But what did the public think about the conflict between Ottawa and the provinces? Although opinion polls in the late 1990s and early 2000s seemed to show a gradual shift away from unquestioning support for the health care system and growing anxiety about the length of wait times and the quality of care, relatively few Canadians were outright advocates of user fees, privatization or paying for diagnostic services. (See poll results [PDF].) Indeed, health care had been a key issue during the 1997 election campaign, and the Liberals had promised to renew funding to meet the calls of the business community and the public to maintain not only Canada’s economic advantage over American manufacturers but also the country’s communitarian values. This led Minister of Finance Paul Martin to increase funding to the provinces as the federal government began to run a surplus and it enabled Ottawa to develop the federal–provincial health accord, signed in September 2000. This agreement provided federal funding to assist the provinces to develop new modes of primary care and to begin to upgrade the infrastructure within hospitals and other facilities.
But money alone could not repair the damage that unilateral federal action had inflicted on the provinces and territories as they struggled to control costs, identify problems, shift attention to the determinants of health and respond to public expectations. Was Canada’s much-touted medicare system sustainable in the twenty-first century? In the first six months of 2000, Quebec, Saskatchewan and Alberta all established provincial task forces or commissions to examine this question. Quebec’s Clair Commission, headed by Michel Clair, reported first and recommended limiting health care coverage, encouraging more public–private service partnerships and implementing federal tax transfers rather than cash transfers. In Saskatchewan, Ken Fyke’s report, Caring for Medicare: Sustaining a Quality System recommended establishing a Quality Council, reducing the number of small rural hospitals and creating primary care teams that were not paid through fee-for-service. But the most far-reaching proposal for change came from Alberta and was found in A Framework for Reform: Report of the Premier’s Advisory Council on Health.
Headed by former federal Cabinet minister Don Mazankowski, the task force recommended that Albertans who wished to do so should be able to purchase diagnostic, surgical and other medical services from private providers. This would alleviate the pressure on overstrained public facilities through creating healthy competition among health care facilities and providers. As well, the Mazankowski Report recommended further decentralization of health functions to the regions, a delisting of services and speedier reform of primary health care. These provincial reports attracted extensive press coverage and indicated that health economists, politicians, bureaucrats and the public were all searching for effective ways to improve access and quality within the financial restraints of the respective provincial budgets.