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Op-ed in the Victoria Times Colonist 13 September 2004
Ottawa Needs to Get Tough with Provinces on Health care
By Henry E. McCandless
In the bickering between the provinces and the federal government
over conditions attached to federal health funding, public accountability
has been purposefully left out -- the obligation to answer publicly
and adequately for the discharge of important responsibilities.
The feds say that the provinces should meet reasonable standards
of delivery in key responsibilities, such as in waiting times. The
premiers say that since health care is a provincial responsibility,
its delivery (to whom and for what, and to what standard of accomplishment)
is a matter for each province to decide. Just give us the money.
But the federal government has yet to say to the premiers that
funding will be conditional on one thing at least: their commitment
to full and fair reporting to their citizens for their intended
and actual use of federal public money.
The premiers should be told: "No public commitment to account
to your citizens, to a reasonable standard of public answering,
no funds." Further: "Here are reasonable standards for
reporting your intended and actual health spending. We invite you
to tell your citizens why you needn't meet them."
All federal political parties would support the federal government
on this because the public answering obligation is politically neutral
and tells no one how to do their jobs. It is simply the requirement
to explain, and no political party would say that citizens shouldn't
be better informed.
Public accountability is a society imperative. It is not the political
issue of deciding whose needs are to be honoured, how, and whose
are not.
Citizens across Canada would support this answering requirement
because it is unthinkable in a democracy that provincial governments
needn't explain fully and fairly to their citizens their achievement
aims for federal funding and the reasoning behind them, their actual
use of the money, and the results and learning that came from it.
This allows citizens to assess their province's intentions (in
Premier Ralph Klein's words, whether the intentions meet "the
wishes of the people in that particular constituency") and
to decide their level of trust in their government's competence
and motivation.
Equally important, but never mentioned, the requirement to answer
publicly and to a standard instills a powerful self-regulating influence
in authorities -- so long as they know that the adequacy of their
reporting will be audited.
To ensure independent audit, the national Health Council can fairly
ask the provincial auditors general to collectively and publicly
propose the accountability reporting standards that they think citizens
have the right to see met. They would then publicly audit the adequacy
of their own province's reporting. The Council can assemble these
audit assessments, infer pattern and lay it out on the internet
and on paper.
Each provincial government can be expected to report:
- What the premier and health minister see as their specific responsibilities
in health, ranked, with the reasons, and for prevention as well
as treatment
- How the government allots the funding it now receives -- to
which categories of citizen needs and to which corporations, and
for what, exactly -- and the percentage of the total spent on
each set of responsibilities. And how, specifically, it would
spend a larger amount of funding
- What the government's achievement standards are and would be,
given greater funding, in each of its responsibility areas, and
what its management control processes are to ensure that the achievement
standards are met
- What the actual accomplishment is for each responsibility, as
the government sees it, and the explanations of significant variances
from plan.
- The learning obtained in each responsibility area (including
other provinces' experience) and how this was applied.
This reporting isn't costly. Provincial health ministers must
have this information to do their jobs properly, and what they know,
they can report.
Health-related public interest groups and organizations across
Canada can hold the provincial governments to account for this reporting.
But instead of writing supplicating letters of the type, "We
urge the Premier to..." they should start with legitimate expectation:
"We think it reasonable that you tell citizens your specific
accountability reporting intentions for your health care responsibilities.
We will follow up publicly and relentlessly if you give us fog."
The catch is that if the feds suggest that the premiers account
to their citizens, the premiers will hold the Prime Minister publicly
to account for stating what federal public money is available to
the provinces for health care.
So who will require our elected representatives to produce full
and fair public answering? An individual can't do much on his or
her own, but there is no reason why the large public interest organizations
can't start holding government ministers publicly to account for
producing adequate public answering.
Henry McCandless is the author of A
Citizen's Guide to Public Accountability: Changing the Relationship
Between Citizens and Authorities (www.accountabilitycircle.org)
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