Health Care, Entitlement, and Citizenship

K.V. Nagarajan is a professor in the Department of Economics at
Laurentian University.

In the context of federal–provincial fiscal relations, the Charter of
Rights and Freedoms, and the Health Canada Act, Candace Johnson Redden
argues, Canadians have come to “feel entitled to health services, and
the (inevitable) rationing of services is perceived as a violation of
rights. The right to health care is no longer merely a ‘just
expectation’ or normative claim, but a serious legal matter.” That
is to say, people can use the aforementioned documents as the basis for
lawsuits charging lack of care. This situation has frustrated attempts
at health-care reform and kept the health-care system in a state of
ongoing “stasis.”

There has been movement of sorts. Redden describes the community
governance structure experiments in Nova Scotia, Saskatchewan, and
Oregon, and highlights the difficulties in bringing about change through
public participation. She also recommends a consideration of the “New
Universalism”—advocated by the World Health Organization—under
which governments recognize their limits but retain responsibility for
leadership over and financing of health systems. But that is the system
we already have in Canada. Disappointingly, Redden finds “no
definitive answer” to the problem of entitlement and stasis her book
articulates.