Former Minister of Finance (Liberal) John Manley on CBC's Power & Politics today as much as said that he'd like Stephen Harper to scrap the Canada Health Act. (Video)

Today Manley is president and chief executive officer of the Canadian Council of Chief executives. In a recent letter to Prime Minister Harper Manley urges Harper and his party to "move forward boldly" using the new power afforded them with their majority standing in the House of Commons.

What does move forward "boldly" likely mean to Manley in the context of the Canadian Health Act?

Gut it. Start anew.

That does sound scary but does he really mean that? To answer that question we'll have to parse what he said on Power & Politics today. In Manley's view, the five basic principles underlying the Canada Health Act need to be reviewed. "Who has looked at those lately", he wondered aloud.

Fair enough, let's look. Our review won't take long, as there are only five principles or program criteria and they aren't complicated:

1. Public Administration, requiring a public not for profit authority carry out the administration of provincial health insurance and be accountable to the province or territory;
2. Comprehensiveness, requiring provincial health insurance cover all necessary health services;
3. Universality, stipulating that all insured residents are entitled to comprehensive health care services on a uniform basis;
4. Portability, subject to pre-defined limitations, ensuring that all insured residents are entitled to insured coverage when travelling to other Canadian and foreign jurisdictions.
5. Accessibilty, requiring that all insured residents have reasonable access to healthcare facilities and services regardless of where they live, and that health service providers are paid for the services they deliver.

Readers should note that I've repeatedly emphasized the word insured. This has been done because the concept of health insurance is a cornerstone of our universal national health care framework.

Distilled into one sentence, the underlying premise of the Canada Health Act is that all insured Canadian residents shall receive essentially the same level of service regardless of where they live and that services shall be paid for and administered by not for profit public authorities that report and are accountable to the provinces.

If Manley has a problem with that simple definition then, by definition, he has a big problem with health care in Canada as we have all come to know it. Is his problem with public administration or universality? Does comprehensiveness cause his brow to furrow or is it accessibility?

Or could it be that that what troubles Manley most is the public provision of insured health services, with the emphasis on public insurance? Does he want to change who pays whom?

While openly musing today about which of the five principles of the Canada Health Act are most important or relevant, John Manley said the following (near the 5 minute mark in the video clip):

"From my point of view the relevant [principles] are we don't want anyone suffering from a catastrophic illness that causes them to go broke, and secondly we don't want anyone refused treatment, in Canada, who is a Canadian citizen, because they can't afford treatment." John Manley, CEO Canadian Council of Chief Executives

Manley then dismissed all five principles with a glib "After that, let's go!"

In simplistic terms, Manley wasn't in fact commenting on the existing principles embedded within the Canada Health Act.

It is very important to note that no Canadian today gets refused treatment because "they can't afford treatment" because under the CHA Canadians do not pay for treatment -- we pay for insurance, or our employers or social assistance programs pay the insurance premiums on our behalf.

What Manley is talking about is not a simple refinement of our current system but a radical departure that contemplates user-pay and means testing. You'd have to rip up the most meaningful part of the Canada Health Act to achieve this level of change. And you'd need a majority government to ram it through.

Manley's short quip on change is a hint about some future vision of health care delivery in Canada that sounds remarkably like a user-pay system we might find in the United States.

• Health care for Canadian citizens only
• User-pay
• State-paid based on means testing?

In recent months we've heard similar talk from Stephen Harper himself.

During the English language leader's debates of the recent federal general election, on the subject of health care Harper said, paraphrased, "we believe that Canadians should receive the health care they need regardless of their ability to pay".

Ability to pay is not a founding principle of the Canada Health Act. Ability to pay for treatment is quite a different concept than "ability to pay the insurance premium". Stand on guard Canada, "ability to pay" is a code phrase that doesn't mean what we've come to expect.

During the election through Harper's careful choice of words voters heard what they hoped to hear, but the words strung together do not hold the meaning most voters expect. How long will it be before we find out what the code words and phrases employed by Harper and Manley really mean?

Not long, I'll wager.