Allan Rock comes a-courting
Charlotte Gray
CMAJ 1997;157:1730-1
Charlotte Gray is a CMAJ contributing editor.
© 1997 Charlotte Gray
s Allan Rock looks forward to 1998, visions of good-news headlines dance in his head. Within months of Rock's appointment as health minister, the prime minister announced that the deficit dragon had been slain. "Now we have options," Rock said during a year-end interview. "We can look at whether we can solve our problems through reallocation of existing funds or new spending."
Rock's predecessor, David Dingwall, had no such luck. During the Chrétien government's deficit-obsessed first term, Dingwall never had a chance to utter the magic words that make politicians giddy: "new spending."
He also had the bad luck to address the CMA's annual meeting in 1996 immediately before the big debate on whether Canada needs a parallel private health care system. When he entered that lions' den, Dingwall defended the government's commitment to the public system and said he would waste no time talking to those who wanted more privatization. His combative style and truculent message did not endear him to doctors, who felt they had unwittingly provided the backdrop that allowed Dingwall to deliver a broadly televised and free message that made light of their concerns.
The response to Rock at this year's CMA meeting was much different. "I had the luxury in Victoria of speaking after the privatization discussion," says Rock, who chose the CMA annual meeting as the venue for his first public speech as health minister. "The debate on privatization had happened the previous day and the proposal for a parallel private system had already been defeated. I could move forward."
But the way forward is not always clear because health care offers few absolute answers. Today the question preoccupying him concerns the role Ottawa should play. He has gone out of his way to acknowledge public anxiety about deterioration of the health care system and recognizes that federal budget cuts have played a role in this. "For my own and the government's credibility, I had to acknowledge that and start from there."
He has talked about gaps in care and waiting lists, but like his predecessors he has discovered that he can talk all he wants about the resulting anxiety but can do nothing to alleviate it because the levers of change are in provincial hands. Ottawa can act like the defender of medicare and crow about the 5 principles of the Canada Health Act, says Rock, but it can't deliver the care.
So what can he do? As he did in Victoria, Rock is taking a conciliatory approach. He has convinced his provincial counterparts he will fight for dollars at the cabinet table, but unlike them he has not insisted there is already enough money in the system. He has invited groups like the CMA to show him where service gaps exist and says he is shocked that physicians have frequently gone unrepresented on regional health authorities and been excluded from debates on primary care reform. In October he had a "very good meeting" with Dr. Victor Dirnfeld, during which he asked the CMA president to invite him to the next board meeting so that "we can close the door and have a good frank discussion on where things stand."
When I interviewed Rock in his 16th-floor office he, and not a ministerial minion, came to fetch me from the waiting area. He spoke with the easy fluency of a good lawyer. "I'm certainly not afraid to stand up on a matter of principle, but the public doesn't want to see any more disputes. I avoid unnecessary disputes. I often bite my tongue."
This nonconfrontational style has won him a friendly audience at most of his public and official appearances, and it appears to be good therapy for a system strained by antagonism and turf wars. But he won't yield on one thing: opposition to a parallel private system. "The best way to protect medicare is to strengthen it so the publicly funded system meets our needs and there is simply no market for a private system."
He argues that much of the support for a private system comes from those frustrated by the public system's shortcomings -- things like shortages of MRIs and lengthy waiting lists -- and those frustrations can be overcome. As for those who support a private system for ideologic reasons -- several of them attended the CMA's Victoria meeting -- Rock is adamant: "I just plain disagree with those folks. Our platform is for a single-payer system. We shall not budge."
He is moving fast to deliver a national agency that will collect and integrate health care data. "There is good work being done in solitude. . . . The trick is to coordinate efforts and ensure that everybody is working in the same digital language. Then we can look at nationwide data on the outcomes of particular strategies or the causes of waiting lists."
Rock's major challenge is to put some meat on bare-bones election promises of national pharmacare and home-care programs. Wealthy provinces resent these incursions onto provincial turf, and the poor ones shudder at the cost. Rock insists that Ottawa simply wants to "build on what is already in place to create a stable standard national system -- what we have now is hit and miss." On the home-care front, for example, he says 20% of working middle-aged Canadian women are already providing care to elderly or disabled relatives and "we cannot continue to off-load from hospitals onto individuals." He thinks home care is a more urgent priority than pharmacare but hopes to develop both initiatives.
Rock refuses to be drawn into a debate on how national standards for access and quality might be established and maintained. He is also cautious when asked what he'll do about the law outlawing cigarette advertising passed before this year's election and the prime minister's promise to make an exception for the 300-km/h
tobacco billboards driven by people like Canada's and Quebec's latest hero, Jacques Villeneuve. "We will fulfil the prime minister's commitment," says Rock, "but we won't go any further than we have to -- we will have to manage that carefully."
Rock's gentle manner belies his intensity. Until 1984 he smoked 30 cigarettes a day. He quit and promptly became a marathon runner, competing in the New York Marathon in 1985, '86 and '87. He gave up the marathons in 1987 after his wife had twins, but he still runs up to 10 km a day. "I just replaced one addiction with another."
Throughout the interview, I was conscious that Rock was being careful about the message he wanted to deliver to physician readers. "I am very interested in whatever the CMA can tell me about gaps in the system," he said more than once. "Our only way forward is to work together."
In his previous life, first as chief executive officer with the Law Society of Upper Canada and then as minister of justice, he was always known as a "lawyer's lawyer." Today he's happy to have landed another role. "For the first time in 25 years I am something other than somebody's lawyer."
His hope, perhaps, is that he might emerge as medicare's healer.
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