that his province is going “a little bit further, perhaps a little bit more quickly” than what is suggested in the report. He said that on the matter of generic drug costs his government’s actions have already saved Ontario taxpayers over $500-million annually.

Besides bulk-buying of the drugs, the report – From Innovation to Action – also looked at other areas of the health-care system, including managing chronic diseases.

In the report, which the two premiers worked on for only six months, they call for a standardized approach to dealing with wounds and foot ulcers, related to diabetes.

Premier Wall noted that in Saskatchewan last year there were 453 people hospitalized because of foot ulcers. And he said that 30 per cent of those hospitalizations would be unnecessary if they adopted the recommended standard of care outlined in the report. As well, there were 118 foot amputations of which 80 per cent were unnecessary. This cost the province between $3- and $4-million.

“They didn’t need to happen if we were using the standard of care …,” said Premier Wall.

The report lists a number of clinical practice guidelines for the ulcer treatment, such as preventative measures including better monitoring of an individual’s lifestyle, body weight and annual or even more frequent examination of feet in high risk individuals.

The premiers took up leadership on the health care file after the Harper government decided to “absent itself,” said Nova Scotia Premier Darrell Dexter, the host of this summer’s gathering, from the debate.

“We took it upon ourselves to provide that leadership,” said Premier Dexter, who has repeatedly called for a first minister’s conference to talk about national issues such as health care and the economy.

There has not been a first ministers’ conference since 2008.

The Premiers were highly critical of the federal government for not negotiating with them for a new health accord. The one negotiated between the then Paul Martin government and premiers expires in 2014.

Late last year Stephen Harper told the provinces that they would have the funding it wanted for health care but left the ball in their court. Health care delivery is a provincial responsibility.

Provinces have tried before to co-ordinate on health care issues but have failed. This time, however, is different, claimed PEI Premier Ghiz because they are now co-operating at the “premier level.”

“We decided as provinces we don’t need the federal government … we run the health-care system,” said Premier Ghiz, noting that the “only thing” the federal government does is “provide a cheque for about 20 per cent of the costs …”

He said the recommendations in this report are things that the provinces can accomplish “without the federal government being at the table.”

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CBC News (July 25, 2012)
Protesters send message to premiers over healthcare

A health care protester strolls the waterfront in Lunenburg, NS

Protesters in downtown Halifax have been trying to get a message to the premiers as they head into healthcare discussions at the Council of the Federation meeting in Halifax.

One group staged a parade of giant puppets. They wanted to give premiers a model of what not to be, as they negotiate with Ottawa.

“The future of healthcare depends on what comes out of these meetings this week,” said organizer Kyle Buott, of the Nova Scotia Citizens’ Health Care Network.

The Harper government will add to its health expenditures in the next few years, but protestors say after that, a unilateral change in policy will cut $31 billion from the pot over the next decade.

Just a few blocks away, nurses with another advocacy group handed out healthy brown-bag lunches. The nurses want premiers to re-focus medicare toward more long-term care for seniors, and programs that prevent obesity. They say both would help reduce expensive hospital visits.

“A study came out this winter where Canada won the gold medal for the most use of [emergency rooms] in the world,” said Linda Silas of the Canadian Federation of Nurses Unions.

“Why? Because we have no other option. You’re sick, you go to the ER. We want people to have better choice everywhere, and the premiers can lead that discussion.”

Speakers at the nurses’ event said the Prime Minister should also be in on that discussion, or too many hospital visits could make medicare unsustainable.

Prince Edward Island Premier Robert Ghiz and Brad Wall of Saskatchewan will present a report to the rest of the premiers today on possible innovations in healthcare. It is expected to deal with the growing number of elderly people, and the need for a federal health human resources strategy.

Protestors from the Nova Scotia Citizens’ Health Care Network staged a parade of giant puppets, to send a message to the premiers to stand up to Ottawa

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Toronto Star (July 25, 2012)
It’s time to protect, strengthen and extend public health care
Op-Ed by Maude Barlow and Michael McBane

Health care is always rated as Canadians’ top election issue and number one social program. Yet the federal government isn’t interested in shaping health care in Canada. Instead, responsibility for the future of health care is being downloaded onto the provinces.

In December of 2011 — without consulting premiers, health ministers, or health-care providers — finance minister Jim Flaherty announced that the 6 per cent escalating Canada Health Transfer would be reformulated and tied to economic growth starting in 2017. He then announced that the federal government would not be discussing the 2014 Health Accord further, and left the room.

