1. Secure the Future of Medicare A Call to Care Presentation to the NB Nurses Union By Michael McBane Canadian Health Coalition

2. 5 Questions What is the Health Accord? How does it work? What does it mean for the provinces? What about Harper proposal on the renewal of the Health Accord and what would this now mean for NB and other provinces? What can we do to prepare for 2014?

3. Background to Health Accord Following major federal cuts to health transfers in 1995 Following the Romanow Commission Report in 2002 First re-investment in 2003 Health Accord Second re-investment in 2004 Health Accord

4. 2004 Health Accord In September 2004, first ministers signed a 10- year plan to strengthen the health care system. $41.3 billion in new federal spending, beginning in 2004-2005. 6% annual growth in federal transfers

5. 2004 Health Accord Reducing Wait Times Health Human Resources Home Care Primary Care Reform Access in the North National Pharmaceuticals Strategy Improvements to Aboriginal health Prevention, Promotion and Public Health Health Innovation Accountability and Reporting to Citizens

6. National Pharmaceutical Strategy catastrophic drug coverage; National Drug Formulary; Strengthen drug safety and effectiveness; bulk purchasing strategies; improve the prescribing behavior; broaden the practice of e-prescribing; accelerate access to generic drugs; address cost drivers and cost-effectiveness.

7. Canada’s Drug Problem Prescription drugs is a leading cause of death; >8 million Canadians lack affordable access; Rx’s in Canada are 30% more expensive than the international average; Harper negotiating to increase the cost of prescriptions by $2.8 billion a year; Harper preparing legislation to weaken drug safety; federal government fuels inappropriate prescribing by allowing illegal advertising and off-label promotion.

8. Illegal off-label promotion to MD’s

9. 1. Replace U.S.-style plans with universal, first-dollar coverage 2. End the price-fixing and public subsidies of Big Pharm 3. Establish a National formulary 4. Bulk purchasing and negotiate competitive pricing 5. Pay only for drugs that are safe and cost-effective 6. Improve prescribing and use appropriately 7. Enforce a complete ban on advertising and off-label promotion Universal Pharmacare will save $ billions

10. Federal pharmaceutical management is a failure that threatens the integrity and sustainability of all aspects of health care including: primary, hospital, home and continuing care. By derailing the national pharmaceutical strategy, the Harper government is severely impeding overall health care reform.

11. 2004 - 2014 2004 Health Accord is up for renewal in 2014 F/P/T negotiations were expected Instead, the Harper government unilaterally announced changes to the funding

12. Harper Announcer Cuts to Health Care Dec. 19 th, 2011 Finance Minister announces unilateral changes to health care funding 6% escalator until 2016/17 and then an average 3.9% annual growth in CHT cash transfers between 2017/18 to 2024/25 move to per capita funding in 2014 no plan for renewal – cash with no strings

13. Canada Health Transfer (CHT)

14. A Windfall for… Alberta

15. Harper’s plan would kill medicare The Harper government has set in motion a strategy that will lead to the unravelling of Canada’s national health system. All Harper has to do is nothing. By abdicating the essential federal responsibilities in health care, the system will fragment on its own into 14 separate pieces.

16. Role of the Federal Government Guardian Funder Regulator Service Provider Promoter of national approaches

17. Guardian As guardian of national standards the Federal Minister of Health is supposed to ensure that provinces are in compliance with the Canada Health Act and are not allowing queue-jumping, extra-billing or user-fees for medically necessary services. The Act also says no Canadian should face a financial barrier to care - regardless of where they live. Increasingly flagrant violations of the law are occurring. The federal government plays dumb as patients and the sick are exploited or denied access while wealthier Canadians jump the queue.

18. Funder The federal government is a funder and transfers over $40-billion a year to provinces and territories for health care.

19. Regulator Health Canada is responsible for health protection, including the safety of products (food, pharmaceuticals, medical devices, natural health products, consumer products, cosmetics, and chemicals). Poor regulation of food & drugs is making people sick and killing thousands of Canadians annually. This regulatory negligence also puts enormous strain on provincial health care resources.

20. Service Provider The federal government is the fifth largest service provider in the country. Health Canada provides basic primary care services in approximately 200 remote First Nations communities, home and community care in 600 First Nations, and support for health promotion programs in Inuit communities across four regions.

21. Promotes National Approaches The federal government is supposed to work closely with provincial and territorial governments to develop national approaches to health system issues and promotes the pan- Canadian adoption of best practices. - e.g. national approaches to HHR

22. 22 November 19, 2005 The war on medicare Preston Manning: win the battle over language - rearrange the terms so that what appears moderate today is redefined as extreme and what appears extreme is recast as moderate. Then it will be politically easier to completely dismantle national medicare, have the federal government hand over more taxing power to the provinces and let them handle health as they please. …Start with a vulnerable target…Quebec.

23. 23 Beware of Code Words ‘Innovation’ = Commercialization ‘European Model’ = U.S.-style, 2-tier ‘Experimentation’ = No Experiments (WTO) ‘Flexibility’ = Operate Outside of CHA ‘Choice’ = For the Wealthy & Healthy ‘Partnership’ = Public Pays More & Get Less ‘Activity-Based Funding’ = Profit-Based Motive ‘Modernization’ = Life Before Medicare

24. 24 What the few want - Open up the delivery of health services to market rules and divert public funds to the profit seeking private enterprise. - Segmentation of ‘ markets ’, access, coverage. Trader ethic: -exploit vulnerability (the frail elderly)

25. 25 What most people want - Canada Health Act removes the delivery of health services from market rules to ensure access based on need. - ‘ Un-profitable ’ services, populations and regions are not abandoned. Guardian ethic: - protect the vulnerable

26. Support for Public Solutions in Healthcare QUESTION: Thinking about the future of Canada’s public healthcare, would you support, somewhat support, somewhat oppose or oppose public solutions to make our public healthcare stronger? - Nanos Research, May 2010

27. 27 Health Care: Values in Conflict Public Ethic: Guardians For-Profit Ethic: Traders Health care is a human rightHealth care is a commodity Protect the vulnerableExploit vulnerability First, do no harmFirst, maximize profits Keep people healthyProfit from illness

28. 28 More private means less public Draws off resources from the public system Increases costs overall Introduces the inequities of the U.S. system Source: Marcia Angell, MD, “Privatizing health care is not the answer”, Canadian Medical Association Journal, 2009.

29. 29 Medicare Works

30. Towards A Strong Federal Health Accord in 2014 □ Federal leadership for a new 10-Year Health Accord to ensure that it reflects the needs of Canadians in all regions, including: □Pharmacare; □Home Care; □Residential long-term care; and □Palliative Care □ An Accord that ensures access to health care, based on need and not ability to pay. □ An Accord that ensures improved accountability with secure and predictable funding.

31. What can we do to prepare for 2014? 1. Get informed 2. Sign the Medicare Pledge 3. Endorse the Call to Care 4. Talk to family, friends & co-workers 5. Write a letter to the paper – call-in radio 6. Write, call and meet your MLA and MP 7. Run for office!

32. Medicare … fight for it!