CANADA

INTENSIVE CARE

Can Diane Marleau rescue her damaged reputation as health minister?

WARREN CARAGATA May 23 1994
CANADA

INTENSIVE CARE

Can Diane Marleau rescue her damaged reputation as health minister?

WARREN CARAGATA May 23 1994

INTENSIVE CARE

CANADA

Can Diane Marleau rescue her damaged reputation as health minister?

It doesn’t really bother her, federal Health Minister Diane Marleau is saying. The talk that she might soon be dumped from the federal cabinet does not get her down. She has known her share of adversity growing up as the daughter of a single mother in Sudbury, Ont., and she just soldiers on, doing the best she knows how.

“If you just keep doing your job, eventually people will realize, hey, this person is actually doing a good job,” she says. But by the end of the hour-long interview with Maclean’s, it becomes clear that despite her brave facade, the criticism stings. “Have I stumbled?” she asks. “A lot of people have stumbled more than I have.”

Marleau’s credibility was weakened early by the government’s decision in February to fight cigarette smuggling by slashing taxes on tobacco—reversing a long-established federal policy of fighting smoking by raising prices.

Even Prime Minister Jean Chrétien has admitted that his minister was hurt by the move— although he denied at a news conference marking his first six months in office that he was planning to shuffle her out of his cabinet. “She was in the comer where the flak was to come,” said Chrétien. Gaston Levac, the administrator of Laurentian Hospital in Sudbury, who counts himself as a friend dating back to her time as the municipal council’s appointee on the hospital board, says there was little that Marleau could do. “If you’re perceived to have stumbled on the first major issue you face,” he said in an interview, “then you have to wear crutches for a while.”

But the 50-year-old Sudbury MP has not yet been able to restore her battered reputation. Not that she isn’t trying: her recent high-profile battles with Alberta over private medical clinics and with British Columbia over extra billing seem designed to showcase her as medicare’s Joan, of Arc, the ever-vigilant defender of the 1984 Canada Health Act, which enshrines the key principles of universal medicare. Marleau’s problem is compounded by the complexity of her department, which has an $8.2-billion annual budget and includes responsibility for medicare, the safety of drugs and food and consumer products. In addition to overall health care reform, she must also deal with such issues as the tainted blood scandal and the ethical dilemma posed by new reproductive technologies. It is a thorny portfolio at the best of times, one that only the strong and able can survive. And critics say that Marleau has yet to show that she is up to the task. “I think her days are numbered,” says Reform MP Keith Martin, a Victoria doctor. “She doesn’t get it. She doesn’t have the background, she doesn’t have the knowledge, she doesn’t have the vision, she doesn’t have the understanding.”

In the five years Marleau spent in Opposition after her election to the House of Commons in 1988, there were few signs that would foreshadow her elevation to cabinet. A former municipal politician, she had been a loyal backbencher of second rank, deputy whip, associate finance critic and vice-chair of the party’s policy committee. Even at the 1988 riding association meeting at which she was acclaimed as the party’s candidate, she remained in the shadow of Doug Frith, then the Liberal MP who was resigning to return to private business. Officially, Chrétien named her to the cabinet because he was impressed with her commonsense approach. Unofficially, according to insiders, she made it to Health because of the last-minute plight of Hedy Fry, a star Liberal candidate, Vancouver family doctor and former president of the B.C. Medical Association. Fry, now Marleau’s parliamentary secretary, seemed a shoo-in as health

minister but was undone immediately after the election by a reprimand from the B.C. College of Physicians and Surgeons for changing the name on a prescription. Marleau admits she really didn’t expect to become health minister. “You always hope to be in cabinet,” Marleau told Maclean’s. “Obviously I was hoping, but I hadn’t particularly thought of any one portfolio.”

Now that she’s in it, though, she says it is a natural fit that goes beyond her time as a board member at Laurentian Hospital, where Levac said she impressed him mostly for her zealous pursuit of cost controls and efficiency. Marleau spent much of her career working for accountants, but she also managed a restaurant (Hugh’s Dining Lounge in Sudbury), worked as a medical secretary and helped to raise funds for cancer research. So how does that varied background prepare her to over-

see the national health system? Her answer: “I’ve done many things in my life, including, when I first married my husband, I worked for a doctor as a medical secretary basically because I needed a job and it was a pretty good job and I loved being a medical secretary when I did it. I sort of had a lot of experience. I am really a community person. I can really speak to the people and I think it’s important. I always think in terms of government of the people, for the people, by the people. I think I fit that.”

