The adulation being lavished on Gen. Rick Hillier makes me glad he's stepping down as chief of defense staff.
That's no criticism of Hillier. He's obviously smart and astute. If I were in the Canadian Forces, certainly in a management role, I'd be sad to see him go.
Hillier had a vision for the military - the equipment, budget, support and public profile it should have.
He wanted Canada to be seen as, and act like, a significant international military force - "one of the big boys."
Like a good corporate guy or politician, he set out to get what he wanted.
And he was good at it. Pushing the politicians a bit sometimes, seeking allies others, charming the media, highly quotable and keeping regular soldiers front and centre. He knew how to cast the military and himself in the best light.
Hillier became a celebrity general, something almost unprecedented in Canada.
Politicians - especially ones like Stephen Harper who shared his desire for more military spending and foreign expeditions - welcomed the chance to share the spotlight with Hillier.
But they learned quickly that Hillier wasn't afraid to use his celebrity and popularity to advance his agenda, whether the government shared it or not.
When he was sworn in as chief of defence staff in February 2005, Hillier used the ceremony - attended by then prime minister Paul Martin - to criticize the Liberal government for neglecting the armed forces.
It was an early warning. Governments that didn't accept Hillier's priorities better watch it.
And they quickly learned that Hillier was adroit in capturing headlines and public support, and setting the agenda. More adroit than the politicians.
Four months later, while government and the public were grappling with what the Afghan mission should be, Hillier defined it.
Canadian Forces were going to fight "detestable murders and scumbags," he said. Their focus wasn't reconstruction or aid. "We are the Canadian Forces, and our job is to be able to kill people," he said.
Which on one level is true. We give our forces weapons so they can kill people when necessary.
On another level, Hillier was on shakier ground. The Canadian Forces job is - or should be - to fill the role that elected representatives set.
Hillier tended to elbow those elected representatives off to the side.
Don Martin, the fine Canwest News columnist, notes that even Canada's participation in the war in Afghanistan was partly Hillier's doing
"With carefully timed speeches and politically incorrect outbursts defending the needs of the soldier, Hillier dwarfed queasy voter opinion about the Afghanistan mission by focusing on strong public support for the military," Martin suggests.
The result of all this was that Hillier became more powerful, in some ways, than the defence ministers he supposedly served.
Whether it was a battle for bigger defence budgets or new arms spending or a power struggle with former defence minister Gordon O'Connor, Hillier emerged victorious.
But who should be setting the objectives for the military and making policy decisions? A career military manager with good political skills, or elected representatives?
O'Connor was a fumbling defence minister, but he was elected. No one has ever voted for Hillier.
The general is being given for a multibillion-dollar increase in military spending. New weapons programs have won quick approval thanks in part to Hillier's effective lobbying and political positioning.
His task was made easier because Canada was at war. What politician wants to be accused of depriving troops of needed equipment?
But that increases concerns about Hillier's role, particularly in steering Canada into an overseas conflict.
And again, it raises questions about what Canadians gave up - tax cuts, or improved health care - to fund the military spending Hillier so adroitly won.
"He didn't fear the politicians," Martin noted in a column on Hillier's departure. "They feared him."
Accurate, I suspect. And anytime politicians are afraid of generals who supposedly work for them, something has gone seriously wrong.
Footnote: Hillier's successes on behalf of the military raise another issue. Were the defence ministers he reported to unusually weak? Or has the increasing centralization of power in the Prime Minister's Office left all ministers with such a diminished role that they can be swept aside?
Wednesday, April 16, 2008
Tuesday, April 15, 2008
The health care sustainability scam
The best you can hope for from George Abbott's bill making "sustainability" a sixth principle of medicare is that it doesn't mean anything.
That's a reasonable assumption. The Liberals have been trying to make health care a theme of this session, presenting lots of bills. Some are bound to be slight.
But if the Liberals argue that the bill does demands action, people who support public health care should be worried.
Gordon Campbell promised that sustainability would be added to the five principles of the Canada Health Act in the throne speech in 2006, at the same time he announced the conversation on health.
The conversation took a year to get going and didn't produce the results Campbell expected. Generally, people were keen to protect and improve the current public system.
Despite some fear-mongering by the government, British Columbians public weren't overly concerned about paying for heath care.
Not what the government had expected. Campbell had made much of the need to cut health spending radically to avoid a looming crisis. The public, rightly, didn't buy it.
The sustainability bill could just be an effort to deliver on the 2006 promise.
But it raises concerns that the Liberals are creating a legislative pretext for radical change in health care - perhaps denying patients' treatment that has been accepted as medically necessary or closing hospitals.
The Canada Health Act sets out five principles for medicare: All medically necessary procedures have to be covered; the system must be be publicly managed and paid for; everyone has to be covered; access has to be equal - no user fees or special payments for preferential treatment; and provinces have to make sure residents are covered within Canada. There are additional details, but broadly the principles are pretty clear.
