OTTAWA - Prime Minister Stephen Harper is scheduled to address a conference on wait times Wednesday, and bets are that he will announce the fulfilment of his election promise on medical wait-time guarantees.
Organizers of the Taming of the Queue conference, an annual meeting in Ottawa on wait times, had expected an appearance by Health Minister Tony Clement but the surprise visit by Harper suggests political news in the offing.
Care guarantees were one of the five priority election promises of the Conservatives in the 2006 election - the idea was that patients unable to get timely medical care would be sent to another jurisdiction or allowed to get treatment in private clinics at public expense.
Failure to deliver on the high-profile promise would provide a target for opposition parties in a possible election. But provinces initially refused to buy into the plan on which they had not been consulted.
The March budget provided $612 million for provinces and Ottawa to fulfil a somewhat reduced promise: a care guarantee in one treatment area rather than all five priority areas - cancer, heart, diagnostic imaging, joint replacements and sight restoration - initially outlined.
To get its share, a province can promise to provide a guarantee in the area of its choice, and do so in the manner of its choosing.
"No government's going to walk away from a pot of money," said Harvey Voogd of Alberta-based Friends of Medicare, suggesting that provinces could merely continue to do what they were doing anyway.
"Nobody has signed on to a difficult wait time, all have signed up for wait times they're already beavering away at or successfully meeting.
"Anybody who follows this stuff can see what the federal government is doing is not a well thought out wait-time plan but is covering their political backside for any federal election."
Tom McIntosh, research director at the Canadian Policy Research Networks, said there is little enthusiasm about care guarantees at the provincial level.
"Many people have been deeply ambivalent on the idea of a care guarantee unless it's really properly designed and based on some really strong evidence. What happens to those things that are deemed not to be a priority? Do we sacrifice those to meet our priorities?
"I think there's a feeling that the federal government is trying to push provinces in a way that may not necessarily result in either the reduction of wait times or good policy; that there could be unintended consequences that haven't been thought out.
"At the same time they don't want to leave the money on the table."
Meanwhile, the federal and provincial governments have quietly abandoned one of the key elements of the 2003 first ministers' health accord, which was the requirement for accountability in the spending of billions of federal health dollars.
Jeanne Besner, interim chair of the Health Council of Canada, reported earlier this year that it is impossible to know where the federal money is going because provinces have not provided the necessary data.
"We are unable to say where the provinces and territories are investing funds from the federal health-care agreements because no financial breakdowns are provided," she said in her 2007 report.
The 2003 accord required that provinces provide comparable health indicators but they have not done so, and the federal-provincial committee overseeing the work has been disbanded, Besner said.
Consequently there is no pan-Canadian evidence that waiting lists are being shortened.
