Amid smiles and declarations of mutual devotion, the happy couple moved through public life last week showing only occasional signs of discomfort. After Kim Campbell captured the Conservative leadership, outgoing Prime Minister Brian Mulroney praised her intelligence. Then, at a meeting of the party’s parliamentary caucus, he said of Campbell, “She’s tough, she’s a winner—and she’s ours.” In case anyone had missed the point, he praised her again in the Commons during his last parliamentary speech before stepping down as prime minister on June 25. She, in turn, told Mulroney that the country would miss his grace and charm. Finally, both heaped praise on the candidate Campbell barely defeated, Environment Minister Jean Charest. The point, as Mulroney said repeatedly, was that even after a divisive
leadership contest, “We are all family.”
But even the closest of families fall victim to periodic arguments and bruised sensibilities. In Campbell’s case, one immediate challenge was to placate Charest, whose strong showing in the leadership race threatened to divide the party. Senior Tories said last week that Campbell, in announcing a reshuffled, pared-down cabinet this week, will likely name Charest deputy prime minister. Among those expected to join cabinet for the first time are Newfoundland MP Ross Reid, Campbell’s campaign manager, and Albertans Barbara (Bobbie) Sparrow and James Edwards, who finished third in the leadership vote. The only retiring minister who will keep his portfolio until the election is International Trade Minister Michael Wilson, who is still involved in talks over the North American Free Trade Agreement.
Along with massaging bruised egos, Campbell also faces several wrenching policy decisions before calling an election later this year. Among the most serious is whether to campaign in support of medicare user fees, the introduction of which would spell an end to the principle of universal access to health care without direct billing of patients. A related question is whether Ottawa should abandon the health-care field entirely, handing over full responsibility to the provinces. Those issues, says a veteran Tory MP who is expected to play a key role in the new Prime Minister’s cabinet, will be the focus of “some very intense debate.” He added: “We must resolve [this] before we go into an election.”
Within the party, there are sharply divergent views about the imposition of user fees. Beyond the obvious political pitfalls, critics
point to a series of studies that suggest user fees raise relatively little extra money and primarily discourage poor people from seeking medical treatment. Up to now, Mulroney and Health and Welfare Minister Benoit Bouchard were the strongest voices in the government against the idea. But with Mulroney’s departure, some Tories say that changes to the existing policy are inevitable. The issue, they say, is not whether user fees will be introduced, but when and how. “There are some surgical procedures and office visits that probably should not be covered by the taxpayer,” says Stan Wilbee, a Vancouver-area physician and Tory MP. Other Tories vow to fight within caucus to defeat any pro25 posai for user fees. Says § Calgary North MP AÍ ¡2 Johnson, the head of the o party’s informal family | caucus: “User fees just “■ create nother problem in my view. There’s no evidence that they work.’And Toronto MP Barbara Greene, who chairs a parliamentary committee on health and welfare, adds that any such suggestion would likely be opposed in caucus. In her view, “Real savings are in managing the system better and providing better health care.”
During the leadership race, both Campbell and Charest said they were prepared to consider user fees. At one point, Campbell mused that she might allow one or two provinces to impose user fees to see how effective they were.
BEFORE CALLING ANELECTION, KIM CAMPBELL NEEDS TO SORT OUT HER PARTYS POSITION ON MEDICARE FEES
She backed away from the idea amid a flurry of negative public reaction and sharp attacks by the Liberals and New Democratic Party. But senior Tories say she is likely again to consider changes to the existing plan. The most obvious reason is financial: health-care costs have almost tripled in the past decade, to the point where Canada now spends more per capita on health than any other country in the world except the United States. Moreover, recent polls indicate that most Canadians might be willing to pay for some medical services. A Maclean’s/CTV poll on June 13, by the Angus Reid Group, found that 19 per cent of respondents favor user
fees as “a matter of principle,” while another 46 per cent said that although user fees make them “uneasy,” they would support them to reduce the cost of health care.
Still, both the Liberals and the NDP are salivating at the prospect of an election campaign fought on medicare. They believe that most Canadians will strongly oppose any major change. NDP Leader Audrey McLaughlin launched a cross-country pre-election tour last week with the gibe, “If you like assaults on our health-care system, Kim Campbell’s the choice for you.” The Liberals say that they will build their own election platform around a promise to preserve the existing system, contrasting that with conflicting statements by Tories. “We plan to hold her feet to the fire on this,” Liberal MP Mary Clancy says of Campbell. “This is our issue.” Speaking in Toronto last week, Liberal Leader Jean Chrétien won enthusiastic applause when he promised that his party would not tamper with medicare.
But the reality that all federal politicians must confront is that Ottawa’s control over the health-care program is becoming increasingly tenuous. Until 1977, the costs were shared almost equally among the federal government and the provinces, most of which collected health-insurance premiums from their citizens. But in that year, Pierre Trudeau’s government introduced a new formula that abolished direct federal funding for medicare. As compensation, Ottawa cut the federal personal income-tax rate, while the provinces raised their rates by an equivalent amount. Since then—and particularly during the Mulroney years—the federal government has sharply curtailed its share of health-care spending. While Ottawa retains jurisdiction over healthcare standards by virtue of the 1984 Canada Health Act, the provinces now pay about 85 per cent of the cost.
One possible option for Campbell would be to transfer full control over health care to the provinces, along with full financial responsibility. Such a move would win favor in Quebec, where both the governing Liberals and the Parti Québécois want the province to have full control over medicare. But it would be less popular in the rest of the country, and among Canadians who believe in the need for national standards. As a result, said a federal cabinet minister: “We will try to resolve where we stand—and we will also try not to talk about this too much publicly.” But with the Liberals and the NDP ready to pounce, that prescription may not cure the Tories’ health-care headaches.
ANTHONY WILSON-SMITH with GLEN ALLEN and LUKE FISHER in Ottawa
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