Economist connects the dots

Resolution of decade-long constitutional debate behind health care talks
January 22, 2003

(OTTAWA) Of the three competing visions for health care that are on the table -- proposed by Senator Michael Kirby, Roy Romanow, and the provinces -- only one will end up defining the direction of the upcoming First Minister's conference and, ultimately, February's federal budget, says economist Armine Yalnizyan.

In the third of an on-going series entitled Paying for Keeps: Securing the Future of Public Health Care, Yalnizyan lays out the difference between the three visions for health care and makes the case for a strong federal role.

"The upcoming First Minister¹s conference and the February budget are the true test of this federal government ­ will it reaffirm a purpose to nationhood or continue its experiment with decentralization?" Yalnizyan says.

"If the feds back Romanow's vision of cooperative federalism with strong federal dollars, it will be a victory for Canadians hoping to end more than a decade of battle over health care dollars, and put quality public health care within timely reach of every Canadian."

Yalnizyan's series, which can be downloaded on-line at, breaks down the numbers behind the health care proposals put forward by Kirby, Romanow, and the provinces.

Despite the wide variation in approaches and rationale for the amounts of money proposed, the numbers add up to a remarkable consensus: the appropriate federal contribution for public health care in this country should be about 25% of all public health spending undertaken by the provinces.

But apart from agreement about numbers, the three visions see very different roles for the federal government. "We are all waiting to see what kind of leadership role the federal government wants to play. It¹s really about whether they think nationhood matters in the highly decentralized and globally dependent country they have so actively help create."