Pity Ujjal Dosanjh; it is sometimes not good to get what you want. Prime Minister Paul Martin made him Minister of Health, and, therefore, made him responsible for delivering on some of the key Liberal campaign promises.

Health is predominately a provincial responsibility under Canada's constitution, but the federal government has "intruded" into provincial jurisdiction through the use of conditional grants in aid. In other words, the federal government uses its superior taxing authority to raise money and give it to the provinces subject to certain conditions. Under the old Canada Assistance Plan, the conditions involved virtually micromanaging some aspects of the system. Since 1984 the conditions have been expressed as five principles in the Canada Health Act, universality, accessibility, portability, comprehensiveness and public administration. The federal government can withhold money from the provinces if they violate any of the principles. The Act was originally designed to stop hospital user fees in BC and to stop extra billing that was occurring in Alberta and Ontario. Today there is an argument that penalties should be levied against provinces that allow private clinics where patients pay some sort of facility fee to jump the queue..

The website for Health Canada lists 17 Acts for which the Minister of Health has total or partial responsibility. The Canada Health Act tops the list which also includes the Controlled Drugs and Substances Act, the Food and Drugs Act, the Hazardous Products Act, the Patent Act (which granted longer patent protection to drug companies), the Pest Control Products Act, and the Tobacco Act. There are many controversial issues involving those statutes, but none is as immediate as dealing with the issue of reliable, predictable federal funding for health care and what conditions are attached to that funding.

Ontario is attempting to stop the gradual privatization of health care by purchasing seven private clinics and making them public. The Globe and Mail quoted an unnamed spokesman for Ontario Premier Dalton McGuinty saying "We are committed to delivering on our platform commitment to bring MRI clinics back to the public realm." McGuinty's platform commitment may also be related to the anticipated move by the federal government to implement penalties for provinces that permit the private clinics.

BC has both private MRI clinics and stand alone surgery centres. Last November the Campbell government flip-flopped on legislation that would have cracked down on private clinics. Amendments to the Medicare Protection Act were first promoted as necessary to fulfill BC's obligations under the Canada Health Act, only to be shelved after questions were raised as to whether the government really intended to take on the clinics. No one's hands are clean in the creeping spread of private clinics. Objections were not raised when stand alone abortion clinics were established; at least the objections had nothing to do with the public or private provision of health services. Twenty years ago it was felt that private clinics could be stopped by prohibiting physicians from participating in the public system if they worked in a private clinic. Simple economics meant that there wasn't enough demand for private clinics to survive if their physicians couldn't also work in the public system. In the 1990s BC allowed WCB and ICBC to send patients to private surgery centres. That established a financial base for the clinics which then proceeded to also accept patients who paid privately, a clear violation of the Canada Health Act. Dosanjh sat at the BC cabinet table, and eventually became Premier, when that creeping privatization surged forward. Now he is charged with stopping it.

On the evening of his appointment to cabinet, Dosanjh appeared on CBC's National TV news to respond to hard hitting questions on what he will do. He spoke about "stemming" the privatization of health care. Dosanjh is both a lawyer and a politician. When lawyers and politicians use tricky words like "stemming" rather than "stopping", they have a reason. Is the Martin-Dosanjh position to slow the growth of the clinics, stop the growth, or eliminate the practice? The answer is not clear.

BC could follow Ontario's example and attempt to buy out the existing clinics. It is likely, however, that their operators or others like them would turn around and open new private clinics. Eliminating private clinics would require dealing with the existing clinics and stopping any new clinics. The only way to make that happen is to make the public system good enough so there is no demand for queue jumping at private clinics.

The Prime Minister made a lot of specific promises during the election campaign including providing long term stable funding for health care that eliminates the Romanow gap, in other words increasing the federal cash contribution to 25%. He also promised "A major effort to work with provinces and territories, to measure and publish existing waiting times, determine which waiting times should be reduced first, and, then to do what it takes to bring waiting times down. Federal support for the strategy will be provided by $4 billion in new and targeted funds." He specifically promised to significantly reduce wait times by 2009 for cancer, heart, diagnostic imaging, joint replacements, and sight restoration.

The minority government is unlikely to survive without an election before 2009. It is unlikely that measurable, credible progress will be achieved on reducing wait lists by the time Martin goes back to seek a majority government. Dosanjh will have to account for any failed expectations with respect to Martin's ambitious health care agenda. The public has had enough of one level of government blaming another while the health system deteriorates. The promised public first ministers' meeting will be closely scrutinized. Dosanjh is expected to be at Martin's side playing a key role in those talks. He will have to say more than he did on CBC to have any credibility. The provinces want more than vague references to the need for innovation.