Former Saskatchewan Premier Roy Romanow was appointed by Prime Minister Jean Chretien in 2001 to lead a one-man royal commission into health care in Canada. Romanow had been a youthful confidant of Saskatchewan premier Tommy Douglas, whose government introduced Canada’s first public, tax-financed, medical care insurance plan. After eighteen months of consultation and research, Romanow concluded that Medicare should remain a public program, but that it must be supported financially by governments and reformed to provide prompt and quality service. He released his report at the National Press Theatre in Ottawa on November 28, 2002 and he made the following remarks.
The changes I am proposing are intended to strengthen and modernize Medicare and place it on a more sustainable footing for the future. They are based on a vision of Medicare as a national endeavour, where governments work together to ensure timely access to quality health care services as a right of citizenship, not a privilege. And they are designed to achieve a more effectively integrated and a more accountable world-class system that helps to make Canadians the healthiest people in the world.
Medicare is sustainable
Before summarizing the final report’s recommendations, permit me to speak briefly on the issue of sustainability. After carefully reviewing the available evidence—hard facts, not unproven assumptions—I also make the case in my report that Medicare is sustainable if we want it to be, that historically, single-payer health systems have proven to be significantly more cost-efficient than alternative approaches, and that despite the sometimes overheated rhetoric, Canada’s health outcomes remain among world’s best. Nor does a review of the evidence suggest that our health care spending is out of control . . . After several years of restraint, governments recognized the imperative to reinvest, to play catch-up. The result has been the sharp increases in health spending of recent years, a trend made all the more dramatic by the September 2000, $23.4 billion National Health Accord.
While I agree with those who argue that recent health spending trajectories cannot be sustained, I also note that the Canadian Institute for Health Information has reported that these growth trajectories have already begun to level off.
More to the point, my report also notes that despite this recent reinvestment, we are still spending less today on health as a share of our GDP than we did a decade ago, that our health spending is in line with that of other wealthy countries, and that there is a need for some immediate, targeted investments in some priority areas that are eroding public confidence in Medicare’s future . . .
Investing in change
But I want to make one thing absolutely clear. The new money that I propose investing in health care is to stabilize the system over the short term, and to buy enduring change over the long term. I cannot say often enough that the status quo is not an option! If the only result of these past eighteen months of collective effort by Canadians is simply more dollars for health care, our time will have been wasted.
Let me quickly summarize my report. In terms of modernizing the system’s foundations, I propose establishing a Canadian Health Covenant that expresses Canadians’ collective vision for health care and that outlines the responsibilities and entitlements of individual citizens, health providers, and governments in regard to the system. We need consensus on why the system exists, what it is intended to achieve and how its component parts should fit together. This is vital to restoring the public’s confidence in the system.
I also am proposing to modernize the Canada Health Act by updating the principle of comprehensiveness to include priority diagnostic and homecare services, by clarifying the principle of portability to guarantee portability of coverage within Canada, and by adding a sixth principle of accountability.
Finally, I am proposing the creation of a Health Council of Canada. This intergovernmental council would serve as a meeting place and focal point for collaboration among governments, providers, and citizens in establishing overall system objectives, common indicators and benchmarks, criteria for measuring, tracking health, and reporting to Canadians on system performance.
These efforts are designed to help end the demoralizing long-distance hollering and bickering that passes as federal-provincial discourse on health care. Canadians want their governments to work together to make Medicare better, not fight over it!
Paying for it
Now let’s turn to funding. In recent speeches and press statements, I have described the “stop-go” approach that has characterized funding for our health care as deleterious. We need stable, predictable and long-term funding that is allocated in a way that makes it clear who is spending what, and with what results, so that we can understand where accountability rests.
Accordingly, my report recommends that the federal government commit to funding a minimum of 25 percent of the cost of insured health services under the Canada Health Act by 2005–06. I also recommend that the annual Canada Health and Social Transfer be replaced by a cash-only Canada Health Transfer that includes a built-in escalator to ensure more stable and predictable funding and greater accountability.
Because it will take time to negotiate a new transfer, and consistent with my overarching conclusion that any additional money invested in the health care system must achieve transformative change, I am also proposing provisional funding over the next two years . . . to an estimated additional $3.5 billion investment in health care in budget year 2003–04, rising to an additional $5 billion in budget year 2004–05. In 2005–06, these special funds and transfers will be subsumed within the proposed 25 percent federal funding base that should provide about $6.5 billion more for health care than is currently forecast . . .
Home care also figures in my final recommendations. With an increasing number of Canadians now receiving care at home, I am proposing we recognize this reality by creating a foundation for a national home care system . . .
I am also suggesting a new program for unpaid caregivers to relieve pressure on families and on the health care system by allowing informal caregivers to take time off work and to qualify for special benefits under Canada’s Employment Insurance program.
It is also important that we acknowledge that prescription drugs are an increasingly important part of our health care system. But too many Canadians have no drug coverage at all, and existing provincial drug insurance coverage is uneven. I have therefore proposed a Catastrophic Drug Transfer. This transfer will enable provinces to protect Canadian families by increasing their capacity to expand existing drug coverage, while also fostering more effective medication management approaches.
I also believe Canada needs a new, independent National Drug Agency to control costs, evaluate new and existing drugs, and ensure quality, safety, and cost-effectiveness of all prescription drugs on behalf of all governments and all Canadians. Finally, I believe certain aspects of the drug patent legislation must be reviewed to ensure Canadians can have access to lower cost alternatives as soon as possible following the expiration of the statutory period of patent protection.
In completing this report, I am acutely aware that the support of Canadians for their health care system is not given freely. It is given in exchange for a commitment that their governments will ensure that high quality care is there for them when they need it. If Canadians come to believe that their governments will not honour their part of the bargain, they will look elsewhere for answers. And the grave risk we will face is pressure for access to private, parallel services—one set of services for the well-off, another for those who are not. Canadians do not want this.
Our reform agenda is an ambitious one, but at a time when one of our most cherished national programs is at a crossroads, Canadians expect no less than an ambitious plan.
I am always mindful of the lineage of Canada’s Medicare system—it began with the CCF party in my home province of Saskatchewan. It was a Conservative Prime Minister who appointed Emmett Hall, and a Liberal government that introduced legislation to create modern Medicare. And it was politicians of all stripes, and from all regions, who joined together to unanimously approve it . . .
Forty years ago, when visionary men and women came together to create Medicare, we had private medicine in Canada. You paid out of pocket to receive medical services if you could afford them or relied on the dole if you couldn’t. If you needed an operation, you cashed in your savings, mortgaged your home, or sold your farm so you could pay, or you simply did without. If you had the resources or good fortune, you were able to pay your way to the front of the line; if you didn’t, you waited and prayed for the best.
Making a choice
Many of the so-called “new solutions” being proposed for health care—pay-as-you-go, user and facility fees, fast-track treatment for the lucky few, and wait-lists for everyone else—are not new at all. We’ve been there. They are old solutions that didn’t work then and were discarded for that reason. And the preponderance of evidence is that they will not work today.
In the coming months, the choices we make, or the consequences of those we fail to make, will decide Medicare’s future. I believe Canadians are prepared to embark on the journey together and build on the proud legacy they have inherited.
It is now in their hands.
Sea Change Magazine: Roy Romanow’s Battle for Universal Healthcare
Canadian Museum of History: Making Medicare: The History of Health Care in Canada
The Canadian Encyclopedia: Roy Romanow
Final Report of the Commission on the Future of Health Care in Canada
Government of Saskatchewan