Sustainability takes the government on to murkier ground, and at worst manufactures a crisis.
Health-care costs are increasing. New drugs, expensive technologies, an aging population looking for great care - cost pressures are inevitable.
But there is no crisis. Back in 1985, about one in every three dollars the government took in went to pay for health care. In 1995, the same. And last year, it was about the same - 35.5 per cent of the money government collected was consumed by health care.
Look at it another way. In 1985, health spending was about five percent of GDP. By 1995, it was 6.6 per cent. This year it will be about nine per cent. The increases are an issue, but the notion that we can't afford health care - that it's not sustainable - is simply not supported by the facts. (We spend four per cent of GDP on dining out in restaurants and taverns.)
Health-care spending was just under $13 billion last year. With the government's encouragement, British Columbians put about $10 billion into slot machines and lottery tickets.
And other countries - including France, Germany and the U.S. spend a higher proportion of GDP on health care.
None of this is to dismiss the importance of good heath-care management. Especially over the next two decades, as the boomer bulge moves into the senior years, pressures will mount. It will be important to reduce demand by encouraging healthier choices and to look for the most cost-effective ways to deliver services.
But there's no sustainability crisis.
Perhaps Abbott will clarify the government's intentions during debate on the bill.
In the meantime, the legislation fuels fears the government will use scare tactics to justify cutting care or offering patients the chance to pay extra for private treatment. (A shift that would actually increase health care costs overall. User fees mean the total cost for a specific procedure rise.)
Health care will cost each British Columbian about $3.50 a week more this year
than it did last year.
That hardly seems a crisis.
Footnote: Even the federal Conservatives are on the opposite of this issue. Abbott asked his federal counterpart to add sustainability to the Canada Health Act last year. Federal Health Minister Tony Clement said he saw no need to make the change.
That's a reasonable assumption. The Liberals have been trying to make health care a theme of this session, presenting lots of bills. Some are bound to be slight.
But if the Liberals argue that the bill does demands action, people who support public health care should be worried.
Gordon Campbell promised that sustainability would be added to the five principles of the Canada Health Act in the throne speech in 2006, at the same time he announced the conversation on health.
The conversation took a year to get going and didn't produce the results Campbell expected. Generally, people were keen to protect and improve the current public system.
Despite some fear-mongering by the government, British Columbians public weren't overly concerned about paying for heath care.
Not what the government had expected. Campbell had made much of the need to cut health spending radically to avoid a looming crisis. The public, rightly, didn't buy it.
The sustainability bill could just be an effort to deliver on the 2006 promise.
But it raises concerns that the Liberals are creating a legislative pretext for radical change in health care - perhaps denying patients' treatment that has been accepted as medically necessary or closing hospitals.
The Canada Health Act sets out five principles for medicare: All medically necessary procedures have to be covered; the system must be be publicly managed and paid for; everyone has to be covered; access has to be equal - no user fees or special payments for preferential treatment; and provinces have to make sure residents are covered within Canada. There are additional details, but broadly the principles are pretty clear.
Sustainability takes the government on to murkier ground, and at worst manufactures a crisis.
Health-care costs are increasing. New drugs, expensive technologies, an aging population looking for great care - cost pressures are inevitable.
But there is no crisis. Back in 1985, about one in every three dollars the government took in went to pay for health care. In 1995, the same. And last year, it was about the same - 35.5 per cent of the money government collected was consumed by health care.
Look at it another way. In 1985, health spending was about five percent of GDP. By 1995, it was 6.6 per cent. This year it will be about nine per cent. The increases are an issue, but the notion that we can't afford health care - that it's not sustainable - is simply not supported by the facts. (We spend four per cent of GDP on dining out in restaurants and taverns.)
Health-care spending was just under $13 billion last year. With the government's encouragement, British Columbians put about $10 billion into slot machines and lottery tickets.
And other countries - including France, Germany and the U.S. spend a higher proportion of GDP on health care.
None of this is to dismiss the importance of good heath-care management. Especially over the next two decades, as the boomer bulge moves into the senior years, pressures will mount. It will be important to reduce demand by encouraging healthier choices and to look for the most cost-effective ways to deliver services.
But there's no sustainability crisis.
Perhaps Abbott will clarify the government's intentions during debate on the bill.
In the meantime, the legislation fuels fears the government will use scare tactics to justify cutting care or offering patients the chance to pay extra for private treatment. (A shift that would actually increase health care costs overall. User fees mean the total cost for a specific procedure rise.)
Health care will cost each British Columbian about $3.50 a week more this year
than it did last year.
That hardly seems a crisis.
Footnote: Even the federal Conservatives are on the opposite of this issue. Abbott asked his federal counterpart to add sustainability to the Canada Health Act last year. Federal Health Minister Tony Clement said he saw no need to make the change.
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