Election 2008: Where the Parties Stand — Or Not

Early release, published at www.cmaj.ca on September 18, 2008. Subject to revision. News

Election 2008: where the parties stand — or not

Early release. Published online at www.cmaj.ca What are the priority areas in which on Sept. 18, 2008. your party would make new health investments? pinion polls consistently indicate The Conservatives favour the status that health care remains a main quo, while the Liberals and New De- O concern of Canadians, while mocrats broadly affirmed support for health care expenditures now amount to publicly funded health care, timely ac- 10.3% of Canada’s gross domestic prod- cess to care, public health and disease

uct, “the highest level in more than 30 prevention, and a health human re- Reuters / Andy Clark years,” according to the Canadian Insti- sources strategy. The New Democrats Liberal leader Stéphane Dion and can- tute for Health Information. added long-term and home care to their didate Roxanne Stanners on the trail. Health care spending is now annually list of priorities. in the neighbourhood of $150 billion. In The Greens were by far the most 2006, overall health spending increases prescriptive in response, saying they’d boost medical school quotas by 1200 outstripped inflation and population focus new investments on health pro- spots. The New Democrats and Greens growth — for the tenth consecutive year. motion and preventative measures such endorsed student loan forgiveness for In light of those staggering numbers, as “removing chemicals that are known health care professionals who staff rural it would be reasonable to expect that to pose a risk to human health, promot- facilities and family practice clinics, health care would be a major campaign ing greater physical activity thereby re- while the Bloc and Conservatives said issue, yet the 5 political parties con- ducing obesity rates, and imposing a physician supply is a provincial matter. tending for Oct. 14, 2008, votes have national junk food tax.” They’d invest been remarkably silent on health care 1% (roughly $1.5 billion) of Canada’s Are current catastrophic drug cost issues in the early run-up to Canada’s health budget on promotion initiatives. programs adequate or should Canada 40th general election. The Bloc Québécois, meanwhile, reit- move immediately to introduce a na- erated their oft-stated position that tional pharmacare program? health is a provincial jurisdiction and The New Democrats and Greens cham- the federal government’s only role is to pioned national pharmacare, as well as write cheques to the provinces. national bulk buying of drugs and patent reforms to reduce the duration of protec- What specific measures should tion now offered to pharmaceutical firms Canada take to resolve its current on new drugs. But the Greens qualified shortage of physicians? their stance by saying they’d first strike a None of the parties boldly stepped out in commission to conduct a “cost–benefit” favour of a comprehensive pan-Cana- analysis. They would also launch a “pub-

Reuters / Chris Wattie dian strategy for educating, recruiting, lic inquiry into the rising costs and over- licensing and equipping doctors, as rec- prescription of drugs.” Prime Minister Stephen Harper plays with 14-month-old Eric Huang. ommended by Task Force Two (CMAJ The Liberals and Conservatives, by 2006;174[13]:1827-8). contrast, ducked the issue, saying their But Liberals and New Democrats preferred approach is catastrophic pro- In the hope of drawing them out of supported some form of fast-tracking gramming, as articulated in the National their shells and elucidating their views the licensing of international medical Pharmaceutical Strategy agreed to as part on health issues, CMAJ submitted a 10- graduates, although the Grits qualified of the 2004 intergovernmental 10-Year question survey to each of the parties. that with the proviso, “if residency po- Plan to Strengthen Health Care. The Lib- In general, their responses reaffirmed the sitions could be found and remedial erals later announced on the campaign new truism of Canadian politics that cam- training supplied.” trail they’d invest $900 million to that paign front-runners take no, or at best, The New Democrats and Greens end. The Bloc said Ottawa has no role ex- few positions on issues, while parties would open federal coffers to expand cept transferring cash. trailing in the polls bend any, and all ears, quotas at medical schools, while the with concrete proposals. But the rule of Liberals said more training spots re- Should Canada adopt a national im- thumb was hardly inviolate as each of the quire “closer collaboration among munization program to prevent parties, at times, responded with what health, postsecondary education and provincial and regional discrepancies could only be politely described as artful labour market sectors.” But they later in immunizing children? dodging. All responses can be viewed, vowed on the campaign trail to create a The Liberals and New Democrats were verbatim, at www.cmaj.ca. $420 million “Doctors and Nurses careful not to step on provincial toes but Nevertheless, there were discernable Fund,” while the New Democrats an- indicated they were amenable to a na- differences in party policies, as follows: nounced a $1 billion, 5-year plan to tional strategy. The Greens had no posi-

