Friday, May 16, 2025
No Result
View All Result
  • Media
Support Us
Macdonald-Laurier Institute
  • Home
  • About
    • Who We Are
    • Who Makes MLI Work
    • Tenth Anniversary
  • Experts
    • Experts Directory
    • In Memoriam
  • Issues
    • Domestic Policy
      • Economic Policy
      • Justice
      • Rights and Freedoms
      • Assisted Suicide (MAID)
      • Health Care
      • COVID-19
      • Gender Identity
      • Canada’s Political Tradition
      • AI, Technology and Innovation
      • Media and Telecoms
      • Housing
      • Immigration
      • Agriculture and Agri-Food
      • Competition Policy
    • Energy Policy
      • Energy
      • Environment
    • Foreign Policy
      • Israel-Hamas War
      • Ukraine
      • Taiwan
      • China
      • Europe and Russia
      • Indo-Pacific
      • Middle East and North Africa
      • North America
      • Foreign Interference
      • National Defence
      • National Security
      • Foreign Affairs
    • Indigenous Affairs
  • Projects
    • CNAPS (Center for North American Prosperity and Security)
    • The Promised Land
    • Voices that Inspire: The Macdonald-Laurier Vancouver Speaker Series
    • Dragon at the Door
    • Canada on top of the world
    • Justice Report Card
    • The Great Energy Crisis
    • DisInfoWatch.org
    • Double Trouble
    • Digital Policy & Connectivity
    • Managing Indigenous Prosperity
    • Defending The Marketplace of Ideas
    • Reforming the University
    • Past Projects
      • Canada and the Indo-Pacific Initiative
      • The Transatlantic Program
      • COVID Misery Index
        • Provincial COVID Misery Index
        • Beyond Lockdown
        • COVID and after: A mandate for recovery
      • Speak for Ourselves
      • The Eavesdropping Dragon: Huawei
      • Talkin’ in the Free World with Mariam Memarsadeghi
      • An Intellectual Property Strategy for Canada
      • Munk Senior Fellows
      • A Mandate for Canada
      • Confederation Series
      • Fiscal Reform
      • The Canadian Century project
      • Fixing Canadian health care
      • Internal trade
      • From a mandate for change
      • Size of government in Canada
      • Straight Talk
      • Labour Market Report
      • Leading Economic Indicator
      • Centre for Advancing Canada’s Interests Abroad
      • Indigenous Prosperity at a Crossroads
        • Aboriginal Canada and Natural Resources
  • Events
    • Upcoming Events
    • Past Events
      • MLI Dinners
      • Great Canadian Debates
  • Latest News
  • Inside Policy
  • Libraries
    • Columns
    • Commentary
    • Papers
    • Books
    • Video
  • Home
  • About
    • Who We Are
    • Who Makes MLI Work
    • Tenth Anniversary
  • Experts
    • Experts Directory
    • In Memoriam
  • Issues
    • Domestic Policy
      • Economic Policy
      • Justice
      • Rights and Freedoms
      • Assisted Suicide (MAID)
      • Health Care
      • COVID-19
      • Gender Identity
      • Canada’s Political Tradition
      • AI, Technology and Innovation
      • Media and Telecoms
      • Housing
      • Immigration
      • Agriculture and Agri-Food
      • Competition Policy
    • Energy Policy
      • Energy
      • Environment
    • Foreign Policy
      • Israel-Hamas War
      • Ukraine
      • Taiwan
      • China
      • Europe and Russia
      • Indo-Pacific
      • Middle East and North Africa
      • North America
      • Foreign Interference
      • National Defence
      • National Security
      • Foreign Affairs
    • Indigenous Affairs
  • Projects
    • CNAPS (Center for North American Prosperity and Security)
    • The Promised Land
    • Voices that Inspire: The Macdonald-Laurier Vancouver Speaker Series
    • Dragon at the Door
    • Canada on top of the world
    • Justice Report Card
    • The Great Energy Crisis
    • DisInfoWatch.org
    • Double Trouble
    • Digital Policy & Connectivity
    • Managing Indigenous Prosperity
    • Defending The Marketplace of Ideas
    • Reforming the University
    • Past Projects
      • Canada and the Indo-Pacific Initiative
      • The Transatlantic Program
      • COVID Misery Index
        • Provincial COVID Misery Index
        • Beyond Lockdown
        • COVID and after: A mandate for recovery
      • Speak for Ourselves
      • The Eavesdropping Dragon: Huawei
      • Talkin’ in the Free World with Mariam Memarsadeghi
      • An Intellectual Property Strategy for Canada
      • Munk Senior Fellows
      • A Mandate for Canada
      • Confederation Series
      • Fiscal Reform
      • The Canadian Century project
      • Fixing Canadian health care
      • Internal trade
      • From a mandate for change
      • Size of government in Canada
      • Straight Talk
      • Labour Market Report
      • Leading Economic Indicator
      • Centre for Advancing Canada’s Interests Abroad
      • Indigenous Prosperity at a Crossroads
        • Aboriginal Canada and Natural Resources
  • Events
    • Upcoming Events
    • Past Events
      • MLI Dinners
      • Great Canadian Debates
  • Latest News
  • Inside Policy
  • Libraries
    • Columns
    • Commentary
    • Papers
    • Books
    • Video
No Result
View All Result
Macdonald-Laurier Institute

