It was standing-room only last Thursday as hundreds turned out to see Roy Romanow, the former Royal Commissioner on Health Care in Canada, speak about “The Past, Present, and Future of Medicare.” Organized by the Health Law Group at U of T’s Law Faculty, the talk drew mostly students of medicine and health policy from around Toronto.
“The 18 months I spent as royal commissioner were the most satisfying and rewarding of my public life,” said Romanow. “We completed, I would argue, the most comprehensive report on the state of medicare,” which he referred to as “the most sacred of all Canadian social programs.”
Romanow said he was in “a bit of a reflective mood” following the recent first-ministers’ conference, which saw nearly all the provinces and the provincial government reach new agreements on their responsibilities to health care, and committed millions of dollars to improving the system. He said some progress was made, but that the process of striking the deal remained flawed.
“Most of the real stuff [at the conference] was settled behind closed doors,” said Romanow. He contrasted that with his own Royal Commission, where thousands of ordinary Canadians were consulted during the course of his research.
“Medicare demonstrates to me that as a community, we can accomplish more together than we ever could individually,” he said. “It’s not just health care. People were talking about other things in the emails we received. I think a large number of Canadians saw in [the Royal Commission’s] process a chance to participate in the political process-that they were not powerless.
“What was also clear was that people wanted an end to the intergovernmental wars and squabbling over health care.”
Romanow spoke about what he sees as the fundamental divide in the debate over the future of health care: “There are only two competing visions,” he said. “That health is a commodity; or that health care is a public good.”
He argued for the latter view.
“Since tabling my report, we can see that 30 percent of our health care is already delivered privately,” he said. “Still the argument is that private health care is necessary.
“‘We can’t afford it’-that’s essentially the message.”
Romanow countered that argument by citing some examples from the US health care system.
“In the United States, health care costs 15 percent of GDP, and 100 million US citizens are uninsured. In Canada, health care costs are still less than 10 percent of GDP…and will likely stay at less than 10 percent. The analysis discounts theories that rising health care costs will bankrupt the country. The evidence regarding sustainability in this respect is overwhelming.”
To the idea that privatized health care offers citizens more choice and control over their own care, Romanow simply said, “ask the millions of Americans without health care if they enjoy exercising their freedom of choice.”
He acknowledged that serious problems with Canada’s health care system remain. He referred in particular to the standard of health among Canada’s First Nations population, which he called “a blight on all of us.”
Romanow returned to the First Ministers’ meeting at the end of his speech.
“Was the First Ministers’ meeting of two weeks ago a success? Unequivocally, maybe” he said to laughs from the crowd. While he said that some progress had been made in areas like aboriginal health and accountability, that the issue of private versus public delivery of health care had again been sidestepped.
“Eventually this discussion needs to be brought out of the shadows and into the light of day,” he said, “so that Canadians can make an informed decision.”
“This is our most cherished social program,” he concluded. “For my part I am hopeful that we are on the road to a truly reformed program an a united country.
“The true guardians of medicare are the people of this country, all of you,” he said. “Time will tell.”
