Our Democracy is in Bad Shape
by Margret Kopala

Published in the Ottawa Citizen, May 22, 2004

Weíre resigned to the fact this election wonít engender a debate about ideas but does it matter?

After all, at no time in recent memory has such a pall descended on governance issues and it isnít just the politicians, itís the whole system. From Enron to Martha Stewart to Nortel, we watch inured as heads role from the highest corporate edifices while Abu Ghraib and the sponsorship scandal, not to mention broken promises, could do the same to heads of government. Even our political parties canít seem to get it right as party members who arenít eligible to vote in elections select leaders and candidates for whom the rest of us are eligible (and expected!) to vote.

All tolled, itís little wonder weíre so apathetic. Where else do you put your embarrassment and shame, your exasperation and incredulity?

Still, thereís bound to be a few who are old and cranky enough to do their civic duty while younger voters, we can hope, are simply delaying political engagement in the same way they are delaying having children and acquiring mortgages. If so, we have to wonder what kind of country theyíll find when they do get around to getting involved. In this light, ideas are important, as are the ways we make decisions about them.

Hereís one to start:

Until citizens hold governments accountable, healthcare will continue as a sink hole for government spending. Citizens canít hold them accountable because provincial and federal governments have a symbiotic love-hate relationship predicated on sharing of tax revenues. Transferred in block funding arrangements, they are then disbursed into the Byzantine world of union monopolies over government services and government monopolies over patients. A world, in other words, which is impossible for citizens to comprehend much less monitor and hold accountable.

A case in point is the Canada Health and Social Transfer struck in the name of deficit reduction in 1995 by then Liberal Finance Minister Paul Martin with the provinces. In return for accepting a lot less in federal transfer payments, provinces received tax points and an end to national standards for social assistance benefits.

Almost ten years later, the results are in: a $50 million Romanow commission calling for more money for healthcare; the creation of a health council to ensure money is spent where it is supposed to be spent, British Columbia unions desperate about the prospect of Ďprivatisationí; the McGuinty healthcare Ďpremiumsí and across the board promises of increased spending by federal political leaders.

While healthcare remains the obfuscated political darling of governments who brazenly play to the fears of an aging population without offering any substantive ideas for reforming the system, we can bet these results are the tip of the iceberg.

One answer is for citizens to divide and conquer their governments.

Empowered to take charge of their own health care spending, perhaps through some form of federally funded medical savings accounts for which provincially monitored and delivered services then compete, thereís a chance citizens could cut through the fog. More importantly, it would allow citizens to comprehend how, on healthcare issues, they relate to their federal and their provincial governments and so keep them accountable.

Certainly, this kind of jurisdictional and citizen realignment could prevent the blame-game governments are so fond of playing.

Giving patients the freedom to shop around in a number of jurisdictions could also improve timely delivery of services. One Montrealer who couldnít get his second hip replacement operation without waiting for months went to court to have it done privately.

On June the 8th, the Supreme Court will hear his case. Rather than approve private delivery, it may agree with intervener Senator Kirbyís argument that by paying the costs of a patientís treatment elsewhere if it cannot be offered in a timely way locally, governments will have an incentive to clear backlogs.

More likely, though, it will mean more bureaucracy and a larger, better funded, power base for the vested interests making determinations about timeliness.

Of course, itís another idea but because it has received no public debate or decision, that paragon of fiscal rectitude, the Supreme Court, will decide instead. Then who is accountable?

If this is the kind of country we have in mind for young Canadians, the failure of this election to debate ideas gets us well on our way to achieving it.

Margret Kopalaís column on western perspectives appears weekly.

To comment, please send Margret an e-mail.

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