Editorial

The Romanow Report and the Future of Medicare

While the response of provincial premiers to the Romanow report on Medicare has been mixed, they appear to have reached a consensus on one aspect of the report - that the system is facing a funding crisis. Romanow proposes a number of possible solutions to this problem: greater government funding, increased privatization, user fees or reorganization of the system (with the possible inclusion of pharmacare and home-care). He has also proposed a public debate on how Canadians want to fund the soaring costs of medical care.

What are the economic returns on Canada's investments in health-care? Who benefits from this investment and to what degree? What types of health-care do Canadians require? Who should pay for health-care and how should they pay? Who should the health-care system serve, people or corporations? These are some of the questions that should be examined in any serious discussion of the health-care system.

The problem is that neither Romanow, the federal government, nor the provincial premiers begin with the recognition that medical care is both a right and an important investment in human capital, an essential component of any modern society. Instead, they treat medical care as simply a cost, as a "burden on taxpayers" which must be minimized. However, they take a somewhat different approach to the issue of increased military spending and bail-outs of corporations. These are treated as crucial expenditures, too important to even debate.

It is a fact that the fastest growing components of Canada's health-care system are pharmaceuticals and medical supplies and that companies in those fields are among the most profitable in the world. It is also a fact that public expenditures on health-care provide a significant competitive advantage to corporations operating in Canada. (In the United States, medical insurance for employees constitutes a major cost of doing business.) On the other hand, the proliferation of "hallway medicine" and user fees would tend to indicate that patients are not at the top of the list of those served by Canada's medical system.

The framing of the alternatives in the Romanow report is done in such a way as to limit the scope of the discussion to a reshuffling of the status quo. He is not proposing a debate on what kind of health-care system Canadians need, nor on who should pay for the system. Rather, it focusses the entire debate on how the people should pay - through their taxes or through user fees. Even the issue of privatization is somewhat of a red herring, since Canada's health-care system is already primarily a publically-funded, but privately-owned system.

If Romanow was genuinely interested in strengthening Canada's health-care system, he would be calling for a real discussion of all of the issues - whether the health-care system should be funded by people or corporations, whether it should remain a pharmaceutical-driven treatment model or move towards a preventive model, whether health-care is a right or a privilege and so on. However, the way the "public debate" is shaping up it is clear that efficiency and effectiveness are not the real objectives of the federal and provincial governments. Rather, they appear interested only in justifying further cutbacks in government expenditures, increased user fees and increased privatization of public assets. In other words, it is not really the cost of the system that they are concerned with, but rather how to increase the proportion of the cost borne by patients, while maximizing the profits of various health-care corporations and the pharmaceutical giants.