tion, while the Conservatives and Bloc medical mishaps (CMAJ said immunization is not a federal matter. 2008;179[4]:309-11, CMAJ 2008;179 [5]:407-9 and CMAJ 2008;179[6]:515- Are you in favour of a progressive li- 7). The Conservatives equated such com- censing regime for pharmaceuticals? If pensation to “government auto insurance so, does the proposed progressive drug plans,” and said that’s the domain of the licensing regime have the teeth to pro- provinces. The Bloc concurred on juris- tect consumers and ensure that regula- dictional grounds, while the Liberals and tory authorities can obtain evidence Greens said they’d be “open” to discus- from pharmaceutical firms during the sions on the issue. The New Democrats

post-market surveillance process? Reuters / Mike Cassese were the most amenable to pursuing a The Conservatives lined up squarely be- no-fault compensation scheme, saying Green leader Elizabeth May holds up a hind their proposed revisions (CMAJ report at a campaign stop in Ontario. that such a system “offers the best 2007;176[9]:1261-2), arguing that the chance of achieving patient safety, pa- regime “would tailor oversight to risk tient compensation and physician ac- and thus strike an appropriate balance Should the PHAC be made an inde- countability while protecting physicians between the freedom of Canadians to pendent agency reporting directly financially.” choose, and the protection of their to Parliament? health.” Industry laxity, they said, would The New Democrats argued that giving be deterred by stiff $5 million fines. the Public Health Agency of Canada in- The Liberals and Greens completely dependence and direct accountability to dodged the issue, while the New De- Parliament is the only way to ensure mocrats offered the most nuanced re- “timely responses,” while the Liberals be- sponse, saying they would strengthen lieve that reporting to a public health adverse reaction reporting requirements, minister, rather than a health minister, is while also raising the bar for initial mar- the solution. The Greens and Bloc took ket authorization licences, including no position, while the Conservatives ar- “stronger application of the precaution- gued that PHAC “is already a separate

ary principle.” They would also fund a agency within the Health Portfolio.” Reuters / Paul Darrow “drug effectiveness research network New Democrat leader Jack Layton and the public reporting of clinical trials Given the demise of the MAPLEs re- peers through a microscope. and their outcomes.” The Bloc ex- actor project, how would you ensure pressed concern about trading off a long-term supply of medical isotopes? lower threshold for market authorization The Liberals, New Democrats and Since the new millennium, what is at the expense of Canadian’s health. Greens were extremely generous in their the single largest failure of a health criticisms of the Conservative handling minister in Canada? Would you restore the public health of the isotope crisis and subsequent can- The political spin was often dizzying in ministry to full cabinet status? cellation of the the MAPLES reactor response. The Liberals tagged the Con- The Liberals and New Democrats sup- project (CMAJ 2008;178[13]:1648 and servatives’ handling of the listeriosis port the notion, while the Greens and CMAJ 2008;178[7]:813-4). The Greens outbreak and revisions to the food Bloc side-stepped the issue. The Conser- even called for a full public inquiry. safety regulatory regime (see page vatives said public health is the responsi- The New Democrats would seek an 755), as a betrayal of public trust. The bility of the Health Minister. international contingency plan for unin- New Democrats said all past health min- terrupted isotope supply and vowed to isters were equally culpable for the cur- develop a long-term strategy for domes- rent physician shortage. tic production. The Bloc plans to raise The Conservatives said predeces- the matter in Parliament, while the Con- sor Liberal governments were indif- servatives argued that all matters are ferent to wait times, while “history firmly in hand: the National Research will undoubtedly judge the tragic re- Universal reactor will be relicensed for fusal to compensate Hepatitis C vic- 5 years in 2011, while consultations will tims for their pain and suffering as subsequently be held on the question of one of the greatest failures of any long-term supply after 2016. Canadian health minister.” The Greens declined to “point fingers,”

Reuters / Mathieu Belanger Should Canada have no-fault com- while the Bloc offered no comment. pensation for medical mishaps? —Wayne Kondro, CMAJ Bloc Québécois leader Gilles Duceppe Only the Conservatives completely ruled campaigns in St-Tite, Quebec. out pursuit of no-fault compensation for DOI:10.1503/cmaj.081460