I keep changing my mind about whether the recent federal- provincial deal on health care and its ”œasymmetrical” annex for Quebec is a good thing or bad.
On the one hand, it’s ridiculous and disheartening that every time Canada’s governments come to an agreement, Quebec, like a petulant schoolboy, insists on standing apart. Whether it’s blood or health or pharmacare or work- er’s compensation Quebec’s govern- ment won’t deign to admit it’s part of a Confederation which in fact its voters have not yet opted to leave.
The situation is ridiculous because in many instances, probably most, the policies Quebec adopts aren’t very dif- ferent from what happens elsewhere in the country. I suspect that’s what fed- eral heritage minister Liza Frulla was trying to say when she argued that whenever she left the room at UNESCO meetings Quebec’s culture minister could take over for her. This country’s elites are uniformly social democratic and speak from the same Big Book of Political Correctness. In this respect Quebec isn’t at all distinct from its English-speaking neighbours.
The situation is disheartening because of the bleak future it portends. If Quebecers must never be asked to admit they are part of Canada and share common assumptions with their co-citizens " even when they clearly do " how can the country possibly endure? Post-modernism offers many interesting paradoxes but what exactly is the purpose of a political institution whose main virtue is that the people belonging to it can pretend not to? Groucho Marx wouldn’t join a club that would have him as a member. Quebecers will only join clubs that don’t require them to acknowledge they are members. This year both US presidential candidates were members of Yale’s secret Skull and Bones society, one of whose by-laws is that members who admit they are members must leave. If Quebec opts out of every internal agreement the rest of the country makes, Canada will soon be a secret society, too, with the exception that while Skull and Bones has been around for 172 years, this country that dare not speak its name won’t make it nearly that far.
And then again, I think to myself, the annex Quebec and Ottawa signed really isn’t that radical. Quebec accepts all the basic principles the other provinces do. It’s going to develop its own wait-reduction plan. It’s going to report to citizens using ”œcomparable indi- cators, mutually agreed to with other governments.” Its health commissioner is going to ”œcooperate with the Canadian Institute for Health Information.”
It would be better if Quebec’s federal- ist politicians possessed the testos- terone to say ”œIt’s a good deal. It works for Quebecers. We’re going to sign it and we’re not going to be ashamed of it.” But if they decide they need the protection of a document that says they’re not part of the deal even though they’re going to do most of what it requires, well, if Paris was worth a mass, maybe Canada is worth a charade.
Besides, there’s the even more fun- damental point that health care is actually a provincial jurisdiction. Why should Quebec " why should any province? " tolerate federal intrusion in an area of provincial responsibility? It’s not as if federal leadership is need- ed to persuade the provinces or Canadians in general that waiting lists are a problem that has to be addressed. Smaller governments closer to the action are better able to judge where needs are greatest and to tailor supply responses to local peculiarities. (Competitive markets in health care would be even better at that but we seem still an election or two away from that kind of discussion.)
Looked at this way, the problem is not that Quebec stood aside from the federal deal but that the other provinces didn’t. It’s not as if Ottawa was bargaining from a strong position. ”œSign on to our accountability deal or we’ll withhold health care funding until you do” translates roughly to: ”œWe’re going to hold your sick people hostage until you do what we say.” At the bottom of the feds’ tactical toolkit supposedly lay an implicit threat to call an election if the provinces proved stroppy in ”œfixing health care for a generation.” But it wouldn’t have taken much skill from the premiers " or the federal Conservatives " to turn that tactic against the feds.
If the feds have any legitimate role in health care, it should be in making medicare cross provincial boundaries better. My wife sliced her toe open on a clamshell this summer, was charged $30 for closing it by the Ontario hospital we went to but got only $21 of reimburse- ment from the Quebec government and a note inviting us to seek the rest from our insurance company. I understand the reasons for it but this lack of coordi- nation is basically bizarre.
Of course, if we do accept a feder- alism of reasonably watertight com- partments, watertight seals both ways. The feds have their jurisdictions, too, and provinces that want Ottawa to stay out of their backyards should stay out of Ottawa’s. If Jean Charest wants to go to Mexico with the prime minis- ter of France, he should wait until he’s a private citizen.