In the two years since Roy Romanow wrapped up his work with The Royal Commission on the Future of Health Care in Canada, the headlines have been taken over by issues such as same-sex marriage and missile defense. That doesn’t mean, said the former Saskatchewan Premier in an interview earlier this week, that “health care has fallen off the public agenda. Every poll I’ve looked at indicates that health care remains a top priority for Canadians.”

Interest may have cooled somewhat since last September (when the Health Care Accord was signed, delivering $41 billion to the provinces over ten years and setting out objectives for reform), because “the public may believe that governments need to be given time to implement these reforms.”

When asked whether he had confidence that most or all of his recommendations will eventually be implemented, he answered with a half-joking “Definitely maybe.” While it’s true that action has been taken on only a few of the commission’s 47 recommendations, “I think it’s good news that the funding question has been dealt with. Because Ottawa is now returning to its traditional share of health care funding, money should no longer be an excuse for inaction. As well, it’s important that the goals for reform are set out and the accord is signed, even if it’s going to take some time to implement those goals.”

On a more worrisome note, Romanow indicated that, “I don’t think the goals are specific and measurable enough. The accountability is really lacking. In addition, I have some difficulty with the fact that the Health Council was not established in the form that was recommended, and that Alberta and Quebec are not participating. As well, the conditions that should be attached to the new money are not there. I argued in my report that new money has to buy change to meet the goals (for reforming the system). Without conditions, pouring new money into health care is like spilling ink on an ink blotter. It’ll just be soaked up by the system and the system will keep demanding more.”

During his work with the commission, Romanow openly challenged advocates of private health care to make their case. No one came forward to make that case at the time and, he notes, “I’m still waiting.” Romanow cautions that “there have always been those in Canada who were opposed to medicareâe¦ and that’s not likely to change.”

When he released his final report in November 2002, Romanow recalled that “Forty years ago, when visionary men and women came together to create medicare, we had private medicine in Canada. You paid out of pocket to receive medical services if you could afford them, or relied on the dole if you couldn’t. If you needed an operation, you cashed in your savings, mortgaged your home or sold your farm so you could pay, or you simply did without. If you had the resources or good fortune, you were able to pay your way to the front of the line; if you didn’t, you waited and prayed for the best. Many of the so-called ‘new solutions’ being proposed for health care — pay-as-you-go, user and facility fees, fast-track treatment for the lucky few, and wait-lists for everyone else — are not new at all. We’ve been there. They are old solutions that didn’t work then, and were discarded for that reason. And the preponderance of evidence is that they will not work today.”

Instead of continuing with the rush to privatization, “what needs to happen is that the existing provisions of the Canada Health Act must be enforced by either the federal government or the new Health Councilâe¦ It will require leadership, and a commitment to medicare and to Canada.” Remember, says Romanow, “We’re not just trying to save health care. We’re trying to build a nation.”

Fortunately, Canadians seem to be looking for that leadership. Romanow agrees that Tommy Douglas’ recent selection as The Greatest Canadian is “a strong sign that Canadians value public health care, but also a sign that they are hungry for the sort of leadership that he providedâe¦. I am very confident that Canadians see health care as a public good. In our time of greatest need, we count on each other for assistance.”

Romanow cites the book Fire and Ice, in which pollster Michael Adams documents the differences between Canadians and Americans, to bolster his claim. “Adams found that Canadians deeply valued public health care as a fundamental part of being Canadian.”

“Our one common denominator as Canadians is that our health matters to us,” says Romanow. “We’ve chosen to organize our society to ensure that health care is equally available to all Canadians. That spark of Canadian values needs to be fanned, and that won’t happen if all we do is pour money into the system. After ten years of underfunding, the problems of the health care system are not going to be solved only with money and they’re not going to be solved overnight. We’re going to need to watch this file for a long time.” (Incidentally, Romanow readily accepts his share of blame for that underfunding. “We pushed some of these costs out of our own budgets, and onto the residents of the provinces. It was, in other words, a false economy,” he admitted in 2002.)

“Medicare didn’t fall from Mars. Men and women who believed in it made sure that it happened. I saw during the commission’s hearings that that strong band of support is still out there. There were over 30 million hits on our website. We received thousands of submissions. Our hearings would start first thing in the morning and often continue well into the evening. Canadians demonstrated their commitment to preserving medicare and that commitment is still thereâe¦. They want their governments to work together to make medicare better, not fight over it!”

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Scott Piatkowski

Scott Piatkowski is a former columnist for rabble.ca. He wrote a weekly column for 13 years that appeared in the Waterloo Chronicle, the Woolwich Observer and ECHO Weekly. He has also written for Straight...