New “point man” for federal health negotiations

Newly appointed Health Minister Ujjal Dosanjh will be the behind-the-scenes point man for tough health care negotiations this summer before Prime Minister Paul Martin meets provincial premiers Sept. 13 to achieve what he calls “a fix for a generation.”

Martin named Dosanjh to the Health portfolio July 20, when he unveiled his new cabinet following the June 28 election that reduced the Liberals to a minority government. Dosanjh, the former NDP premier of BC, is a lawyer and former human rights advocate who immigrated to Canada in 1968.

Immediately after being sworn in at Rideau Hall, Dosanjh sent a signal distancing himself from former health minister Pierre Pettigrew, who had appeared to favour opening the door to private delivery of health care services.

“We will work together to make sure we have a better health care system in Canada,” Dosanjh told reporters. “I can tell you what we need to do is stem the tide of privatization in Canada and expand public delivery of health care.”

As a former New Democrat, Dosanjh's appointment may have been intended to appease that party, which holds a critical 19 seats in the House of Commons. To pass legislation, the Liberals will need to build coalitions within the House.

Dosanjh's appointment “signifies that the federal government is if anything going to tilt left on the medicare issue,” says Dr. Michael Rachlis, a Toronto-based health policy analyst and author of Prescription for Excellence: How Innovation is Saving Canada's Health Care System.

That tilt is likely to send Dosanjh into direct conflict with at least a few of the premiers, scheduled to meet Martin in a televised meeting beginning Sept. 13. Martin's election promises — $3 billion over 2 years in unconditional health transfers, $4 billion over 5 years to cut waiting times, and $2 billion for a national home care program — are expected to rank high on the premiers' agenda.

Dosanjh is saddled with the role of carving out common ground before the September meeting. Already, he faces entrenched positions. Alberta Premier Ralph Klein has mused publicly about giving healthy people a tax break over those who are a drain on the health care system, of imposing changes in Alberta that may violate the Canada Health Act, or of opting out of any agreement the other provinces reach in September.

Many of the other premiers, notably Quebec's Jean Charest, are opposed to having any conditions attached to federal health dollars.

Fulfilling the Liberal election promises, especially on wait times, will be difficult within the limited time frame of a minority government, says Rachlis. “It's a challenge for Dosanjh, because I do not think the information about how to fix these problems is widespread enough for it to be implemented quickly.”

Dosanjh has also echoed Martin's commitments to not only improve the medicare services that already exist, but to expand them — a jurisdictional challenge, since health care is delivered largely by the provinces.

The new minister pledged not to take a combative approach, hoping that his previous experience as a premier will help bridge differences.

“By getting tough you won't get anywhere,” Dosanjh said after his first cabinet meeting. “You'll get somewhere by being cooperative, and our approach is to make sure that we work with the provinces.” — Laura Eggertson, CMAJ