Without a 2014 Health Accord, there will be no national improvements to health care, no continuation of Tommy Douglas’ ultimate vision of universal health care including necessary programs such as pharmacare. And despite Canada facing an aging population, there will be no national standards for home and community care. The provinces are on their own, and we’re not confident that they can fill the shoes of the federal government, nor should they need to.

This week, from July 25-27, the premiers are meeting in Halifax. On their agenda will be the 2014 Health Accord, and in particular they will be looking at areas such as innovation and financing. They are trying to work out how to improve health care in Canada for the next 10 years. But without calling the federal government back to the negotiating table, it is unlikely that the premiers will be able to protect, strengthen and extend public health care as Canadians are calling on all of our leaders to do.

“A rising tide lifts all boats” is supposed to mean that everyone’s quality of life will improve together. But without the federal government ensuring that the water is fairly distributed in each province, some boats will rise while others sink. Resources in Canada are not equally distributed, and it is the job of the federal government to try and even out some of that inequality.

In health care this is mandated by the Canada Health Act. The principle of “portability” ensures that Canadians can travel from one province to another and receive the same quality of care. It’s what makes our universal health care universal. Without the involvement of the federal government, who will compare the basket of services and quality of care being offered in each province and territory to ensure we’re all meeting the highest standard? Are provinces and territories expected to be watchdogs for each other?

In the 2004 Health Accord, the federal government found areas of weakness in health care across Canada. They tied financial bonuses to national standards in those areas of weakness. Provinces that met certain benchmarks were rewarded financially. In 2011, the Health Council of Canada came out with a report that showed that this strategy worked remarkably well and wait times for targeted areas fell by years.

If the federal government does not look after the needs Canadians, who will? Who acts as a catalyst for innovation and best practices? Who will protect national standards and ensure universal access without financial barriers to care, as called for in the Canada Health Act?

Canadians expect both levels of government to work together to secure the future health-care needs of all.

Maude Barlow is the national chairperson of the Council of Canadians. Michael McBane is the national co-ordinator of the Canadian Health Coalition in Ottawa and author of Ill-Health Canada: Putting Food and Drug Company Profits Ahead of Safety (2005).

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CBC News (July 25, 2012)
Canadians lack confidence governments can solve issues
Survey suggests doubt in governments’ ability to balance budgets, fix health care

As premiers gather for their annual Council of the Federation meeting in Halifax this week, a new Institute for Research on Public Policy-Nanos Research survey suggests a lack of confidence in the ability of provincial and federal governments to solve some pressing issues.

The findings, to be published next week in Policy Options magazine, attempt to connect issues Canadians identified as their top priorities with the confidence they felt in federal and provincial governments’ ability to find solutions.

Nik Nanos, the president of Nanos Research and the author behind the study, characterizes Canadians’ views as a “bit of a limp handshake in terms of confidence” in government.

Nova Scotia Premier Darrell Dexter, seen here with fellow Atlantic premiers at their meeting in P.E.I. last month, will chair the Council of the Federation talks in Halifax this week. (Andrew Vaughan/Canadian Press)”When Canadians see their elected officials gathering, they expect them to do something. They expect them to accomplish something,” he says.

“Canadians are more likely not to have confidence, and the sad thing is that confidence relates to many issues that are very very important to them. I think it’s almost a public policy despair,” Nanos adds.

The findings don’t necessarily bode well for the premiers on some fronts, although they do support the prioritization of at least two of the meeting’s top agenda items.

Health care tops both public and premiers’ agenda

When premiers shut the doors and sit down to talk amongst themselves on Thursday morning, the first thing up for discussion is a report from PEI Premier Robert Ghiz and Saskatchewan Premier Brad Wall, who have co-chaired a “health care innovation working group” to research new ways to deliver better health care with limited budgets.

Their work has considered things like applying “just in time” industrial management techniques, more common in manufacturing assembly lines, to delivering health care.

The Nanos study found health care topped Canadians’ priorities by a comfortable margin, across Canada.

Top 5 issues, ranked by ‘importance to Canada’s future’:

   1. Keeping our health care system strong

   2. (tie) Creating jobs, and

   2. (tie) Investing in our education system

   4. (tie) Ensuring safe communities, and

   4. (tie) Balancing government budgets

Top 5 issues, ranked by confidence in governments’ ability to find solutions:

  • Developing our natural resources
  • Protecting our borders
  • Ensuring safe communities
  • Encouraging research and development
  • Having trade policies that encourage investment

   [SOURCE: IRPP-Nanos survey of 1,333 adult Canadians, using online survey conducted between July 5-9, 2012]

In and of itself this is not new: health care often tops polls ranking Canadians’ top issues. But when Nanos examined public confidence in governments’ ability to address health-care issues, he found a lack of faith.

