RM Issue #030715
Romanow's star has rightly fallen
Thursday, July 10, 2003
What a difference a year can make. It was, after all, just a year ago that Roy Romanow seemed poised to breathe new life into Canada's health care system. Commissioned by the federal government to study medicare, Mr. Romanow became more than a health policy expert; he emerged as a medicare super-star. His every comment seemed meritorious of reporters' ink; his public musings made headlines across the country; special interest groups swooned in admiration. When Ontario Minister of Health Tony Clement had the audacity to suggest that reforms might proceed before publication of the commissioner's final report, the criticism was universal: How could anyone contemplate change pre-Romanow?
And now, 12 months later, hearing mention of Mr. Romanow is like running across the distantly familiar name of a faded pop star.
Earlier this week, on the eve of the annual premiers' conference, the commissioner angrily told the Ottawa Citizen that should his recommendations be cast aside, medicare would die "a death of a thousand cuts." As for those premiers who ignore his ideas, he explained that they did so at their own peril. And the political negotiations over health reform? "This is one hell of a bad way to build a country." If Mr. Romanow seems a bit irritated, it's no wonder. The bulk of his recommendations -- the Health Covenant, the catastrophic drug coverage, the National Drug Agency, the revised Canada Health Act -- have all been forgotten.
Even the National Health Council, the most central idea in his report, looks stillborn. Months after it was supposed to be created, the provinces and the feds still can't agree on a structure.
What happened? It would be easy to dismiss Mr. Romanow's failure as simply bad luck. His hope for success hinged on two factors: a public hungry for a dose of strong medicine and a prime minister willing to administer it. With a war in Iraq, SARS at home and economic malaise everywhere, the public has been distracted. To make matters worse, his patron and friend, Mr. Chrétien, busies himself these days by packing boxes.
But the real failure of Mr. Romanow is far more significant: We are seeing the end of an era.
Canadians like to trace medicare's history back to Saskatchewan premier Tommy Douglas. In fact, Canada's health care system -- like Sweden's and Australia's -- finds its roots in the British National Health Service (NHS). Commenting on the era, Stephen Pollard, a senior fellow at the Centre for the New Europe, notes: "When the NHS was founded in 1948, we Britons lived in a different country. Food was rationed. Life expectancy was 50. A third of the houses in Birmingham had no sanitation."
And people perceived the role of government to be fundamentally different. Lord Douglas Jay, the intellectual influence behind the Labour government of the 1940s, wrote: "Housewives on the whole cannot be trusted to buy all the right things where nutrition and health care are concerned. This is really no more than an extension of the principle according to which the housewife herself would not trust a child of four to select the week's purchases. For in the case of nutrition and health, just as in the case of education, the gentleman in Whitehall really does know better what is good for people than the people know themselves."
Canada's medicare is built on this paternalistic vision. Patients are considered ignorant; doctors work for the state; and, above all else, government is the best provider, funder and manager of all medically necessary health care for everyone, under every circumstance.
Looking at the problems of Canada's medicare, Mr. Romanow hopes for more of the same. He has drafted a document that could have sailed off the typewriter of Lord Douglas six decades ago. For every problem, there is one simple solution: central planning. What to do about waiting lists, physician compensation and a myriad of other thorny issues? Just form a National (read: Central Planning) Health Council. That is, to use Mr. Romanow's words, the very "heart and soul" of his reforms.
Not surprisingly, premiers have failed to embrace the idea. Mr. Romanow warns that they will pay a price for this, but as a former premier, he should know the provincial scene better. Canadians aren't pining for yet another committee to plan out their health care system. There have been three elections since the release of his report, and a fourth is underway. In none of these campaigns have politicians found voters standing on their doorsteps, demanding a national committee.
For those of us interested in sweeping reforms, these are frustrating times. The growing waiting lists and the stale political rhetoric exhaust us. We want to see some fast changes and are disappointed. But change occurs. In British Columbia, the biggest regional health authority contracts out day surgeries to for-profit clinics. In Calgary, public-private partnerships are the norm. The newly elected premier of Quebec promises similar reforms in his province.
Canadian health care is changing, albeit slowly. The consumer revolution that has transformed society since the 1940s is taking hold in health care. No wonder Mr. Romanow is so irritated.
David Gratzer, a Toronto physician, is the editor of Better Medicine: Reforming Canadian Health Care, and author of Code Blue.
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