There are a fair number of people who think otherwise, and even Marleau’s supporters agree that she still has not proved herself. Richard Plain, a health economist at the University of Alberta in Edmonton, says that Marleau seems to be learning the ropes, but adds that he will wait a while to make a final judgment. “I think she’s going to win or lose on enforcing the Canada Health Act,” he says. Attacks by the opposition, meanwhile, have been scathing. Pierre de Savoye, associate health critic for the Bloc Québécois, says that Marleau’s insistent defence of the act is tiresome. “Apart from repeating that phrase, what has she done?” he asks.

Reform MPs make particular fun of Marleau’s support for plain packaging of cigarettes as a way to counter the effect of the February reduction in tobacco taxes, a proposal that her critics say she is pushing simply to polish her image. “Our system is literally crumbling around the minister’s ears,” says Alberta Reformer and physician Grant Hill. “Her reaction to that: plain packaging for cigarettes. She’s lost her marbles.”

The jibe that Marleau is taking action just to remake her sagging image extends to her battles with British Columbia and Alberta. The B.C. fight is likely to come to a head this week, when Marleau says the federal government will impose a financial penalty over extra billing. “They are going to be docked for sure,” she said. The only issue still to be worked out is the size of the penalty, which is to match the amount by which the 44 opted-out doctors in the province have exceeded the fees set out under the B.C. health plan—estimated at about $750,000.

Marleau is also doing battle with Alberta over private health clinics such as the Gimbel Eye Centres, which charge a $1,000 “facility fee” for a cataract operation (page 14). But a sometimes inconsistent message about the clinics has given her critics ammunition to accuse her of picking a fight for political reasons. The minister first expressed concern about the clinics late last year, but seemed mollified by a meeting at the end of March with Alberta Health Minister Shirley McClellan. The key thing, she said then, is that Alberta “must offer health services to sick people for free when they need it. That is absolutely basic and we both agree on that.” But Marleau, who said she was reassured then, is no longer so sure. “I am looking seriously at the facility fee that they charge,” she told Maclean’s. “I am very worried about it.”

Marleau’s own officials, on the other hand, seem less concerned. “Our interest is more a problem with the global phenomenon of private clinics,” explained Serge Lafond, director of program analysis at the health insurance branch of her department. Lafond said last week that the key question is whether Albertans have reasonable access to cataract operations without charge and whether, as is the case at the clinics, the doctor’s fee is covered by medicare. Alberta officials, meanwhile, say they are perplexed. “We’d been given the impression that she was satisfied,” said Gordon Turtle, a spokesman for the provincial health minister. “We are committed to the letter and the spirit of the Canada Health Act.”

Marleau said the main problem with enforcing the act is that no one has done it for such a long time. “The extra billing in British Columbia has been going on for at least three years,” she said. “One of the problems we have is that the previous government allowed these things to go on.” That is an argument that Jonathan Lomas, a health policy expert at McMaster University in Hamilton, finds convincing. “She is encumbered by the fact that the federal government under the Conservatives had a strongly held and well-implemented policy of neglect. You can’t just turn a policy machine around on a dime when there has been a decade of policy designed essentially to minimize the federal role.”

The challenge for Ottawa is that it has no constitutional role in medicare, except for its power to raise and spend money—and in the age of soaring deficits, that clout, which Lomas calls “the bribery capacity,” has waned. So it is not surprising that some of the biggest changes in the way that health care is managed can be found at the provincial level. One province that gets special notice because of its role as the pioneer of medicare in 1962 is Saskatchewan, whose NDP government is making wholesale changes that have kept the province’s health care budget steady at about $1.5 billion since 1991-1992. “We are paying enormous amounts towards health care,” Saskatchewan Health Minister Louise Simard said in an interview.

Simard added that while Canada spends a bigger share of its gross domestic product—10 per cent—on health care than almost all industrialized countries except the United States (which spends 13.4 per cent), Canadians are by many international standards not as healthy as Europeans. Says Simard: “It is time for us to make changes to the health system to ensure first of all that we are providing services that are going to result in a healthier population and to make sure that medicare is affordable for future generations.” To that end, Simard has overhauled the way the system is funded and given power to district boards that will not only manage hospitals but also look at such issues as sewers and housing and other factors that affect public health.

Such solutions, and those being tested in other provinces, are proof, says Hedy Fry, that the health care system is not so much underfunded as it is in need of a management overhaul. “The pressures on the system are severe,” she says, “but I don’t think they are problems we can’t find solutions to. When people say the health care system is going down the tubes, they’re panicking.” The same might be said about Marleau’s tenure as Canada’s minister of health—that rumors of her demise are at least exaggerated. So far.

WARREN CARAGATA

LUKE FISHER