Bégin speaks out on health reform
When Canadians visit their medical doctors or go into hospital, they pull out their wallets for their health cards, not their cash. Since 1984, when Parliament passed the Canada Health Act, all costs attached to doctor visits and hospital stays are paid for by provincial and federal governments.
This legislation is now under review by two groups:
- The federal Commission on the Future of Health Care in Canada, headed by former Saskatchewan Premier Roy Romanow
- The powerful Senate Social Affairs Committee, led by Senator Michael Kirby.
Monique Bégin is watching both leaders attentively. As the Federal minister of health from 1977 to 1984, she guided the Canada Health Act through its creation and defended it against all challengers.
CARP forum speaker
She was the keynote speaker in June for CARP’s National Forum on the Canada Health Act from the Perspective of Seniors.
Bégin, 66, is now visiting professor and professor emeritus in the health administration program at the school of management at the University of Ottawa. She teaches two post-graduate courses about the health care systems in Canada and otr countries to students who are destined to become hospital administrators or executives in the health care field.
Bégin remains a fierce champion of universal health care but has rarely spoken out in the current national debate re-shaping the future of the Canada Health Act. From her office at the University of Ottawa, she spoke recently to CARPNews about her views on health reform.
CARPNews: What is it you want to impart to your students? You must feel quite subversive as a health educator.
Bégin: (laughs) That’s exactly the word I use in my head. I want to impart to them the notion that systems don’t just float in the air. They’re rooted in values. But I don’t believe in brainwashing. I’m very respectful of students and always discuss their expectations. However, I am, of course, rooted in a single-payer universal medicare, the “same-for-all” system.
CARPNews: What do you think the federal commission public hearings on health care reform are accomplishing?
Bégin: They have started the public debate. But I wonder if Mr. Romanow would have been helped by having other commissioners on his team. It’s a one-man commission. That’s a killer for one person.
With more commissioners, they could’ve conducted more public hearings. So there’s only the beginning of a public debate. And I regret that. However, the reports of Mr. Kirby’s senate committee may help him. Instead of these two being competitors, I think they are helping each other in fostering a public debate.
Next page: CARPNews: What’s your sense of what the public wants in reforms to medicare?
CARPNews: What’s your sense of what the public wants in reforms to medicare?
Bégin: It’s a bit unfair to ask the public to know the answers when even the great experts don’t have them. If they did, we would have made reforms a long time ago. But my sense is that the public does not want a two-tier system.
What the public doesn’t want is to wait stupidly on waiting lists with no explanation of all the major risks associated with that. Right now, they have a public system that doesn’t work very well and they want a public system that works.”
CARPNews: Does this mean the Canada Health Act needs to be opened up and rewritten?
Bégin: Yes, in my opinion. It’s broad general legislation that is no longer relevant. And because it’s no longer relevant, it’s no longer applied. Nothing is more dangerous than legislation that is a mockery. And that’s what I think is happening with the Canada Health Act.
The two conditions that really need discussion are that of comprehensiveness and public administration. Public administration simply means there should be a single payer in each province.
But that doesn’t tell us how to judge when any private sector initiative is an erosion or distortion of the public system. We do have private sector elements in hospitals—the food, the laundry, the labs—but when is it acceptable and when is it not?
There are rules of the game that have never been spelled out.
CARPNews: What needs to be changed specifically?
Bégin: My act replaced two other pieces of legislation that created the original limited medicare set up in the 1960s.
The 1984 act is strictly about hospital stays and visits to doctors. That’s too narrow.
For example, two large issues now are home care and pharmacare, especially when they’re direct substitutions for hospital care. And there’s already a strong mix of public and private in these areas, with many different rules.
The providers are confused. So ideally, we should re-open the legislation. And I think we have enough champions [for the public system] that it’s a calculated risk — one worth taking.
CARPNews: How influential has Alberta been in setting new directions for health care in Canada?
Bégin: Very influential because Alberta stands as an icon of Americanism and free enterprise in Canada. They’re very vocal, and they have a great premier who knows how to speak to people.
What I propose is that we say in the Canada Health Act that the onus is on the provinces to demonstrate that any new initiative is not a major distortion or erosion of public medicare. That permits flexibility. I’m not against change.
Next page: CARPNews: When you talk about pharmacare and home care that are direct substitutions for hospital care, does that recognize that hospital stays have become so much shorter?
CARPNews: When you talk about pharmacare and home care that are direct substitutions for hospital care, does that recognize that hospital stays have become so much shorter?
Bégin: Yes. Millions of dollars in costs have been passed onto patients.
For example, they have to pay for the drugs they would normally get for free while in the hospital because they’re out early. And nobody speaks out about all the extra costs patients now have to carry. That’s shocking.
CARPNews: Is it hard for you to stand on the sidelines when something you helped create, launch and fight to protect is under fire and close examination?
Bégin: I have less fear now than I have had in the last decade. My view is that the public is the one big champion of medicare—and always was—standing up to all vested interests.
And that includes provincial governments, organized medicine, insurance, you name it. That’s why I so much want to see a public debate on health care in this country because it’s the public who will decide.
And I don’t want the public to be used through a poll here and a poll there to justify new approaches that will not be for the common good.