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Medicare has been called the Pac-Man that survives by eating all other social programs. The $128-billion system consumes about 40 per cent of provincial program spending. And yet it is so ingrained in the Canadian identity that it seems untouchable.

It is refreshing, then, that several health leaders have put out a report called "Bending the Health Care Cost Curve," which provides ways to eradicate waste. It's about time. The report has suggestions so obviously necessary, it seems shocking to see them in print.

Take the case of wound care, a decidedly unglamorous medical problem but a costly one: If hospitals, nursing homes and home care followed best practices in dealing with these pressure ulcers, venous leg ulcers and diabetic foot ulcers, they could save as least $100-million in Ontario alone in preventable amputations, infections, repeat visits and hospitalizations.

For home visits, nurses are paid on a per-visit basis, not based on whether the wound has healed or the treatment is working - something they want to change.

"What we want to move to is an outcome-based payment process that actually looks at a course of treatment," said Margaret Mottershead, chief executive officer of the Ontario Association of Community Care Access Centres, an author of the report. "And you will be paid for the treatment and the outcome, rather than on a one-off that gives you no guarantee every time you do a visit that you are actually improving the outcome or fixing the problem or helping the wound heal."

Other suggestions including reducing medical mistakes, allowing palliative-care patients to die at home and finding alternatives for patients who are waiting in hospital for nursing-home beds.

The report from the trio of groups, including the Ontario Hospital Association and the Ontario Federation of Community Mental Health and Addiction Programs, comes at a welcome time, particularly as the province tries to rein in costs.

But tough economic times should not be the impetus to make change: providing the best patient care should be.

Why are these common-sense solutions, which are best for patients, not being widely implemented today?

The health-care system is complex and even the brightest minds struggle to manage it. It is built around process, so change is never dramatic, but incremental.

It has also been a recession-proof business with no consequences to those who do a job inefficiently. Pay-for-performance measures exist to some degree, but not enough to spawn widespread change.

What is missing in health care are quality, accountability and value for money. Canadians do not need another royal commission to tell them that; they have been hearing it for almost two decades.

Medicare need a champion, a strong arm that can make transformative change. Without it, the system is doomed to become increasingly inefficient, unmanageable, and like Pac-Man, virtually obsolete.

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