Confusion Over Who is Responsible is Harming Medicare: New MLI study by Dr. Shawn Whatley

August 19, 2019
in Domestic Policy, Health care - papers, Latest News, Papers, Health, Releases, Shawn Whatley
Reading Time: 4 mins read
A A

OTTAWA, ON (August 19, 2019): In a study released today by the Macdonald-Laurier Institute, Munk Senior Fellow and former Ontario Medical Association president Dr. Shawn Whatley calls for a national discussion about the level of government responsible for health care in this country, and proposes reforms that make political decision-makers more accountable to patients and voters.

As Dr. Whatley explains in the paper, titled “The Most Responsible Politician”, in medicine, the Most Responsible Physician or Practitioner (MRP) is ultimately responsible for overseeing the care of an admitted patient. Responsibility for clinical decisions and for a patient’s ultimate outcome falls on the MRP. Any ambiguity around MRP creates the potential for bad patient outcomes.

According to Dr. Whatley, the MRP concept does not just apply to medicine. It applies to all leadership scenarios: “We need one person or governance unit to take responsibility for important issues,” he says. “When it comes to political oversight and accountability for the Canadian health care ‘system,’ we might expand the MRP definition and ask: Who is the Most Responsible Politician for Canadian health care?”

Canadian health care routinely ranks poorly against comparable OECD nations. But who should bear the blame for mediocre performance? On one hand, the Constitution appears to support the notion that health care is an exclusive provincial responsibility. On the other hand, the federal government uses its spending power and legislative authority, based on the Constitution, to shape health care through the Canada Health Act (CHA) and Canada Health Transfer (CHT) payments.

The paper quotes Gregory Marchildon, who writes that “provincial governments have assumed the primary responsibility and authority for public health care. At the same time, the Government of Canada, by using [its] ‘spending power’ … has exerted considerable influence over Medicare.” Needless to say, as researchers Michael Smart and Richard Bird have noted, “The result of this fiscal churning is that no government has clear responsibility for delivering key programs and both sides readily blame the other when something goes wrong.”

In the face of this wrangling, patients can end up paying the price. Identifying a Most Responsible Politician for health care might be the answer. Dr. Whatley’s paper examines the history of the Canadian health care system, the relevant Constitutional debates, and more recent legislation. It determines that “a decentralized approach that brings the administration of care closer to the patient, and allows for a variety of approaches that suit the particular needs of patients in different provinces, is preferable to a top-down system dictated by the federal government.”

Once we’ve identified the Most Responsible Politician, how do we give the appropriate level of government the resources and the responsibility to ensure the job gets done? One place to start could be by reforming the health transfer and allowing for provinces to raise their own revenue for health programs, with fewer strings attached.

Dr. Whatley refers to a proposal by Ken Boessenkool, who explores options to implement a significant reduction in federal transfer payments to match a GST tax point transfer. Boessenkool writes that the current approach to funding and managing health care creates confusion “about which level of government is responsible for health care. This confusion is not costless: it allows the provinces to shift the blame to Ottawa when they make mistakes and allows Ottawa to claim credit for reforms it had nothing to do with.”

Conveniently, the CHT stood at $36.1 billion in 2016-17. The GST brought in $34.4 billion for 2016-17. Instead of having the federal government collect $34.4 billion in GST and then transfer $36.1 billion to the provinces, it seems reasonable to consider having the provinces collect the GST and stop the CHT payments, although some transfer arrangement would still be required for provinces with the smallest tax bases.

“If we asked patients, they would probably place more weight on access to quality patient care than on the vague ideals in the CHA or the details of CHT payments” says Dr. Whatley. “Bad things happen when admitted patients do not have a Most Responsible Physician. The same concept applies to health care at a system level. As it stands, the lack of clarity about which level of government carries responsibility for improving health care performance makes difficult change almost impossible.”

To read the full report, click here.

