Health care Throne Speech shows Liberals' agenda skimpy

VICTORIA - That was an odd Throne Speech from the Liberals.
It's bold to make a look at the basic principles of health care the centrepiece, including a plan to "update" the Canada Health Act.
Gordon Campbell is right in arguing that it's time to decide what the act really means, especially when it promises things like "reasonable access" to medically necessary procedures.
The Quebec Supreme Court has already ruled that the words have to mean something. The court supported a man who argued that he had the right to seek private care - paid for by the government - because he had waited unreasonably long for surgery.
Unless politicians begin to come clean on what the act really means, the courts will take on the task of providing definitions.
But there are obvious problems with the initiative.
For starters, the Canada Health Act is federal law. B.C., like other provinces can have a debate, but Ottawa decides whether to listen, and balances the concerns of all the provinces.
This is also a fuzzy exercise to make the centre of the Throne Speech. Campbell isn't promising fast action on the issues, only some provincial version of the Canada Health Act by 2009. It's hardly a galvanizing agenda item in the near term.
And it's a potentially big political problem, depending on where this review takes the government.
Campbell says that B.C.'s legislation will ultimately set out the province's position on the Canada Health Act's five key promises. The act isn't complex. It says provinces must have a publicly administered health care system that provides needed medical care in a reasonably timely way, fair payment to doctors and equal access for all Canadians. No user fees on top of government payment, or special charges for speedier, better care.
Defining those terms is challenging.
But Campbell proposes to add a fifth principle - sustainability.
And that may be the most challenging of all. Campbell argues that an aging population and rising costs of care mean we just can't keep on doing what we're doing now. "We all know that it's not sustainable," he says.
That's not really true. Cost increases are worrying, but Canadian health care spending as a percentage of GDP was unchanged between 1991 and 2001. A federal finance department review in 2004 that even without changes health spending would remain easily manageable until 2040 and beyond.
But if you do accept Campbell's premise, then the government is looking at some very rough decisions.
This isn't - or shouldn't be - about whether care is delivered by a public hospital or a private clinic. If the health care plan pays the bills, and there is no preferential treatment, then the principles of the Canada Health Act aren't compromised. The public-private debate can be settled on the basis of cost and effectiveness.
The notion that health care spending is not sustainable, and must be capped, carries big implications. Letting people pay directly for special care doesn't decrease health care spending, it increases it.
Capping spending in the name of sustainability can involve finding ways of reducing demand, such as keeping people healthy longer, and cutting costs.
But it also means saying some treatments will simply no longer be done, ebcause we don't want to spend the money. Period. And that is a tough sell.
Once you're past the health care discussion, the Throne Speech was pretty thin - a nod to children and families' ministry problems, more money for the Coroners' Service, some smallish education items and the Spirit Bearfor provincial animal.
The speech highlights a problem for the Liberals. Their first-term agenda was based on reducing government and cutting costs, reflecting a suspicion about government services.
.Now that work is done, it's tougher to come up with an agenda for the second term.
But without a government agenda, the opposition take control.
It's a big problem for the Liberals, and the Throne Speech suggest they have yet to solve it.
Footnote: Short shrift for the regions in this Throne Speech, and no mention of the late unlamented "Heartlands Strategy." Not one word on the softwood dispute. Also mostly silence on the New Relationship with First Nations, which was the dominant theme in last fall's Throne Speech. The challenges of turning the good intentions into specific agreements have proved tough.