Considering Romanow

Winter 2002 CSANews Issue 45  |  Posted date : Apr 12, 2007.Back to list

Snowbirds won't be the only Canadians thinking about health care costs and availability this winter. Eighteen months ago, Prime Minister Chrétien appointed Roy Romanow to head a well-publicized Royal Commission on the Future of Health Care in Canada. After 21 days of public hearings in 18 different cities, 15 expert workshops and round tables, 640 formal submissions and $15 million in public expense, the commission released its long awaited final report titled, Building on Values: The Future of Health Care in Canada. As Canadians everywhere hold their breath, desperate for useful solutions to restoring national pride to our once beloved health care system, the questions now are: What did this landmark report give us? Was it worth it? And will Canadians buy into it?

Reporting directly to the Prime Minister, the Romanow Commission was given the enormous task of looking at the long-term challenges of ensuring the sustainability of Canada's publicly funded health care system. Early on in the process, it became clear that Mr. Romanow, a former NDP Premier of Saskatchewan (the birth place of Medicare), would not be making any recommendations that radically deviated from the established status quo or suggest any kind of separation from our commitment to a publicly funded system with strict limitation on market involvement. This is not to say that Mr. Romanow's final report hasn't made significant recommendations that require legitimate consideration, but it might remind us of an old joke that defines a consultant as someone who borrows your watch to tell you the time.

The commission's final report is comprised of 47 recommendations that seem rooted in a passionate campaign to convince Canadians that their publicly funded health care system will continue to flourish as long as we commit to paying more money, give the federal bureaucracy more power to control how we spend it, and choose our growth areas carefully. Some specific highlights include:

  • Updating the Canada Health Act and establishing a "Canadian Health Covenant" to express Canadian values;

  • Establishing a new federal agency to monitor the performance of provincial health systems, resolve disputes, seek ongoing consultation from the public and health stakeholders, as well as provide recommendations to the provinces for more integrated education programs for health care providers;

  • Establishing a dedicated, cash only multi-year (5-year) Canada Health Transfer;

  • Increasing federal funding to the provinces by $15 billion over the next 3 years and then maintaining it to a minimum 25% of the cost of health services insured under the Canada Health Act;

  • Creating five new targeted funds to deal with immediate priorities until the minimum federal funding threshold of 25% is attained in 2005/2006. These include improving timely access to care in rural and remote areas; reducing wait times for diagnostic services like MRIs and CT scans; improving primary care and the supply of health care providers; establishing the beginning of a national homecare strategy; and a new funding transfer that should help provinces cover larger portions of expensive drug plans;

    Other mentionable recommendations include:

  • Creating an electronic database of personal health records on-line;

  • Encouraging health promotion by improving strategies for government to promote physical activity;

  • Creating a national immunization strategy;

    These recommendations have tried to speak to many struggles facing our health system. They lay out an ambitious approach to moving forward on important issues. To do this, however, government and citizen buy-in will be crucial. Unfortunately, it quickly becomes apparent that Romanow's suggested direction will fail to be comprehensively convincing and citizens will soon wonder about major gaps in the commission's findings. While the areas for new investment targeted by the report are more than deserving, it is unclear how they managed to drastically overshadow other important components of the system such as chronic care, institutional long-term care and mental health. It seems that the more one peers beyond the slogans, criticisms and short falls of Romanow's recommendations aren't hard to identify and explain.

    For starters, the visionary statements and warm sentiments that line the 256 page report will do very little to make people healthy, reduce crippling waiting periods or increase options for wellness. Romanow works very hard to protect our national sense of pride around the health system, but, he does little to recognize that the system may be less than we think it is. Although Canada enjoys one of the strongest economies in the G-7, the World Health Organization recently ranked our health system below 30 other countries. A false sense of security around the strength of our system is being perpetuated.

