Health Care and Federal-Provincial Relations: Charting a New Course Into The 21st Century

Abstract

Universal publicly-administered pre-paid health insurance, commonly known as public health care or Medicare, is easily Canada’s single most high-profile public policy. Yet very few Canadians understand exactly what the Medicare program is, how it is structured, and how it works. Even fewer are aware that federal provincial intergovernmental relations is the crux upon which the entire Medicare program rests, with all the significant attendant implications of that reality for the day-to-day lives of millions of Canadians. The purpose of this thesis is to explain how Medicare is structured in Canada, distill the complex and continually raging debate surrounding this topic into comprehensible, clearly articulated worldviews, and expose those worldviews to scholarly analysis. The thesis concludes with recommendations for the future direction of the Medicare program based upon its findings and analysis. To this end, this thesis examines the developmental trajectory of Medicare in Canada with a particular emphasis on federal-provincial fiscal relations and their impact on the program. The debate over the best way to structure and operate Medicare is distilled into two distinct schools of thought: the ‘centralist’ and the ‘decentralist.’ The positions of each school are exposed to a comparative qualitative analysis of their contrasting proposals for federal-provincial relations in the health care field. The thesis concludes that the ‘centralist’ school of thought is the superior of the two proposals and should be implemented given that it provides a blueprint for meaningful reform and expansion of the Medicare program while avoiding various pitfalls which are associated with the ‘decentralist’ approach. Further, it is asserted that federal engagement and leadership has been essential to the inception and maintenance of Medicare up to the present and will be central to the maintenance, reform, and expansion of Medicare moving into the future.