By PAUL ADAMS and BRIAN LAGHI
Globe and Mail
Montreal and Owen Sound, Ont. Liberal Leader Jean Chrétien has thrown down the gauntlet to Canadian Alliance Leader Stockwell Day on health care, challenging him to spell out in detail how he would enforce the Canada Health Act's prohibition on extra billing.
Mr. Chrétien said Friday that Mr. Day's recent defence of the federal health act rings hollow given the Alliance's plan to transfer responsibility for enforcing the act to the provinces.
"We ask them to be honest with the Canadian people. Tell us what is their real agenda," he said.
The debate over the future of Canada's public-health-care system has dominated the second week of the election campaign, with several senior Alliance officials musing about the need for more private clinics and a "parallel system."
Mr. Day has sought to limit the damage by insisting that his party would support the Canada Health Act's prohibition on user fees for medically necessary services.
Campaigning yesterday in Owen Sound, Ont., Mr. Day suggested the definition of medically necessary services might have to be broadened.
He was visiting an Owen Sound family to illustrate his tax cutting plan but was forced back onto the health care issue.
Cathy Snider, a former breast cancer patient, said she was concerned that some women were being forced to travel to the United States to get diagnostic MRIs more quickly than they can get them in Canada. The Alliance Leader told her that the government should consider paying for services such as MRIs that are currently offered at privately run clinics as well as publicly.
"Under the present Liberal government, MRIs are available if people have the money," Mr. Day told the woman. "We'll be broadening out and, in a uniform way, defining essential services. What could be added to that? Could we add MRI to that?"
In fact, the federal government already requires provinces to cover MRIs when they are ordered by a doctor. In the last five weeks, Health Minister Allan Rock has written to both Alberta and Quebec, asking those governments to investigate allegations that private MRI clinics are charging patients and allowing them to jump the queue.
In a Sept. 27 letter to Alberta Health Minister Gary Mar, Mr. Rock noted that the recent federal-provincial agreement on health is providing money for new MRI machines and other high-tech diagnostic machines across the country.
"The practice of insured persons purchasing medically necessary MRI services is a [Canada Health Act] concern," Mr. Rock wrote.
"This practice can result in queue jumping for this service. It can also result in queue jumping for follow-up treatment in the public health system."
The letters are the first step in the federal government's enforcement of the act. Provincial violations can eventually trigger a federal decision to withhold cash transfers.
Mr. Chrétien argued that Mr. Day is prepared to give up federal tools for policing the act with his proposals to hand over the enforcement to an interprovincial arbitrator and to end all federal cash support in favour of transferring taxing power to the provinces.
The Liberal Leader said private MRI clinics that violate the Canada Health Act will not be tolerated. However, it is up to the provinces to decide precisely what services they will provide under medicare.
"There is some flexibility in the system, but the basic system, when you are sick in Canada, you want to go to a hospital, you have the same service and access exactly equal," he said.
Mr. Chrétien also referred to remarks made by the party's former health critic, Keith Martin, that the majority of Alliance MPs personally support the creation of a private market in health care, but decided the idea was too risky politically.
"We saw Dr. Martin and many others who said to the Canadian people: ‘We are for that but we can't talk about it during the election because we might lose votes,' " Mr. Chrétien said.
For much of yesterday, the Alliance leader tried to steer away from the health-care debate, which pollsters say could hurt the party badly in its quest for a electoral breakthrough in Ontario.
An Ipsos-Reid poll — done for The Globe and Mail and CTV — said the Liberals enjoyed 53 per cent support in Ontario, compared to only 24 per cent for the Alliance.
When asked why he thought the Alliance has stalled in Ontario, Mr. Day said he was optimistic about the party's chances in the province.
"It does show that we continue to have work to do in Ontario, we've always known that," he said. "And as we get around and get the types of crowds that we do have coming out, more and more people are hearing the Canadian Alliance's proposals."