Romanow Lifts Many Ideas from CTF Health Care Paper but ...
Ottawa - Saturday, February 9, 2002 - by: Walter Robinson, Federal Director, Canadian Taxpayers Federation
no suprises	This week, Roy Romanow released his interim report looking at the future of health care. Bottom line: there were not great surprises in what he wrote, rather people should look to what he said for clues to where he will ultimately end up when he finishes his work this fall. More on this in a moment, but first some of the salient points of his report.
rhetoric	While Mr. Romanow rightly admonishes all who are raised the invective rhetoric in this debate, he engages in a bit of it himself.
remodeling	Page 2: “First and foremost, I am convinced that the Medicare house needs remodeling not demolishing.”
improve	As Howie Meeker would say, stop it right there. No one is talking about demolishing our system. Fixing, fundamentally restructuring and improving yes, but demolishing … as we say on the basketball court, quit the trash talk and just bring your game.
initiatives	Page 4: “There are many approaches to the delivery of health care across Canada — approaches like telehealth, regionalization, integrated community programs, public-private partnerships, population health approaches and a myriad of initiatives …”
financing options	Yes some — not all — but some of these have been beneficial. But these are all supply-side, bureaucratically driven … we need to equally focus on the demand side and fundamental funding reform like co-payment or generational financing options where appropriate.
web site	Page 6: “The Commission will carefully review all submissions (read: public input — ed.) and take account of their contents, positions and advice. These submissions are available to all Canadians through our web site.
untrue	NO, CATEGORICALLY UNTRUE … at least in the case of the CTF. On September 20th the CTF submitted its — now nationally acclaimed — 140-page health care research and position paper entitled The Paper, The Condition, The Treatment. On October 3rd, Mr. Romanow wrote to the CTF to confirm receipt of our submission. But it is not listed on the web site as a formal submission, even though it was acknowledged by Mr. Romanow and is available electronically on the CTF website.
why not import	Page 7: “It is unlikely that in the end, Canada will be able to simply import solutions from abroad.” Ahem, excuse me, why not? Other countries have adopted some of our medical practices holus bolus, why not the inverse for medical savings account options in primary care, or sickness funds in union environments or Swedish hospital management?
similarities	On the positive side, it is clear that Mr. Romanow has echoed statements and findings the CTF made public six months ago. Consider the similarities.
debated	Romanow (18): “The Canada Health Act needs to be debated to ensure it still expresses values Canadians share and provides a clear, coherent and modern vision for our health care system.”
new principles	CTF (31): “It is becoming … clear that the CHA does not reflect the reality of health care in 21st century Canada.” (37) “The CTF proposes updating the principles of the CHA in order that it becomes a more realistic, flexible & useful document to guide health reform initiatives.” (38) “The CTF proposes that the CHA be modernized with a “new” set of principles: public governance, (enhanced) universality, quality, accountability, choice and sustainability.”
expectations	Romanow (25): “One of the most significant cost drivers is how our own expectations have grown over the past few decades.”
expectations	CTF (96): “… the largest factor that will drive costs for health care: patient and family expectations.”
no standard	Romanow (27): “There is no absolute standard for what any country should spend on health care. The choice will reflect history, values and priorities of each.”
ability to pay	CTF (13): “Moreover, there is not set or optimal level of health care spending for any given country. Expenditures are a function of patient use patterns, availability of human resources, access to technology, diffusion of medical knowledge, and thousands of other unique variables including national ability to pay.”
transparency	Romanow (25): “There should be more transparency in terms of how much money is being spent, by whom, on what basis and with what results.”
accountability	CTF (40): “… accountability must include consistent system monitoring and reporting on all aspects of the health care system including funding, resources, waiting lists and health outcomes.” (40) “The accumulation and periodic reporting of quality data must be as transparent and public as possible, with due regard for individual privacy considerations.”
want to know	Romanow (29): “Canadians want to know that they are getting quality health services — services that cure illnesses, improve quality of life, and improve overall health.”
goals	CTF (15): “… it becomes apparent why quality is not a principle in the Canada Health Act. We’re not doing the best job with the resources available, despite the best efforts of health care workers. We have little in the way of goals or targets.”
quality focus	CFT (39) “A quality focus should ensure at a minimum that:Citizens receive medical care that is appropriate and evidence-based; · Every reasonable effort is made to provide patients with the best pharmaceuticals, technology and diagnostic tools available; and · Progression of the patient’s treatment is as quick as possible and without undue delay.”
measure	Romanow (31): “It is often said that you cannot improve what you cannot measure, and this certainly holds true for the health system.”
measure	CTF (40): “However, you can’t manage what you don’t measure. From waiting lists to out-of-province treatment of workers compensation clients or cancer patients, many provinces are still woefully inadequate in measuring such information and consequently, cannot measure the resources expended in many areas.”
	But the real question becomes has Mr. Romanow already made up his mind. Consider this exchange (a direct transcript) between Peter Van Dusen (PVD) and Roy Romanow on CPAC on February 6th.
put out to tender	PVD: “Do you believe that that’s where most of the ability for reform lies on the efficiency side? I mean which one of these options … and I know you said earlier you haven’t picked one … but I get the sense in talking to you if you had to pick one that system is fixable from within and doesn’t need to be put out to tender necessarily.”
within	RR: “No, to be frank with you what I have a hunch about right now is that it’s probably a combination of more money which I think is inevitable given the costs of technology which is coming … to a flood of new change which is going to hit us, plus reorganization.”
Yikes	Yikes, more money and efficiencies through reorganization. That’s all we’ve been doing since the Medical Care Act since 1966. The Canada Health Act must be modernized. We must implement generational pre-funding (like we do in public and private pensions) to ensure long-term sustainability and we cannot be afraid to try and adopt best practices on the delivery and financing and patient accountability dimensions from other countries.
	We’ll take most of Mr. Romanow’s written words over his spoken words.
	Walter Robinson Federal Director
---------------References:
	Canada Online summary of Health commissions and background to the Romanow Commission.
	The speech Mr. Romanow made about the Interim report issued February 6, 2002
	The actual Interim report is available as a PDF document from this page click on the Interim report for it to download, it is over 300K.