Romanow’s report: gone and forgotten

Commentary, Healthcare & Welfare, David Gratzer

The Prime Minister thinks that his provincial colleagues are unrealistic and naive. The premiers view Ottawa as cheap and out of touch. Lost in the din of sabre-rattling is the big news emerging from the developing provincial-federal health care negotiations: The freshly minted report prepared by Roy Romanow is dead on arrival.

It wasn’t supposed to be this way. The Romanow report, after all, was published just last November, scarcely two months ago. Its release was a spectacular PR success. Pressure groups, from professional associations to blue-collar unions, applauded the report’s veneration of medicare as we know it. And yet, there is the undeniable fact — the heart and soul of the report has neither federal nor provincial support. The latter, of course, isn’t surprising given Mr. Romanow’s endorsement of extensive federal intrusion into provincial responsibility. The shock is that the Chrétien government has also distanced itself from Mr. Romanow’s work — and didn’t wait long to do so either.

Consider federal Minister of Health Anne McLellan’s speech on Tuesday outlining the federal government’s position. At first glance, she seemed to embrace various ideas forwarded by Mr. Romanow. She spoke in favour of primary care reform, home care and catastrophic coverage for pharmaceuticals. She waxed poetic about Canadian values. She argued for better accountability.

But in her roughly 3,000-word address, she mentioned Commissioner Romanow and his report just four times — and thrice she added the caveat that these recommendations appeared in “other studies.” True, the initiatives she outlined have been mentioned in Romanow’s work — but they are hardly his. The federal government has long supported expanded home care and drug coverage. Primary care reform has been part and parcel of federal health ministers’ speeches for more than a half decade, as has the talk about values and accountability.

Indeed, what’s striking about McLellan’s speech — or, for that matter, the Prime Minister’s pronouncements or Ottawa’s draft “Accord on Health Care Renewal” — is the dearth of enthusiasm for Mr. Romanow’s report. Not once has any federal official mentioned amending the Canada Health Act with a new sixth pillar, as Mr. Romanow implored, or drafting a “Health Covenant.” Nor are the feds serious about creating Mr. Romanow’s thuggish Health Council, charged with policing the provinces, but instead they promote an advisory board. As for the challenge to abandon public-private partnerships, even Mr. Romanow has backed off, suggesting the statement was “just an opinion.”

A majority of Canadians feel the system is in crisis; not Mr. Romanow. For him, the basic problem is that a socialist health care system ought to be perfectly socialistic. And Canadian medicare isn’t. There are medical procedures paid for by one province but not another, for example. That type of inconsistency is grievously offensive to the Commissioner. What to do about it? Mr. Romanow wants national agencies to involve themselves in everything: physician prescribing habits, immunization strategies and medical education, to name a few examples.

The contrast between the reports of Mr. Romanow and Senator Michael Kirby couldn’t be greater. The Senator produced six weighty volumes. It was written in the style of “if I were the Medicare Czar for a day.” And so, Mr. Kirby tells us how hospitals ought to be funded, the way physicians should be paid, what to do about specialist shortages, and a score more details — a policy wonk’s dream. Perhaps Senator Kirby was overzealous but he was confident: If his reforms failed to bring waiting times down to a clinically reasonable time, Canadian patients could go for care elsewhere, including the United States.

Mr. Romanow offers no guarantee and no details. Why should he? Who can get weighed down by such matters when you’re busy nation building?

Ironically, Mr. Romanow’s report is now remembered for two ideas: a massive infusion of federal cash and catastrophic coverage for prescription drugs. The former was never close to his heart. Last summer, he stated that the system had adequate funding. His final proposal for $15-billion over 3 years seemed more in response to Senator Kirby’s report than any deep conviction. Indeed, he told reporters in late November that they shouldn’t get stuck on that recommendation.

Mr. Romanow’s report does call for catastrophic coverage for prescription drugs — but not until chapter 9. And even there, the exciting ideas aren’t about coverage — rather, he champions national bureaucracies. Mr. Romanow wants a new National Drug Agency “to control costs, evaluate new and existing drugs, and ensure quality, safety and cost-effectiveness of all prescription drugs,” and a national formulary of prescription drugs “to provide consistency across the country, ensure objective assessments of drugs, and contain cost.”

Set for early February, the federal-provincial negotiations will be a colourful “dance of the dollars,” to borrow a line from Terry Corcoran. The provinces want more health money. The federal government wants more credit for its contribution. We know the eventual result — they will agree to more funding, with some strings. Arguably, the compromise would have been reached months ago were they not waiting for Mr. Romanow’s report. The more interesting agreement has already been reached, however: that the days of grandiose central planning are over, even for our socialist medicare system.

Ten Myths about Medicare