February 14, 2012
Desperate to maintain seats in Quebec, New Democrats — like the Liberals and Conservatives before them — are going through a familiar round of ideological contortions.
Is the party of Tommy Douglas still a stout defender of national medicare? Absolutely yes when New Democrats are speaking to audiences outside Quebec.
But inside that province, as NDP leadership candidate and Toronto MP Peggy Nash made clear Sunday, matters are more complicated.
During a debate with fellow contenders in Quebec City, Nash was asked how she would react if the Quebec government decided to charge patients user fees every time they went to a doctor or hospital.
“It’s a provincial decision so it’s the decision of Quebecers,” was her answer.
Had that same question been asked in Toronto about, say, a decision by Prime Minister Stephen Harper to let provinces charge such user fees, I expect the moral outrage from all seven NDP leadership candidates would have been palpable.
They would have vied with one another to point out that the Canada Health Act, the federal law governing medicare, specifically bans user fees.
They would have pointed out, correctly, that such fees penalize the sick, that they offend the very idea of universal medicare and that, unless set high enough to act as a barrier to care, they cost more to collect than they raise in revenue.
But not in Quebec City. During the debate proper, none of the other leadership candidates challenged Nash. Rival Paul Dewar, who asked the question, later told reporters he was “surprised” by her answer.
Nor was the question an abstract one. With the possible exception of British Columbia, Quebec has gone farther than any other province in permitting two-tier care.
Two years ago Premier Jean Charest specifically proposed user fees for visits to physicians and hospital emergency rooms — in direct violation of the Canada Health Act.
At the time, then-Liberal leader Michael Ignatieff got into hot water for making the kind of statement Nash did this week. He later had to recant.
The NDP’s then-leader, Jack Layton, was more dexterous. He questioned Harper’s willingness to enforce the medicare law but very carefully didn’t criticize Charest for planning to break it.
Layton’s Quebec push was on at the time and the NDP chief didn’t want to queer his chances in the province.
So what answer might Peggy Nash have given? Well, she got it half right. Health is a matter of provincial jurisdiction and no province is obliged to adhere to the principles of medicare. Quebec, or any other province, may do what it pleases.
But the other half of the answer is that provinces that don’t uphold these principles don’t get federal cash. That’s the deal. And for provinces that impose user fees, the financial penalties are very specific.
Sure Quebec can have user fees, she could have said. But if my party wins power federally it won’t get a dime from us.
And she could have pointed out that Quebecers, just like other Canadians, value medicare, which is why Charest eventually backed down.
Of course, she didn’t say such things. Federal politicians trawling for Quebec votes rarely do. Quebec governments traditionally demand both money from Ottawa and the right to spend that money as they choose. A political party that challenges this somewhat self-serving formula risks being labelled unsympathetic to the province’s “specificity.”
No aspiring NDP leader wants that. For New Democrats, Quebec is a necessary way-station on the road to power. Even national medicare can be sacrificed. But not Quebec’s amour propre.