They blew it. In early February, our federal, provincial and territorial leaders had an historic opportunity to reform and reinvigorate Medicare. They had a chance to keep our health care system healthy by keeping it public.

But the Prime Minister and the Premiers choked under pressure – and they dropped the ball that had been passed to them by Roy Romanow, chair of the widely respected Royal Commission on the Future of Health Care.

Of course, being politicians, our leaders tried to dress up their failure as success.
For example, there was a lot of talk about the new money that will be spent on health care over the next few years.

Obviously, given the pressure on the system being caused by staff shortages and a growing population, any new funding is welcome.

In fact, the amounts pledged by the federal government are substantial – $17.3 billion over three years and nearly $35 billion over five.

But, as Roy Romanow said shortly after releasing his report last November: when it comes to Medicare, money means little without meaningful reform.

The really frustrating part of this whole situation is that, thanks to the Romanow commission, the First Ministers had a workable roadmap.

They also had the political momentum to do big things: Canadians overwhelming supported the Romanow vision and were willing to get behind major reforms.

But instead of being bold – instead of grabbing the opportunity and the ideas handed to them by Romanow – our leaders decided to do the bare minimum.

The premiers and the federal government failed to measure up in many areas – but there were two, in particular, that stand out.

First, in his report, Romanow said clearly that Medicare needs to be expanded to cover a broader range of services and treatments.

He pointed out that the practice of medicine in Canada has evolved dramatically from the time Medicare was first introduced.

Back then, Canadians received most of their health services either in their doctors’ office or in hospitals – and that’s what Medicare was designed to cover.

But today – with changes in technology and approaches to health care management – more and more people are accessing services outside of these traditional settings.
Homecare. Diagnostic imaging. Prescription drug therapies administered on an outpatient basis.

These things all represent the new face of medicine – but all of them fall outside of the traditional Medicare umbrella.

Roy Romanow rightly identified these new approaches to medicine as key to keeping Canadian healthy – and he said Medicare should be expanded to cover them.

For Romanow, covering things like home care, diagnostic services and prescription drugs was not only consistent with Canadian values – it was also the economical thing to do.

But instead of seizing on these suggestions, the First Minister did nothing. There was no pledge to amend the Canada Health Act to cover homecare or diagnostics. And there was no agreement on a new national Pharmacare plan.

The First Ministers were similarly silent on a second issue that was central to Romanow and to the thousands of Canadians who made personal submissions to his commission. And that’s the issue of privatization.

In his report, Romanow said the evidence on American-style two-tier health care was clear: it is a disaster, both is terms of access and economics. He also expressed grave doubts about farming public health services out to for-profit providers – similar to the Bill-11 style approach to health care being advocated by the Klein Tories here in Alberta.

But on this issue, the First Ministers – once again – failed to step up to the plate.
The federal government could have attached strings to the new money for health care. They could have said “no cash if it’s going to be spent on private delivery.”

But they didn’t do that. Instead – contrary to the strictly targeted spending proposed by Romanow – the federal government will be writing blank cheques to the provinces.

Here in Alberta, that means the money we’ve all been calling for – the money that Romanow proposed – will be not all be going to the publicly administered and delivered services Canadians cherish.

Instead it will be used to further our province’s on-going experiment in market medicine.
In the end, the only people who got what they wanted out of this round of negotiations on Medicare are people like Ralph Klein and others who want to dismantle the system.

By not seizing the moment the federal government and the more progressive premiers have basically given the Klein’s, Harris’ and Campbell’s of the world a green light to proceed.

By doing nothing, they’ve have betrayed all those who believed in the promise offered by the Romanow Commission. And, in many ways, they have left Medicare more vulnerable than ever.

Gil McGowan, AFL Executive Staff
March 2003