Watching the Romanow Commission

Fall 2002 CSANews Issue 44  |  Posted date : Apr 09, 2007.Back to list

"The Medicare House needs remodelling, not demolishing."

It's no secret that for many years, Canadians have viewed their national health-care system as a source of pride and distinction. As snowbirds know all too well, this is particularly true when medical services are required in the United States. Recently, however, rumours and dinner conversations initiated by popular media reports, confusing arguments between the federal and provincial governments, and the all-too-important grapevine began to repetitively suggest that we might want to think twice about how confidently we toot our health horns when travelling this winter.

As you can well imagine, Canadians were not about to allow their governments to leave these concerns and discussions unaddressed. More and more citizens throughout the country began looking to their federal and provincial government representatives to reassure them. Canadians everywhere needed to know that their beloved health-care system would continue to provide the high-quality service and treatment that have justified the precious bragging rights to which we have become so accustomed.

In the spring of 2001, Canada's health system emerged from a long and trying winter filled with many stories of inadequacy, inefficiency and inaccessibility. Governments seemed to be bombarded with criticism and endless call for action, reform or even radical change. In response, the federal government put forward a well-timed initiative to try and defuse the problem, specifically, the creation of the Commission on the Future of Health Care in Canada, headed by Roy Romanow.

The Commission on the Future of Health Care, or The Romanow Commission as it is popularly referred to, has been given consistent publicity and colour by the popular press. Canadians everywhere have been asked to believe that Romanow will be the honest rainmaker who will guide us out of this drought of health-care confidence. Federal politicians in particular seem to have put more than one egg in Romanow's basket, as they became desperate for more answers. The endless banter with the provinces on roles, responsibilities and next steps for national health care was causing the public to become more and more sceptical of government's ability to offer effective solutions.

A major issue for health care in Canada is that, while provinces have the responsibility for providing health care, they do so under a very intricate system of taxation, transfer payments and funding which is controlled, for the most part, by the federal government.

This system is so confusing and such a mystery that governments easily point the blaming finger at each other while most Canadians remain confused and disengaged throughout the entire debate.

As a result of constant bickering and provincial pleading for more money, the argument that the system is falling apart is easily spread regardless of merit. The result is significant pressure for governments to respond. By introducing the Romanow Commission, the federal government did just that, and is now undoubtedly hoping that the public thirst for new direction, resolve and settlement would begin to be quenched.

So what has the Romanow Commission been up to? And what might we expect when the final report is released this fall (due November 2002)?

For starters, while funding is obviously the leading issue concerning Canadian health care, the commission's goals are far broader. The government has asked the Romanow Commission to, "carefully examine the state of public health care in Canada and recommend ways it could be more sustainable, well into the 21st century." Not exactly a small job!

To date, the commission has:
  • undertaken an extensive research program involving Canadian and international scholars and experts;
  • obtained input from provincial leaders and officials, Aboriginal organizations, stakeholders and experts;
  • reviewed public health systems in other countries to assess "best practices" and "lessons learned";
  • received formal submissions from organizations, individuals and various groups via the commission's Web site, toll-free number and direct mail;
  • initiated a comprehensive public education program; and
  • held extensive dialogue sessions, public hearings and a national stakeholder conference.
To help frame discussion issues for ordinary Canadians, the commission released an interim report in February 2002. The interim report is neatly organized around four key themes:
  1. Canadian values and how they should be reflected in the Canada Health Act;
  2. Sustainability and funding;
  3. Quality and access; and
  4. Leadership, collaboration and responsibility.

Further, Romanow begins to set up topics that will surely be addressed in his final report by arguing that Canadian views on how to address the challenges confronting health care revolve around four key perspectives or options, including:
  • more public investment;
  • more cost-sharing (introduction of user fees or personal insurance plans);
  • more patient choice about where to obtain health services, including not-for-profit and for-profit health service providers; and
  • reorganized service delivery that is more efficient and makes better use of a range of health-care professionals.
Canadians have been asked to consider these perspectives/options in relation to their personal values about health care. A well-publicized statement and metaphor from Mr. Romanow is that "the Medicare House needs remodelling, not demolishing." This statement served well to immediately cool the nerves of Canadians who may have read too much into all the talk of the system being in crisis. Romanow seems to have been politically astute enough to recognize that fears of the health-care rug being pulled out from under citizens, before they were given a chance to get involved or think about it for themselves, would not help his cause.

The final goal for Romanow and the federal government is a set of timely recommendations that will sit well with Canadians and provide some much-needed direction for sustaining publicly funded health care. Radical suggestions that are not tied into the long-standing sense of pride that has always been associated with our public system are far from unexpected.

One thing that is certain is that Canadians are not alone in their search for change and resolution. Many industrialized and advanced countries and communities are being similarly forced to take a long, hard look at their health-care delivery approaches and values to ensure that their current approach, whether public, private or combined, is properly arranged to meet the incoming challenges of changing health needs and capabilities.

Health and health-care issues are subjects in which Canadian snowbirds have always been actively involved; they will undoubtedly be closely watching and listening as Romanow's conclusion and recommendations are released this fall.

The Romanow Commission is still accepting submissions and comments for public record through its Web site, www.healthcarecommission.ca or through direct mail at:

Commission on the Future of Health Care in Canada
P.O. Box 160, Station Main
Saskatoon, SK Canada
S7K 3K4