New Brunswick Premier Blaine Higgs was “shocked” that at the recent First Ministers’ meeting in Montreal, there was no urgency or strategy to deal with the Alberta oil crisis. He was disappointed and appalled at Quebec actively blocking the Energy East pipeline through that province, and felt that the confederation was “fractured.”

Meanwhile, Manitoba Premier Brian Pallister, in a recent article in the Financial Post , criticized the barriers that still exist between provinces, which he claimed acted like a tariff of seven percent. He suggested that Ottawa introduce a “Charter of Economic Rights,” which would clarify the rights of Canadians to sell their goods and services and exercise their trades and professions across Canada.

To win provincial agreement, Ottawa would ensure that provinces would have revenue sources under their control for healthcare. Federal tax points would be transferred to the provinces. Equalization transfers from Ottawa would guarantee that poorer provinces had adequate financial resources to deliver care.

Pallister did fail to mention that this would require major changes to the Canada Health Act (CHA). Certainly it seems reasonable to allow provinces to experiment and seek greater efficiencies and shorter wait times by looking to health delivery in Europe and other areas with successful blended public/private healthcare systems.

Relevant to this is that Quebec has also persistently violated part of the CHA by refusing pay for the full medical expenses of its residents requiring urgent treatment in other parts of Canada. It is the only province not to sign the Reciprocal Medical Billing Agreement (RMBA.)

For Pallister’s “Grand Bargain” to work, Quebec must agree to sign the RMBA inasmuch as it would no longer be theoretically violating a federal law (albeit never enforced). Canadians must be free to travel to another part of Canada on business or vacation, knowing that they will be fully covered for unexpected illnesses.

The Father of Energy East was NB Premier Frank McKenna, who in 2011 stated, “Moving oil to markets should be “a nation-building exercise.” In December 2012, the NB legislature unanimously endorsed the pipeline. Once in power, Premier Pauline Marois did not oppose Energy East: “There’s certainly an economic advantage given the jobs that could be created in Quebec.” In the spring of 2014, Philippe Couillard favoured the pipeline. He argued that Quebec, as it received equalization payments, owed it to other provinces to help sell their products. Later that year, he and Ontario Premier Kathleen Wynne attached a list of seven conditions, but NB Premier Brian Gallant termed these “very reasonable and achievable.” Quebec Premier Francois Legault in 2016, indicated that he would support the Energy East pipeline if the province received billions of dollars in oil royalties.

Not only would Energy East have been beneficial to Albertans, but according to Kenneth Green of the Fraser Institute, it would have generated an additional $34 billion to the GDP an additional 321,000 one-year jobs across Canada, and $7.6 billion in total tax revenues for Canada.

Energy East may not be dead. Although Premier Legault spoke about “dirty energy” from the West, he failed to mention a few relevant points: In December 2015, Enbridge reversed a section of Line 9 into Montreal. By June 2018, 53% of oil used in Quebec was coming from the West! (About 40% came from the US, and virtually none from Saudi Arabia.)

The Energy East project is supported by Alberta, Saskatchewan, Manitoba, and Todd Smith, Ontario’s economic minister, recently stated, “We wouldn’t stand in the way of that pipeline moving forward. We believe it’s in the interest of all Canadians.” Andrew Scheer has said that a federal Conservative government would seek to revive the project. NB Premier Blaine Higgs recently spoke with TransCanada CEO Russ Girling, and indicated that the company was willing to revive Energy East if it has the assistance of the provinces along the route.

How could the impasse be broken and Quebec be persuaded to join? Perhaps through a “back-door” approach in which Quebec was allowed to increase its health revenue by giving it more autonomy, as suggested by Premier Pallister.

Although in late August 2018, a Compass survey in Quebec showed that the environment was the most important issue for those aged 18-34, these persons should be aware that from 2009-2013, the number of tanker cars carrying oil increased by a factor of 50. The Fraser Institute calculated that pipeline transport of oil was four times safer than by rail. In that same survey, health was the most important issue, especially for voters over age 55. If Pallister’s modified “Grand Bargain’ worked, freed from the constraints of the CHA, Quebec patients might in future see shorter wait times and improved efficiencies with a limited public/private system.

I therefore propose the following compromise: Quebec would no longer oppose the Energy East pipeline (as long as it met the seven conditions of Philippe Couillard) and would sign the RMBA. In exchange, it (and all other provinces) would be granted more autonomy to experiment within its borders with limited privatization of health delivery –an area of provincial jurisdiction — without penalties from Ottawa. Medical tourism would be encouraged.

These measures would generate new revenue to bring provincial budgets into balance. They would help to keep our universal medicare system fiscally sustainable.

As Peter MacKay noted, “Energy East is a nation-building project that can help secure Canada’s economic future and energy independence while fostering national unity and helping our allies. What are we waiting for?”

Dr. Charles S. Shaver holds degrees from Princeton University and Johns Hopkins School of Medicine.

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