NDP’s Nash: caught off guard on user fees?

Sorry, do I have this right? Peggy Nash is running for the NDP leadership…to the right of the Chrétien government on health care? In Sunday’s NDP debate, Paul Dewar asked Nash what she would do if the Quebec government introduced hospital user fees, as indeed it promised/threatened to do in its 2009 budget before eventually relenting. Nash’s answer, translated by the Star: “We hope that we want our health care system to be public, but really it’s a provincial jurisdiction [c’est une compétence provinciale], so it’s the decision of Quebecers.”

Some accounts of the debate overlooked this gotcha move by Dewar, but Nash’s answer could not have been more surprising if she had opened her mouth and ten thousand butterflies had come fluttering out. Nash, widely perceived to be at a disadvantage in Quebec against opponents who call the place home, was certainly motivated by hyperconsciousness of Quebec’s constitutional sensitivities. Her answer, however, would seem to open the door to facility fees in provinces that were actually penalized between 1992 and 2004 for allowing private free-standing clinics to impose them (in some cases while billing the government for the physician services). Alberta had $3.6 million in transfers withheld; Manitoba, $2.4 million; B.C., $2.2 million; Nova Scotia, $372,000; and Newfoundland $284,000.

Among the items that have normally been deemed provincial territory is the definition of “medical necessity” under the Canada Health Act. The CHA provides no core list of medically necessary services, and coverage varies from province to province; but at about the time the provinces were playing chicken with Ottawa and losing, the Alberta government came under fairly significant pressure to defund abortions. It was informed pretty sharply by federal Health Minister Diane Marleau that abortion was definitely always “medically necessary” and that this was NOT a decision to be left to Albertans. One wonders whether Prime Minister Peggy Nash would say the same thing to a province that tried to defund abortion now. Alberta probably isn’t a candidate anymore, but Prince Edward Island seems to find them pretty distasteful. C’est une compétence provinciale?

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