Photo by Chuck Stoody/CP

Edmonton - Monday, December 2, 2002 - by: Ron Thornton


"How come no one pays you $15-million to come up with a report?," my wife asked, "That is how much the feds gave to Roy." At first, I was puzzled as to how my mother's brother had received such a winfall when I realized my wife wasn't talking about my Uncle Roy, but Roy Romanow and his report on health care. This wasn't surprising, as neither my uncle or I have ever been a provincial premier experienced in the spending millions in public funds, nor have we worked with those gullible enough to actually accept our recommendations to toss away billions more.




Mind you, when it comes to spending cash, Romanow isn't terribly fond of the concept of those in need gaining access to faster treatment through paying a private provider. While some might consider this a perversion of Canadian values, Romanow is quoted as saying that he believes
"it is a far greater perversion of Canadian values to accept a system where money, rather than need, determines who gets access to care."
Now, that would be quite a profound statement if the advent of such private facilities would mean the end of the public system, where those in need would be denied treatment due to their inability to pay. As that is simply not the case, then Romanow's statement is rendered as being nothing short of asinine. We need a review of how such facilities as the renowned Mayo Clinic operate, and what lessons might be gleamed for the betterment of both public and private providers. What does Romanow say about such facilities? As far as I know, nothing.




Then again, there is nothing constitutional regarding the report's recommendations. For those able to read, which hopefully includes politicians, our constitution stipulates under Article 92 (7) that the provinces have exclusive jurisdiction for
"the establishment, maintenance, and Management of Hospitals, Asylums, Charities, and Eleemosynary [charitable] Institutions in and for the Province, other than Marine Hospitals."
In short, a federal commissioned health care report makes about as much sense as a province establishing a committee to report on national defense and foreign policy. Such areas are not constitutionally within their mandate. However, the constitution does stipulate that Marine Hospitals are within federal jurisdiction. Such hospitals treated sailors, becoming the responsibility of the federal government's department of marine and fisheries in 1867, and in 1919 were transferred to the Department of Health. This would seem to open the way for a national hospital system, one totally operated, funded, located, and directed by the federal government as it saw fit, a system totally separate from the provincial systems and limited only by federal resources and vision. In fact, the feds could take over the full funding of some existing hospitals presently the responsibility of the provinces. Instead of investigating such things as a separate federal system or how it might work, the Romanow Report concentrates on federal interfering in provincial jurisdiction. However, the limiting of its scope, imagination, and sources for inspiration seems to prevail throughout the report's recommendations.




While the Romanow Report dwells on public administration, a real service would have been provided if he had bothered to review how public and private institutions might have been able to function so as to provide a higher level of health care for all. I think we all would agree that no level of health care is adequate if it fails to provide for our loved ones in all situations, even if our expectations are shown to be unreasonable. An answer as to what we each should expect as basic health care for all Canadians, regardless as to financial or social standing, be it institutional or home care, would have been of substantial benefit. A review of the financially catastrophic ruin we might face along with fighting extraordinary health concerns, and how we might survive both, could have gone a long way in easing our fears and apprehension. To render this to gobblygook catch phrases that we might blindly toss money at would seem to me as being far from responsible.



do what
they want

Of course, you can't toss money without some defined funding models to consider. While Romanow recommends more bureaucracy in a new Canadian Health Transfer of cash from the feds, I suggest we go to Article 36 of the Canadian Charter of Rights and Freedoms for the answer. We are already bound to the
"principle of making equalization payments to ensure that provincial governments have sufficient revenues to provide reasonable comparable levels of public services at reasonably comparable levels of taxation."
As the provincial governments are duly elected by the people of the provinces, and those governments have exclusive powers in regards to health care in provincial institutions, why not allow the provinces to make the decisions for which they have been entrusted? Why must we separate health care from any of the other funds transferred to the provinces under equalization? Why must there be strings attached to funding already bound to the provinces in the first place? It would seem to me more accountable and more constitutional if the federal government kept its nose out of areas that are clearly under the exclusive jurisdiction of the provincial governments and let them be accountable to their people as to how and where such money is spent, be it on health care, education, law enforcement, or museums.




Not everyone is enchanted with the cultural opportunities provided by urban life, preferring things more rustic and more attuned to nature. One downside, obviously, is that one becomes somewhat removed from such conveniences as shopping centres, fine restaurants, cultural and recreational amenities, along with health care facilities. By living in the city, with its higher taxation and housing costs, I have a fine hospital that is a five minute drive from my front door. My parents' country acreage, with its fresh air and forest area, is a twenty minute drive away. It is a fact of life. You can't expect a state-of-the-art medical facility out in the bush no more than you should expect an opera house. Rather than a $1.5-billion Rural and Remote Access Fund, maybe we could spend the cash on providing modes of transportation to better deliver a patient from a remote area to a medical facility. It might even provide a practical training use for our new military helicopters, the ones we've been waiting a decade for. In fact, using our armed forces or some other scholarship proposal might even provide the medical expertise sought for our more remote communities, with graduates "enlisting" for assignment over a specified term in exchange for having their medical education paid for. Then again, I'm not an ex-Premier with millions to spend in order to come up with such ideas, so what do I know?




Now, to be fair, Romanow's report isn't entirely without merit. I would hope that there is some coherent management being done in regards to waiting lists for medical procedures and treatments. Of course, we won't know how waiting lists might have been shortened with the advent of private providers as Romanow rejected the concept out of hand. I agree that it should be tougher for the pharmaceutical industry to have near perpetual patents on drugs than through slight revisions made to existing formulas, along with the practice of pre-emptive lawsuits that effectively keep such drugs out of the hands of generic drug makers. Then again, you would have received such recommendations for the price of a cup of coffee from many members of the general public.



lack of

You would have thought that for $15-million the Canadian public would have received a truly visionary approach to the future of health care, one open to all forms of stimuli. I guess sometimes you don't really get what you pay for. Now, should the government wish to try again, I'm sure I could do it for much less. In fact, my wife suggests I work on such a project with my Uncle Roy, which should ensure that our report would not only be informative, but damned entertaining as well.


Ron Thornton

  Romanow, Roy, Commission On the Future of Health Care in Canada, final report
  Romanow, Roy A message to Canadians, November 29, 2002, Toronto Globe and Mail (PDF)
  Lawlor, Allicson, Roy's version, Political views of former Saskatchewan premier shaped by Tommy Douglas, December 2, 2002, Toronto Globe and Mail



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