“Canadians are probably very happy that the premiers are engaged in health care and talking about it, but there’s a low level of confidence,” he says.

Issues like health care are “very complex”, Nanos says, noting the multiple stakeholders involved in the system. “As a result I think there’s a higher level of skepticism in the provinces’ ability to find solutions.”

“If the premiers could advance the health care file in terms of a definitive position on what they see as the future of public health care in Canada, that would probably be a very good first step in trying to increase confidence,” he suggests.

While health care ranked the highest among the 19 issues probed in the research, “creating jobs” ranked second among the public’s priorities. “Investing in education” and “ensuring safe communities” round out the top tier of the public’s concerns.

Budgets and bickering

At the meetings this week, Manitoba Premier Greg Selinger is tasked with reporting back to his fellow premiers on economic matters, and in particular, the ongoing debate about what Canada’s “fiscal framework” should look like in the future.

The provinces share a stake in maintaining or improving (depending on one’s view) the fairness of Canada’s system of federal transfer payments (to fund health care, education and social programs under provincial jurisdiction) and “equalization” payments (to share resources between currently-richer and currently-poorer, or “have” and “have not” provinces.)

Reports earlier this year unleashed a torrent of debate about what kinds of change should be contemplated, with some arguing that a large province like Ontario was short-changed under the current system.

Manitoba Premier Greg Selinger and Alberta Premier Alison Redford, seen here at the Western Premiers meeting last May, will both make presentations to their fellow premiers in Halifax: Selinger will focus on the economy and federal-provincial transfer payments, while Redford will pitch a national energy strategy. (Jason Franson/Canadian Press)In the IRPP-Nanos study, the public confidence in governments’ ability to balance budgets was lower than for any other issue, despite the fact that it ranked close to the top of the pile in terms of the issue’s importance to Canadians.

“I would have thought intuitively that it would have done better [in terms of Canadians' confidence],” Nanos says. “There’s probably a higher level of pessimism in terms of what governments can do to control spending and also to influence the economy compared to the past.”

Nanos attributes some of this pessimism to international economic instability. But it could also reflect the track record of the public debate so far when it comes to federal-provincial funding.

“I think the perceptions for a lot of Canadians when they tune into the conference and the premiers start to talk about the fiscal framework, that will probably look more like bickering than solution finding. That’s probably the challenge for the meeting,” Nanos believes.

Energy potential

Nanos sees more optimism in the public mood when it comes to the premiers’ expected third focus, on energy: specifically, a discussion Alberta Premier Alison Redford lobbied hard to bring to the table about a national energy strategy.

In the Nanos poll, natural resources fared near the middle in terms of importance to the public, but shot to the top in terms of the public’s confidence in a government’s ability to act on it.

Of the premiers’ top three agenda items, Nanos thinks, “the only one that people have confidence in terms of making a solution is really energy. And I think that’s because there’s been a lot of action on this file.”

Put simply, Nanos thinks it’s about money.

“There’s a perception that the resource economy is fuelling the [national] economy,” Nanos says. “It has to do with what we see in the news and the narrative of prosperity created by the energy sector.”

Still Nanos is cautious about seeing the confidence score as an endorsement of any particular resource policy decision. Confidence in the government’s ability to act on a file is not the same thing as agreeing with the actions themselves.

“We shouldn’t consider this any kind of verdict in terms of the management of resources,” Nanos warns.

Aboriginal “policy despair”

“Developing Canada’s North” and “improving the quality of life for First Nations living on reserves” were the bottom two issues identified by Canadians in terms of the importance of the issue. When ranked by public confidence in governments, the First Nations issue in particular was second last.

Premiers kick off their talks with aboriginal leaders in Lunenburg, N.S., today before the main Council of the Federation talks begin on Thursday.

Nanos explains the relatively low ranking for aboriginal concerns as a “proximity effect.”

“The further away Canadians are from a particular issue the less likely they are to say that it’s important,” he explains. “For a majority of Canadians, it’s not in their face.”

Nanos describes another challenge as well: “public policy despair” in the form of a recurring narrative of governments attempting to do something without delivering results, reflected in the equally low confidence score for the First Nations issue.

