Calgary Sun
Published: Sunday, March 3, 2002

Open minds create a healthy debate

Tommorrow Roy Romanow kicks off his ten-week, 18-city national public consultation tour in Regina. His commission is attempting to engage as many Canadians as possible through deliberative panels, stakeholder briefings, the Internet, public speeches, televised debates, full-day roundtable fora and of course, these hearings. Tomorrow's session even has a rural call-in segment so folks who can't make it into the big cities can be heard.

Yours truly will be in Regina to offer the view of the Canadian Taxpayers Federation during testimony before Mr. Romanow. Without a doubt, reforming health care will be the enduring public policy debate of this decade. What follows is a sneak peak of the main points we will cover in our testimony tomorrow morning.

Mr. Romanow's examination of the health care system and catalogue of reform options must be as broad and encompassing as possible. To date, entrenched stakeholders have regrettably diminished the complexity of health care reform down to facile bi-polar country comparisons and/or left vs. right ideological disputes.

These groups have also fostered a climate where invective rhetoric, slippery slope logic and personal character attacks have combined to mimic a sustained Arctic cold front that freezes out new entrants or ideas when it comes to health care reform. Still, Canadians yearn for an ideas-based discussion about all possible options for reform.

We will spend some $102 billion - or 9.3% of GDP - for health care this year. With health costs consuming 62% of all provincial budget increases over the last three years and provincial increases in health care budgets - just on the operational side alone - tripling the rate of economic growth, it is clear that health care is a taxpayer issue.  We will also lay out our core beliefs noting that:

• Health care is in a state of crisis;
• Canadians are ahead of their politicians on the need for reforms;
• Health care is a shared jurisdiction between Ottawa and the provinces;
• The Canada Health Act is not the Bible;
• It is impossible to measure health systems by numbers alone;
• The present debate is too continental, it must become global; and
• Quality and excellence must be the primary focus, not cost containment.

The development of health care policy in Canada over the past century reveals that Canadians can handle exhaustive and sometimes painful debate. So we owe it to ourselves to mirror and build on this history by objectively considering all options for reform.

The logical starting point is with a review of the Canada Health Act (CHA), since it is the defacto standard by which reform options are judged. Increasingly, scholars and medical practitioners are converging around one dominant school of thought about the CHA: it constrains provincial initiatives and its core principles are often in conflict with each other. Even former federal health minister Monique Begin, the mother of the CHA, has recently done a 180 degree turn and called for the Act to be re-opened and examined during a recent speech in Ottawa.

Health care is complex and it is clear that there are no magic bullet solutions to address its many shortcomings. However, key principles do exist that should be employed both in legislation and in restructuring service delivery. So at the legislative level, a modernization of the Canada Health Act is long overdue. Its five current principles should be replaced by the following six principles:

• Public governance; 
• Definitive Universality; 
• Quality; 
• Accountability; 
• Choice; and 
• Sustainability.

At the structural level, we will advocate guiding principles for financing and service delivery reform including:

• Greater individual accountability and responsibility which could include co-payment for some services but always factoring-in exemptions based on income or health status;
• Intergenerational fairness which means that we should be pre-funding our future primary care needs at a minimum through health care savings allowances or accounts; and an 
• Embrace of innovative approaches including flexible and workable public-private partnerships in facility construction, service provision and technology/equipment renewal.

The principal and laudable aim of medicare was to provide health services without hindrance to all Canadians. But the greatest hindrance to reform today comes from those who remain intransigent and refuse to approach this issue with an open mind. And with that we will say,"thank you, any questions Mr. Romanow?"