Canadians insist
they are not just like those Americans south of the border.
As proof, they
point to their universal health insurance program and to the fact they
celebrate Thanksgiving in October, not November.
There is little
chance they will change the date of Thanksgiving but it looks more and
more as though the health care program will be much like the kind of coverage
offered through the U.S. Medicare plan and supplemental policies available
to those who can afford them.
Canada has been
struggling with its plan for more than 50 years. Early in 2002, Ottawa
created yet another royal commission to study its plan and offer proposals
for keeping it from bankruptcy -- and to improve medical services so Canadians
don't have to wait months for procedures considered routine in the United
States.
That commission,
headed by former Saskatchewan Premier Roy Romanow, has submitted its 356-page
report for consideration by the health ministers of the provinces and territories.
In late January it will go to Prime Minister Jean Chretien and the provincial
premiers. Approval by the provinces is necessary because while the Canadian
plan now is mandated by federal law, it is operated by the provinces.
That division
of responsibilities has been the crux of the program's problems. By collecting
the taxes and parceling the revenues out to the provinces, Ottawa was able
to tell the provinces what they could and could not do. When some provinces
decided they would run a two-tier health system, with basic care covered
by the national plan and "extras" such as MRIs and CAT scans available
for additional fees, Ottawa said, "No, no," and withheld the provinces'
funds.
When the Liberal
Party won control of the federal government 10 years ago it set out to
balance the federal budget. The budgets had been in deficit for so long,
the interest on the federal debt had become a major budget item.
Former Finance
Minister Paul Martin "balanced" the budgets by cutting the funding for
health care. The health program became unfunded mandates for the provinces.
Ottawa's "club" over the provinces became less of a threat and some provinces
actually developed private hospitals and doctors began offering some services
for fees. Worst of all, many hospitals were closed and wages of nurses
and other health care workers were frozen, resulting in strikes.
Adding to the
problem was the fact that the cost of medical care was rising steadily
due to the introduction of expensive diagnostic machines and the rising
cost of pharmaceuticals.
Politicians,
doctors and patients had forgotten the words of the late T.C. Douglas,
the long-serving premier of Saskatchewan and "father" of Canada's medical
care. His plan, he cautioned, was to provide "reasonable access" to medical
and hospital care. Citizens should not expect the moon.
So what is Romanow
proposing to be done to bring expectations back to earth?
To some Canadians
it sounds like "the moon" still. At least, it is $6.5 billion more each
year by 2005. He wants $8.5 billion over the first two years to bring better
health care to rural and remote areas, reduce waiting times for diagnostic
services, hire more general practitioners, nurses and aides, create a home-care
plan and provide some assistance on prescription drug costs.
Romanow says
the system must be more accountable. To achieve that, he proposes creation
of a Health Council, with members from governments, the health system and
the public. The council would establish benchmarks for performance and
report regularly on waiting times and other matters. There were no suggestions
as to penalties for low performance scores.
The Romanow
report comes as Chretien begins what he has announced will be his last
full year in office. He is known to want health care reform as his legacy,
an achievement for which he will be remembered in the history books.
Because of Martin's
budget-balancing act while he was finance minister, Canada is in a somewhat
stronger fiscal position now, but there is no assurance that future finance
ministers will be able to show budget surpluses. Indeed, Romanow himself
says his plan will not begin to show results until perhaps 2005.
Chretien himself
says Parliament probably won't vote all the money Romanow is seeking. His
$6.5 billion a year would bring Canada's bill for public health care to
$72.5 billion. And public opinion polls have shown increasing willingness
to accept some form of two-level care. That swing has been noted especially
in Alberta, British Columbia, Ontario and Quebec. So health care could
be the crucial issue in the next federal elections, which probably will
be called soon after Chretien leaves the scene.
--
Copyright 2003 by United
Press International.
All rights reserved.
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