Federal and provincial politicians will hopefully learn from the public indifference exhibited toward the recent Premier's conference in Victoria: especially as it pertains to the nation's number one issue: the future of health care.

Unlike last year's affair where the Premiers were united in their demand - with public opinion solidly in their corner - for a major federal cash infusion for health care, this year's demand for an addition $7 billion from Ottawa was met with indifference in the most charitable of terms, and in many quarters it was seen as yet another provincial blackmail ploy with Ottawa.

Indeed, the federal government was well positioned in its defensive stance. Ottawa pointed out that the Premiers inked a deal with the Prime Minister just 11 months ago for an extra $21.1 billion over five years, and now the Premiers had the temerity to ask for more

Intergovernmental Affairs Minister Stephane Dion played bad cop by chastising the provinces for cutting taxes with the "right" hand and then looking to pick apart Ottawa's burgeoning $18 billion surplus with the "left" hand.

Health Minister Allan Rock was as equally dismissive in the good cop role as he had one of his aides respond by saying, once the provinces show they can work together and share health outcomes and best practices information, then, and only then, would Ottawa be open to talk about future funding schemes.

So the provinces attempt to strong arm Ottawa for more federal health care cash backfired . big time! And Ottawa still has the "Romanow Ace" up its sleeve and it will keep the provinces at bay until Roy Romanow's commission on medicare reports back to Canadians sometime next year.

As mentioned earlier, the public yawned through this entire three-day affair. And the reason for this indifference is very clear: Canadians are miles (or is that kilometres ) ahead of their politicians when it comes to engaging in a real, honest, leave the silly political rhetoric at home and put everything on the table, health care debate.

In the interest of saving precious time and wasted effort, we should highlight some of the areas where Canadians have already drawn conclusions while our politicians still debate moot points.

This is not a choice between the Canadian and U.S. models of health care. Sadly, many politicians and prominent health care advocates and "experts" are stuck in the past and continue to draw this artificial distinction. The challenge is not to compare our status quo broken system with the exclusive multi-tiered present U.S. style, HMOs, private plans plus Medicare and Medicaid (for the poor and the aged) system, the challenge is to adopt best practices from around the world (Swedish hospitals, U.K. segmenting and Australian top-up billing come to mind) and adapt these approaches to the Canadian environment.

Canadians, for the most part, are not interested in jurisdictional squabbling or constitutional issues. Critics of the federal government like to point out that Section 92 of the constitution delineates health care as a provincial responsibility. This is false! Yes, the constitution does assign responsibility for hospitals, but health care has become much more complex and integrated since the framing of the BNA Act in 1867.

A recent survey of a representative sample of the CTF's 83,000 members revealed that 65% believe health care is a shared jurisdiction between Ottawa and the provinces. It is reasonably safe to assume that this mirrors a national sentiment.

Indeed, Ottawa has responsibility for a great many things in health care. The health of aboriginal Canadians, regulating and certifying medical devices, health of members of the RCMP, running infectious disease laboratories and funding medical research through the Canadian Institutes of Health Research (CIHR), are just a few of the areas where Ottawa has a very clear, direct and fundamental role to play in the health care.

The Canada Health Act should not be viewed as a bible. Sadly, the Act has taken on mythical proportions of grandeur. Former Health Minister Monique Begin put it best when she stated:

"The . Act has taken on a life of its own. It has now reached the status of an icon. Because of that, I personally think that no politician can reopen (it), even to improve it, because it will destabilize people too much."

She is right about the Act's status but draws the wrong conclusion. It is merely a law. Legislation is drafted for a purpose. When the purpose vanishes or changes, legislation is sun-setted or amended.

Such is the case with the Act. The CTF believes that the principle of universality should remain with the other principles of accessibility, portability and comprehensiveness to be rolled into an expanded but realistic definition of universality.

The remaining principle of public administration is too narrow in scope and should give way to a new principle of public governance. Indeed, this is a truer reflection of the current and no doubt future organization of our health care system. Finally, new principles of quality, accountability, choice and sustainability must be added.

The Canada Health Act cannot and will not cover every medical procedure. This is the irony of the entire debate. Everyone focuses on an Act that covers less and less of today's health care delivery. The Act applies to physicians and hospital services, yet more and more health care is being delivered outside these two silos.

In 1975, 44% of health care expenditures were attributable to hospitals and another 14% to physicians. By 2000, this amount decreased to 32% for hospitals and 12.5% for doctors.

Money should not be the focus of the debate, quality should.
The Fyke Commission recently and eloquently made the argument for this school of thought in its report on the future of healthcare in Saskatchewan. Consider these two passages from the Fyke report.

"We have not made quality the central preoccupation of health care, and as a result we do not achieve it."

"Many attribute the quality problems to a lack of money. This claim has been convincingly refuted by evidence and analysis. In health care, good quality often costs considerably less than poor quality."

Finally, Canadians know that we cannot possibly publicly fund every
procedure. This is axiomatic and indeed the United Nations said as much in its 2000 international comparison of world health systems.

"Clearly limits exist on what governments can finance and on what services they can deliver . If services are to be provided for all, then not all services can be provided."

Taxpayers expect the Kirby Senate Committee, the Romanow Commission and any other health care consultations to reflect the realities outlined above that are already embraced by most Canadians.