Highlights
Drugs: Universal coverage too expensive
Private care: Romanow sees no need
Cost: Report has huge price
tag
Canada Health Act: Create health covenant
Watchdog: Romanow calls for Health Council of Canada monitor
Home care: Limited coverage; help for caregivers
Remote care: More access to doctors needed
Reaction: Positive response from medical community
Politics: Chrétien, politicians called to action
Politics: Harper blasts report as 'unrealistic'
Comment
Ibbitson: The debate begins
Winsor: Maybe we were doing something right all along
Mullins: Report looks like the status quo
Evoking the memory of the founders of medicare 40 years ago, Mr. Romanow flatly rejected the idea that Canadians should be able to buy better or faster medical care from private providers.
"Some have described it as a perversion of Canadian values that they cannot use their money to purchase faster treatment from a private provider for their loved ones," he said.
"I believe it is a far greater perversion of Canadian values to accept a system where money, rather than need, determines who gets access to care."
Mr. Romanow wrapped up 18 months of work with recommendations that include a drug plan for catastrophic costs; home care for the terminally ill, mentally ill and those just released from hospital; and money for diagnostic equipment such as MRI machines.
He also suggested new measures to ensure the provinces that run the country's health-care systems use the cash for what it is intended.
"Our reform agenda is an ambitious one," Mr. Romanow said after the report was tabled in the Commons.
"But at a time when one of our most cherished national programs is at a crossroads, Canadians expect no less than an ambitious plan."
The recommendations will now be passed on to Prime Minister Jean Chrétien, who said he and the premiers will have to hammer together a plan in January.
"That will probably lead to some legislation that could be implemented in the spring and next fall. And we can probably begin the 21st century with confidence that there will be a good health-care system for the people of Canada."
Mr. Chrétien acknowledged some provinces will be upset that the federal government wants to attach new conditions to health-care funding, but said it is necessary.
"Accountability is very important," he said. "I have no problem to say we want to know where the money is going."
Mr. Romanow proposes a plan, phased in over three years, that would ultimately add an extra $6.5-billion to the amount the provinces get annually to administer health care. The provinces would see an increase of $3.5-billion in 2003, jumping to $5-billion the next year and $6.5-billion in 2005.
They would get the money only if they agree to use it on specific programs, and accountability would become a key feature of medicare.
Mr. Romanow also recommended money to change the way doctors deliver services, a stronger Canada Health Act, a new Canada Health Council to monitor spending, and a covenant laying out health-care rights and responsibilities.
He said government cannot ignore demands to fix medicare.
"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."
The report got a rough reception from supporters of more private health care.
"I just think this is pie in the sky," Canadian Alliance Leader Stephen Harper said. "This isn't going to, in any realistic sense, help deal with the problems of the health-care system."
Alberta Premier Ralph Klein said Mr. Romanow's idea for a council to monitor spending is an incursion into provincial jurisdiction.
But Manitoba Premier Gary Doer supported the report, singling out the home-care proposals as positive.
If accepted, the drug program would start in 2004 to help Canadians who face financial disaster due to massive drug costs. Ottawa would contribute $1-billion and would reimburse provinces for 50 per cent of prescription drugs over a threshold of $1,500 per patient.
Currently, Canada's drug programs are a patchwork. Some provinces offer extensive coverage. Others fund only those on welfare or the elderly.
Mr. Romanow said a limited home-care program should be unveiled in 2003.
"Home care is one of the fastest growing components of the health-care system," the report says.
Mr. Romanow also wants governments to spend $1.5-billion on rural communities to attract more health professionals and link rural residents to doctors through telecommunications technologies. Another $1.5-billion over a two-year period would be funnelled to the provinces for diagnostic services to help reduce waiting times for MRIs and other high-tech machines.
New Brunswick Premier Bernard Lord said his voters might have different priorities for the money than those laid out by Mr. Romanow. He said the province has adequate access to MRI machines, but faces other challenges.
"We need to realize throughout the country that there are different situations," he said, adding that a province like his might have trouble paying for cost-shared programs.
Sharon Sholzberg-Gray, president of the Canadian Healthcare Association, expressed support for Mr. Romanow's recommendations, but wanted to ensure there would be cash for other basic needs, such as funding wage agreements of health professionals.
"Of course, the devil will be in the details, particularly regarding the amount and timing of funds to support the existing and future system changes," she said.
Mr. Ronanow's most controversial recommendations concerned private health-care delivery. He suggested that the Canada Health Act be modified to cover diagnostic care, which means privately owned MRI clinics that charge patients could be found in violation of federal medicare rules.
He said ideas for private care have been used before and failed.
"They are old solutions that didn't work then, and were discarded for that reason."
Officials from the commission explained that Mr. Romanow accepts that some privately owned clinics can legally deliver care, provided they do not charge individuals for medically necessary services, or allow user fees.
Clinics that charge patients directly would be in violation of the health act and the provincial governments that allow them could face penalties.
Mr. Romanow's other big theme revolved around accountability and transparency. He said that a new principle should be added to the Canada Health Act forcing provinces to be accountable for the money they spend.
He also wants to see a new health charter set out the responsibilities of government and rights of citizens to services, although the covenant would not carry penalties for those in breach of the act.
Mr. Romanow said the government should also change the way it delivers funds to the provinces, earmarking cash specifically for health care rather than delivering it in a block transfer. He is recommending that the federal share of funding the system not fall below 25 per cent of public spending.
With a report from Campbell Clark
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