***

Dr. Shawn Whatley is a Munk Senior Fellow at the Macdonald-Laurier Institute, past President of the Ontario Medical Association (OMA) and has wide-ranging knowledge and experience in the field of health care policy. He is also the author of the highly-praised book on how to fix emergency wait times in Canada, No More Lethal Waits. At present, he runs a small rural family practice and is a frequent commentator on health issues in Canada.

To arrange an interview, media are invited to contact:

Brett Byers-Lane
Communications and Digital Media Manager
613-482-8327 x105
brett.byers-lane@macdonaldlaurier.ca

Tags: healthcaremedicareHealthShawn Whatley

Related Posts

Welcome to the post-progressive political era: Eric Kaufmann in the Wall Street Journal
Social Issues

Welcome to the post-progressive political era: Eric Kaufmann in the Wall Street Journal

May 16, 2025
Spike in church arsons puts reconciliation at risk: Ken Coates and Edgardo Sepulveda for Inside Policy Talks
Domestic Policy

Spike in church arsons puts reconciliation at risk: Ken Coates and Edgardo Sepulveda for Inside Policy Talks

May 16, 2025
Legacy on Trial: Revisiting Macdonald and Diefenbaker
Fathers of Confederation

Legacy on Trial: Revisiting Macdonald and Diefenbaker

May 15, 2025
Next Post
Should Canada ban Huawei from its 5G networks? Yes: Brian Lee Crowley in the Toronto Star

Should Canada ban Huawei from its 5G networks? Yes: Brian Lee Crowley in the Toronto Star

Newsletter Signup

  Thank you for Signing Up
  Please correct the marked field(s) below.
Email Address  *
1,true,6,Contact Email,2
First Name *
1,true,1,First Name,2
Last Name *
1,true,1,Last Name,2
*
*Required Fields

Follow us on

Macdonald-Laurier Institute

323 Chapel Street, Suite #300
Ottawa, Ontario, K1N 7Z2 Canada

613.482.8327

info@macdonaldlaurier.ca
MLI directory

Support Us

Support the Macdonald-Laurier Institute to help ensure that Canada is one of the best governed countries in the world. Click below to learn more or become a sponsor.

Support Us

  • Inside Policy Magazine
  • Annual Reports
  • Jobs
  • Privacy Policy

© 2023 Macdonald-Laurier Institute. All Rights reserved.

No Result
View All Result
  • Home
  • About
    • Who We Are
    • Who Makes MLI Work
    • Tenth Anniversary
  • Experts
    • Experts Directory
    • In Memoriam
  • Issues
    • Domestic Policy
      • Economic Policy
      • Justice
      • Rights and Freedoms
      • Assisted Suicide (MAID)
      • Health Care
      • COVID-19
      • Gender Identity
      • Canada’s Political Tradition
      • AI, Technology and Innovation
      • Media and Telecoms
      • Housing
      • Immigration
      • Agriculture and Agri-Food
      • Competition Policy
    • Energy Policy
      • Energy
      • Environment
    • Foreign Policy
      • Israel-Hamas War
      • Ukraine
      • Taiwan
      • China
      • Europe and Russia
      • Indo-Pacific
      • Middle East and North Africa
      • North America
      • Foreign Interference
      • National Defence
      • National Security
      • Foreign Affairs
    • Indigenous Affairs
  • Projects
    • CNAPS (Center for North American Prosperity and Security)
    • The Promised Land
    • Voices that Inspire: The Macdonald-Laurier Vancouver Speaker Series
    • Dragon at the Door
    • Canada on top of the world
    • Justice Report Card
    • The Great Energy Crisis
    • DisInfoWatch.org
    • Double Trouble
    • Digital Policy & Connectivity
    • Managing Indigenous Prosperity
    • Defending The Marketplace of Ideas
    • Reforming the University
    • Past Projects
      • Canada and the Indo-Pacific Initiative
      • The Transatlantic Program
      • COVID Misery Index
      • Speak for Ourselves
      • The Eavesdropping Dragon: Huawei
      • Talkin’ in the Free World with Mariam Memarsadeghi
      • An Intellectual Property Strategy for Canada
      • Munk Senior Fellows
      • A Mandate for Canada
      • Confederation Series
      • Fiscal Reform
      • The Canadian Century project
      • Fixing Canadian health care
      • Internal trade
      • From a mandate for change
      • Size of government in Canada
      • Straight Talk
      • Labour Market Report
      • Leading Economic Indicator
      • Centre for Advancing Canada’s Interests Abroad
      • Indigenous Prosperity at a Crossroads
  • Events
    • Upcoming Events
    • Past Events
      • MLI Dinners
      • Great Canadian Debates
  • Latest News
  • Inside Policy
  • Libraries
    • Columns
    • Commentary
    • Papers
    • Books
    • Video

© 2023 Macdonald-Laurier Institute. All Rights reserved.