Politics and the Healthcare Policy Arena in Canada: Diagnosing the Situation, Evaluating Solutions

Whitepaper — August 06, 2014

From a political perspective, healthcare in Canada is a strange policy arena indeed. On the one hand, it represents a core function of modern states worldwide. For Canadians, having a reliable healthcare system that is universally available and publicly funded continues to be a national aspiration and at the top of their political priorities.

And yet, on the other hand, there is little in the way of a pan-Canadian health policy, nor is there a national “medicare” system. It bears repeating, lest we forget, that healthcare policy remains primarily and primordially in the realm of provincial government responsibilities, both in terms of organization and financing.

The unique challenge of this policy area in the Canadian context is also highlighted by the task at hand in the scope of this conference: discussing a national strategy for healthcare, engaging national stakeholders, cross-national comparisons ... without any of the usual and necessary “nation-wide” policy mechanisms for the formulation and implementation of reform.

This paper attempts to address this conundrum by unpacking some of the particular political features of healthcare policy and politics in Canada: the tension between perceived citizenship rights and practical service delivery and financing; the juxtaposition of provincial innovation and federal leadership; and the unique form of decentralized policy-making in the context of national stakeholders. The paper then proposes a dose of realpolitik in suggesting avenues for attaining a better dialogue and road to reform in healthcare.

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