    Medicare in Canada was created at a time when the majority of our citizens were young and healthy. The oldest baby boomers were still in their twenties, the economy was expanding and governments had no problem creating massive deficits to win citizen favour by spending beyond their means. Today, the landscape is dramatically different. Health care costs have grown, the population is proportionately older, in need

    of more care, and a technological revolution has increased options so that consumer demands from medical care are tremendously exciting but equally expensive.

    In addition, citizens are less willing to accept governments who recklessly spend with no consideration for the impact on future generations. Controlling deficits in a global economy is no longer an intellectual luxury but a permanent priority. Despite these well-documented issues, Romanow seems to wash away the concern that the system may not be sustainable in its present form, by telling us that it is simply a matter of the choices we make and the implementation of increased measures of accountability. Many see this as naïve and curiously protective of the status quo. Others will be bothered by the suggestion that they must continue to limit their options for care so as not to upset ideological sentiments.

    The suggestion that the federal government will find the billions of dollars in new funding, within a limited surplus accumulated in recent years, is dangerously short sighted. It completely ignores other pressures including education, social programs, the environment, research and development, rebuilding the armed forces and paying down the debt to name a few.

    Further, there is no guarantee that an infusion of new money will do anything to tangibly change health services in any way. Considering the increasing demand for health care funding over the past five years, Mr. Romanow's proposed increases will soon be discovered as magnificently underestimated. They won't even scratch the surface in a system that currently spends $100 billion per year and allows costs to consistently rise. New money is too easily swallowed up into the whale of public spending and digested by higher wages, administration and mismanagement before anybody notices. It also does little to achieve buy-in or renewed confidence. Within hours of the reports release, critics had already announced that provincial governments would find the proposed increases insufficient and that the time it would take to appear in upgraded services would be too long.

    Mr. Romanow seems to have missed an historic opportunity to facilitate the insertion of real innovation into the management of the health system. Surely, the amount of public input, energy and money spent on this endeavour could have produced more imaginative and productive recommendations on cost savings and sustainability. One example is found in last year's open letter to Roy Romanow written by the Canadian Snowbird Association President Ellen White. The simple suggestion was that when snowbirds travel south for the winter, they are taking part in a health promotion activity that significantly reduces the burden on the health system and, thus, warrants better government legislation to facilitate this experience for older Canadians. Clearly, this suggestion was not alone and is but one example in a probable sea of imaginative and practical cost saving innovations that seem to have been ignored by the commission's report. Health promotion and wellness needs to be understood on a much deeper level than simply getting more exercise.

    Roy Romanow, the former NDP premier, has given us recommendations that are largely a recipe for spending new money and creating new government agencies in Ottawa to watch how we spend it. Canadians have been asked to believe that a new Canada Health Council should be created and that it will have the skill and ability to produce results that Health Canada, the Provincial Ministries of Health and all of their related agencies could not fulfil to date. In addition, it is obvious that provinces like Quebec and Alberta will lead the challenge that federal funding for healthcare should not come with strings attached to a new agency in Ottawa, but they will not be the only ones who feel this way. The Constitution is very clear that health is a provincial responsibility and Canadians are becoming more and more suspicious of solutions rooted in creating more government bureaucracy and more red tape.

    Master documents and directional papers like the Romanow Commission's final report are often full of big statements that politicians and ideologists rally behind. Despite this, there is always a hope that real solutions can be pulled out from between the lines. Canadian's everywhere were hungry for a final report from the commission that would have the strength and courage to offer solutions capable of initiating real change and restoring national confidence in the health care system. Many will argue that this is far from what they received. To use a health analogy, Mr. Romanow has touched on the diagnosis but has offered few workable prescriptions. The criticisms outlined here only scratch the surface of the scrutiny that the report will have to endure in the months ahead. What is certain is that national confidence won't come from speeches and reports but only through a series of new and refreshed experiences when individuals and their families find themselves depending on a system that provides all that it promises. Debates will never determine the success of this report, only our collective whispers as we rely on the actions taken in the years ahead.