Infiltrating the scrum: The 1990s battle to save medicare’s funding

Like trained animals, members of the media shuffled into an adjacent room after the end of the then-named Medical Society of Nova Scotia’s annual meeting for a scrum in Halifax in 1991The plait du jour was provincial health minister George Moody. There were a lot of familiar faces, of course, except for one. Who was that guy, and what did he want!As it turned out, it was lucky, though rather unconventional, he was there.Doug Geekie had infiltrated our ranks! He wasn’t a journalist. He was director of communications and government relations for the Canadian Medical Association.Oooo! A lobbyist. This was going to be interesting!And it was.The federal government had been playing fast and loose with healthcare funding for each of the provinces, and he wanted to know what was afoot.Medicare had promised the provinces a shared 50/50 hand in funding. Established Programs Financing (EPF) was a financing program created by the Pierre Trudeau administration in 1977 to finance provincially run health-care and the high-education system, through transfer payments, by cash and tax points.The EPF had been subjected to multiple rounds of cuts since the mid 1980s, under both Liberal and Progressive-Conservative governments. Starting on April 1, 1983, EPF growth was restricted to the lower of GDP growth and a maximum escalator rate of 6%. That rate was further lowered to 5% starting on April 1, 1984.Many, like Geekie, were worried about Ottawa’s intentions, and he came wanting numbers and timelines.(Funding shrank continuously until the program was ended in 1996 and combined with the Canada Assistance Plan to produce a new, block-fund fiscal arrangement called the Canada Health and Social Transfer.)“Our members understand the province’s fiscal problems,” MSNS president Dr. Ron Stokes told the Medical Post at the time. “No one, I don’t think, is anticipating any major fee increases, but there are some fairly serious problems that need to be addressed.(The province had already put in place wage and hospital budget controls to provide 0%, 0% and 3% over the next three years with managed growth of 2% being bandied about.“All that changed over the past month or so,” Dr. Stokes added.) “The province has finally realized the serious financial trouble it’s in.”As of the November meeting, Nova Scotia has lost $800 million in federal transfer payments for health. Geekie smiled a bit. His work was done.But Moody’s wasn’t. He had some reassuring to do.“When I say that funding our healthcare system is becoming more and more difficult, you can take that as gospel and not simply as an attempt to set up our healthcare providers,” he said.“Some adjustments could be radical in the sense they may depart somewhat from traditional patterns of health care delivery. I cannot absolutely predict this one way or the other. I can predict, however that these adjustments will be made and that we will have to make them together.”January, 1992: The Canadian Medical Association told the House of Commons standing committee on finance that it needed to delay cuts to medicare, or at least postpone them, because “the future looks bleak for the system.”“As cash contributions to the provinces and territories under EPF arrangements fall to zero over the next decade, the federal government will not have the credibility to enforce national standards,” then-CMA president Dr. Carole Guzman told the committee.“We are equally concerned that the less affluent provinces will not have the financial resources to meet national standards. Unless sufficient federal cost-sharing resources are available, especially in the ‘have-not’ provinces, it will be difficult, if not impossible to maintain national principles and scope of medicare in Canada.”In its brief, the Canadian Hospital Association told the committee the province and territories had lost $29 billion in federal health transfers since 1989.March, 1992: The federal government’s involvement in the national healthcare system will disintegrate over the next 15 years, Michael Kirby predicted during the CMA leadership conference in Ottawa.Its impact on healthcare policy will decrease despite attempts to exert a strong influence in the area. Efforts to maintain a presence will continue even though contributions to the system will decrease.“It will do this because . . . of the political consequences of being seen to abandon a program, which Canadians regard as a birthright. . . . “Political influence, like political power, cannot be exercised if a government is not contributing to a program.”Matt Borsellino was national editor of the Medical Post for many years.

Infiltrating the scrum: The 1990s battle to save medicare’s funding

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