Roy Romanow says he will consider his report on medicare a failure if all that comes of it are newspaper headlines and $15-billion more in health-care spending.

Primary-care centres that operate 24 hours a day and a national home-care program are needed to make transformative changes in the system, Mr. Romanow told The Globe and Mail's editorial board yesterday, a day after releasing the report of the Commission on the Future of Health Care in Canada.

"If all that comes out of this report is the headline — and I'm not knocking anybody's headline of 15 billion more dollars — and if that's in fact what the provincial-federal end result is, then I do think that the report, that I, failed," he said in Toronto.

The former Saskatchewan premier pointed to the September, 2000, accord that provided $23.4-billion in federal funds to provinces for health and social programs over five years, including money for diagnostic equipment and primary-care reform.

"I thought it was a substantial injection of cash," he said. "Two years later people are saying, 'Where's the money, It's not enough.' Essentially, it was an attempt to keep the status quo."

Nevertheless, Mr. Romanow defended his recommendation that the federal government spend even more on medicare — $15-billion over the next three years and an additional $6.5-billion annually after that.

Money for medicare needs to be replenished after the system was left to starve fiscally for a decade, he said. "We did not get into this problem overnight and therefore it's not going to be solved overnight," he said. "I wish there was one or two simple and easy answers which would mean that there was a quick solution."

The federal government plans to negotiate with the provinces to implement changes to medicare based on Mr. Romanow's recommendations.

Under Mr. Romanow's plan, drug costs would be covered for people who spend more than $1,500 annually on prescriptions; home care would be provided to the mentally ill, those fresh out of hospital and the dying; primary care would be reformed with greater reliance on health clinics rather than on doctors' offices and emergency wards; and a sixth principle of accountability would be added to the Canada Health Act. He also called for the creation of a Health Council of Canada, which would measure the performance of the health-care system and track whether dollars are being spent wisely.

Mr. Romanow's call for $15-billion in federal spending on health between now and 2006 is more than the $14.4-billion that Finance Minister John Manley projected recently would be available for new initiatives of any kind over that time period.

While acknowledging other pressures for tax dollars, Mr. Romanow said health care should have "pretty near the first call" on new government spending.

He said there is only a narrow time window to sow the seeds of transformative changes in the health-care system. "If these seeds are not planted and we end up back into the intergovernmental wrangling, then I guess this report may go the way of the others."

After 18 months of work, Mr. Romanow's report of 256 pages plus appendices has come down to 47 policy recommendations that will be passed on to Prime Minister Jean Chrétien.

What did not appeal to Mr. Romanow were the care guarantees as suggested by Senator Michael Kirby, chairman of the Senate standing committee on social affairs, science and technology, who also wrote a report on medicare.

Under Mr. Kirby's care guarantee, a patient — who has reached a predetermined maximum waiting time for a procedure, test or operation — would be provided the option of care in another part of Canada or even the United States. It would be paid for by the province.

Mr. Romanow said people should have reasonable expectations of service, but "I'm not arguing for guarantees. I think that is just not possible."

He said guarantees are not possible because care guarantees in other countries are either narrowly offered in only four or five life-threatening areas or so broad that they are difficult to accomplish.