Roy Romanow's report on health care is about everything except you. It is about governments, about systems, about policies. It is not about your concerns, your rights, your choices. In that crucial sense it has failed you.

Building on Values: The Future of Health Care in Canada is the product of 18 months of work and $15-million, and it manages, in 256 pages (plus appendices) and 47 policy recommendations, to exclude the individual.

Yes, it addresses itself to Canadians: There is a Message to Canadians, and each chapter contains a section What Does it Mean to Canadians.

But the needs, the priorities, the rights of each Canadian exist outside Roy Romanow's comprehension. Mr. Romanow inhabits a world of forums and consultations, of policy priorities, of actuaries, of charts and graphs.

He holds an abiding faith in this world's ability to manage complex public policy, and a deep distrust of such chaotic and unpredictable forces as the market or individual choice. (Mr. Romanow so abhors the market that his report contains an entire chapter attacking globalization.)

Because his world is illusory, the recommendations of his report would fail. The extra billions of dollars he is advocating would buy peace for a few years, but the real problem would fester. The health-care system is inefficient, hidebound, paralyzed by internal contradictions. Change must acknowledge the market. It must respect the right of the individual to choose.

Mr. Romanow's first and most breathtaking assumption is that nothing is fundamentally wrong with the health-care system, which means all those stories of people dying in the back of ambulances because emergency wards were full are just pulp journalism. Canada compares well with other countries in terms of spending and statistical measures of health, the report notes. So that's that.

But all industrialized nations are struggling to control costs and declining standards. Only one -- the United States -- relies primarily on the market. Only one -- Canada -- excludes the market from physician and hospital care. Everyone else is experimenting. But Mr. Romanow has implicitly decreed: No experiments.

He admits there are problems: a crisis of confidence in the system, and a chronic shortage of funds. The proposed solution: a $6.5-billion federal cash infusion and a Canadian Health Covenant, in which governments define and vow to uphold the values of the public health system -- including the new value of solidarity.

And if they fail? If your family doctor, though with you in solidarity, can't see you for six months? Other nations let people seek care elsewhere. But what individual rights would Canadians have? What powers would they have to seek alternatives? None.

This report would push the private sector further away from health care by bringing home care and diagnostic services into medicare.

But the market exists everywhere. The report warns that doctors and nurses are already well paid, and that new spending should not pad their incomes.

Then it proposes $3-billion to promote primary-care reform (doctors pooling their resources), and to get doctors into rural and remote areas.

How do you get doctors to move? You force them to. Or you woo them. How? With money. How much depends on the doctor market.

At the root of this system-driven rather than individual-driven report lies the assumption that public administrators have managed health care well. Yet the report also notes long waits for some services. A shortage of diagnostic equipment is the problem, so the study suggests more money.

But a well-managed system would not have a shortage. That's the problem: Civil servants and politicians can't predict need and allocate resources, as the Soviet Union finally concluded.

Roy Romanow is Mikhail Gorbachev, the year is 1986, and Building on Values is a call for perestroika.

But perestroika was not the answer. The command-and-control economy didn't work. Individuals demanded the right to choose.

We may soon begin to demand that right.