Anne McLellan: new direction from a new minister?

Within days of being made federal health minister last January, Anne McLellan was off and running. On CTV's Question Period, the new minister broke a Liberal taboo by raising the possibility that companies could build and run private hospitals that might be allowed to operate within the Canadian health care system. “Does corporate structure necessarily matter in terms of a hospital, as long as when I take my Alberta health card they take that card and my stay in that hospital and the treatment therein is covered by a publicly funded, publicly administered health care plan?”

McLellan could not have signalled more clearly that there was a new hand on the tiller. But does she represent a change of style, or of substance? “Look,” the minister told CMAJ, “approach is really important here. The Canadian federation works best when governments work collaboratively. I was one of the federal negotiators for the Social Union Accord in September 2000.”

According to McLellan, that successful agreement between the provinces and Ottawa is a model for how she would like health care reform to proceed. “Canadians have told us to stop bickering and fix health care. So that's what we have to do — sit down and fix it.” And unlike predecessor Allan Rock, McLellan appears to embrace flexibility: “I don't think the Canada Health Act should be etched in stone.”

In early February she took on an issue that has dogged federal-provincial relations for years, announcing that she wants Ottawa and the provinces to develop quickly a dispute-resolution procedure to settle disagreements about the Canada Health Act (CHA).

McLellan, the former associate dean of law at the University of Alberta, says the goal for every minister must be “renewal of the system,” but she distinguishes between pressing challenges and long-term objectives. “Coming from a university background, I understand the importance of research if we want to attract and keep the best scientists, clinicians and students. I think one of the most exciting achievements of this government is the increase in biomedical research dollars and the creation of the Canadian Institutes of Health Research.”

In his 5 years as minister, Rock was known for his close relationship with groups like the CMA, and McLellan may take that approach too. “Doctors are in the forefront of understanding the complexities of these issues,” she says.

Her switch to health from justice was unexpected. Until Industry Minister Brian Tobin's abrupt resignation in January, observers predicted only a minor cabinet shuffle. However, with Tobin gone the prime minister had to make more dramatic changes, and McLellan, a 9-year cabinet veteran, was suddenly in play. She was eating dinner in her Edmonton riding when she was told to catch the red-eye to Ottawa so that she could be sworn into her new job next day.

The Alliance Party's Dr. Keith Martin was pleased with the appointment. “She has given encouraging indications that she is open-minded about the fundamental structural changes that must occur,” the BC MP says, “and she can devote time to the portfolio because she is not running for the leadership.”

Health care analyst Michael Decter lauds her openness: “Maybe we are seeing the emergence of a pragmatic centre on the health issue, which we have never had.”

However, for all McLellan's new approach it is still unclear whether a shift in federal policy will follow this shift in tone. Until Roy Romanow issues his report in November, McLellan is unlikely to make any structural changes. This means that she must stay on top of the debate as several provinces, especially Alberta, take the lead in reforms that may stretch the 5 principles of the CHA.

In her CTV interview, she made it clear that the new-found federal flexibility has its limits. “If Premier Klein chose to violate the principles of the Canada Health Act, I would take him on. Absolutely.” As minister of justice, McLellan has already shown that she likes being the iron fist in a velvet glove — she championed gun control despite the outrage of the Alberta-heavy gun lobby.

What is McLellan's own experience of Canada's health care system? The 51-year-old minister laughs as she admits that her “wonderful family doctor” recently told her she must lose 20 pounds and exercise more — advice that is difficult to follow in a high-stress job characterized by erratic hours and mealtimes. “It is so important,” she reflects, “for all of us to understand what we can do to stay well and help sustain the system.”

But she also recognises that medicare is key to the well-being of Canadians. “My father was 55 when he had his first heart attack, and before he died at age 65 he had surgery 2 or 3 times. We could never have afforded to pay out of our own pockets for the care he needed and received.

“Canadians, including Albertans, want to know that health care like that will be there when they need it.”