What is perhaps most striking about Duncan Sinclair's rethink of medicare is the familiarity of his proposed approaches:
  • More management, not more dollars.
  • Managed waiting lists for rational rationing.
  • Integrated health systems with capitation and other incentives that distinguish need from demand.
  • Increased cost awareness through year-end financial statements and a return to true insurance models.
  • An end to federal-provincial wrangling.

These ideas are not radically new, having been front and centre in the health policy world for years, if not decades. Yet we continue to debate them as almost the sole solutions to our periodic crises in medicare.


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