“You have to first deliver hope that a solution can be found before you start engaging Canadians,” Nanos suggests, urging the premiers to “try to deliver something” that could lead to a broader solution down the road.

Newly re-elected national chief Shawn Atleo from the Assembly of First Nations is expected to continue his push for improved education for First Nations, something in which all provinces have jurisdictional expertise despite education being the federal government’s responsibility on reserves.

Feds “cherry picking” easier issues

In general, the IRPP-Nanos survey found a greater “confidence deficit” (difference between Canadians who said they were confident in a government’s ability versus not confident) for provincial governments versus the federal government.

But Nanos’s “a-ha!” moment came when he mapped the relationship between importance and confidence for the 19 issues polled.

Source: IRPP-Nanos Research study based on an online survey conducted between July 5-9, 2012. 1,333 adult Canadians are included in the findings, weighted to reflect the national population. (2,000 interviews were conducted to allow for a more robust regional and provincial analysis of opinion.)”When I looked at the cluster of issues at the top of the map [high importance and high confidence], they actually aligned with the priorities of the [Harper] Conservative government. And that included trade, border security, safe communities, [and] research and development,” Nanos explains.

Nanos characterizes these issues as “transactional”, whereas the issues clustered lower on the chart are “transformational.” And he thinks the transactional issues are somewhat easier to deal with.

“There’s a certain level of utility in this government: they’re focusing on issues that Canadians feel a difference can be made in. And they’re doing that in order to reap political dividends,” he adds. “Obviously that’s very good politics but not good public policy from a long-term perspective because a lot of those tougher issues – like aboriginal issues, like social programs, like an aging population – they’re much tougher, but still very important.”

Nanos suggests “the Conservatives are cherry picking issues at the top that are easy to deliver on, that Canadians have a greater confidence in finding solutions.”

Provincial premiers, on the other hand, hold jurisdiction over some of the tougher work near the bottom. “But if we don’t deal with these transformative issues, they’re going to bite us back in about ten or twenty years,” the pollster believes.

British Columbia Premier Christy Clark (right) hosted the previous Council of the Federation meeting in January. Both Clark and Quebec Premier Jean Charest (left) are up for re-election sometime in the next year: in Charest’s case, possibly within days. (Jonathan Hayward/Canadian Press)Still, shorter-term priorities may be on the minds of some premiers. Particularly Quebec Premier Jean Charest, who is expected to call an election within days. Or B.C.’s Christy Clark, who must follow him to face voters within months. Ontario’s Dalton McGuinty is managing a razor-thin “majority minority” through several difficult files, with an election threat never very far away.

Nanos characterizes this map as providing good direction to political leaders in terms of short and longer-term priorities.

“Let’s look at the top of the map: here are the things that we can make a difference on, that people have confidence that we can move the dial,” he explains. “However, what are we going to do with things at the bottom of the map that we know are important? And if you’re a government that’s going to be governing for a long period of time you’ve got to look at those other issues that are a little more difficult because it will probably lead to trouble in the long term if you don’t.”

RELATED: Health care of top importance to Canadians (CTV News)

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CBC News (July 25, 2012)
Busload Halifax-bound in support of Medicare

Thirty-eight Prince Edward Islanders are on their way to the premiers’ meeting in Halifax aboard a bus they’re calling the Medicare Express.

Premiers Robert Ghiz of P.E.I. and Brad Wall of Saskatchewan will release recommendations from their health innovation working group at the meetings Thursday. The P.E.I. Health Coalition is joining a rally organized by the Canadian Health Coalition.

“The Medicare Express is underlining the fact that our public Medicare system is our greatest value,” said P.E.I. coalition chair Mary Boyd.

“We want to assure Islanders that we are here as watchdogs on Medicare to keep it as a quality care system.”

Boyd said the group is concerned the use of more private medicine will be suggested as a way for provinces to save money.

Ghiz has said privately-funded solutions weren’t explored, but Wall has said a mix of public and private care might be. In his province private clinics are publicly paid to help clear wait times for some surgeries.

CUPE district president Lori MacKay hopes this isn’t one of the working group recommendations.

“I think that’s very dangerous and we’re certainly opposed [to] that kind of approach to healthcare,” said MacKay.

“If you’re going to use a private clinic in a public Medicare program it erodes the program eventually.”

The rally will also be calling for a national pharmacare program and assurances that P.E.I. will not become a have not province when it comes to the quality of medical care with declining health transfers.

Mary Boyd (left) and Lori MacKay prepare to board the Medicare Express

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