A National Perspective from The Hon. Roy Romanow.

Op-ed Published in the Globe and Mail, June 10, 2005.

Canadians should be optimistic that the nation-building values of Canada's public health system were reaffirmed by yesterday's Supreme Court ruling, with all of the court's contributing members recognizing the need to maintain the integrity of our public medicare plan.

That said, the decision certainly creates the appearance that the slide to privatization has increased in the province of Quebec. It is also fair to say that evidence of creeping commercialization is showing up in other parts of our country as well.

All of this means that the not-for-profit debate that has been around since the beginning of medicare has picked up impetus once again.

There are those who have already seized on aspects of the court's decision to claim victory for selling something old as something new. They advocate for a return to pre-medicare days and, with their strong advocacy for a pure market approach to health care, they have gleefully proclaimed the death of medicare just has they have done in the past.

Not so fast.

The evidence is overwhelming and clear: The two-tiering of health care represents a march backward in time, to when good health care depended on the size of one's wallet - to a situation like that which currently prevails in the United States, where last year, more than 50 per cent of all personal bankruptcies were due to health care expenses. They just eliminated 25,000 jobs in the United States, largely due to the company's burden of health-care costs.

Cherry-picking great examples of American health care practices while ignoring the millions of the uninsured who get sick just worrying about getting sick does not make the case. It is a false economy to advocate for transferring the costs of health care from the public purse to the private purse. We will pay one way or the other.

The simple fact is that the yearly percentage of GDP spent on total health care in Canada is at about 9.6 per cent as compared to nearly 15 per cent the United States. That's more spending in the United States, yet the result is less coverage and worse health outcomes.

Because the U.S. model is so unacceptable to Canadians, modern day advocates of privatization are now cherry-picking various bits and pieces from Europe. But their concocting European/Canadian hybrids as just the latest Trojan Horse for treating health care as a commodity.

The Supreme Court has provided a wakeup call to all of us, especially those charged with fixing our single-tier medicare program. This judgment must serve to hasten the progress of real reform. As a result of last September's first ministers' health-care deal, money is no longer an excuse.

Many elected officials say "they are standing up for medicare". They understand the clear evidence regarding the cost-effectiveness of a "public good" approach over the "market" alternative. And perhaps some leaders also publicly extol the virtues of our single tier approach because they know that's what an overwhelming number of Canadians want. Either way, the rhetoric must be backed up by more urgent and tangible progress.

The blueprint for change is there - it's just waiting to be put into practice. But we must apply the entire blueprint: An integrated approach is critical. To take on the problem of wait times in an isolated way without implementing reforms to primary and home care, will not work over the long haul.

Dealing with some wait times may pay dividends, but other serious problems, such as acute care, will keep popping up if an ad hoc style rules over an integrated approach. What's vital to real progress is investing more money in health promotion, increasing the role of nurses and other health professionals, and committing to the kind of rigorous and transparent accountability that remains elusive.

Medicare needs fixing, not scrapping. Canadians overwhelmingly favor this approach over one (however disguised) that allows those with wealth to purchase health care, draw off doctors from our universal system and, at the same time, does nothing to reform, strengthen, and sustain the system for all Canadians.

The progress and pace of health care reform will either prevent or fuel a myriad of further court challenges. It will take strong, determined, and visionary leadership to achieve a modernized medicare system, and in doing so, a better nation.

This is one of those moments when Canadian people need to stand up for medicare and declare that reports of its death have been greatly exaggerated.

About the Author

Roy J. Romanow led the Commission on the Future of Health Care in Canada


Reprinted with permission at www.longwoods.com