Renewal of health care is finally going to happen, minister tells CMA

CMAJ 2000;163(5):594-5

Rock acknowledged that many of the elements for attaining sustainable health care that he presented to 200 delegates attending the CMA's August annual meeting in Saskatoon, Sask., were old news. But, he said, recent circumstances make him optimistic. For the first time "all the governments are talking about the same elements, we have a specific time frame of 30 days to talk, federal money is committed and we have broad professional support and accumulated evidence."

The provincial and territorial premiers will meet with Prime Minister Jean Chrétien in September to finalize the health care renewal platform. "It's very encouraging," said Rock.

The CMA's outgoing president, cardiac surgeon Hugh Scully, said he too is optimistic that "we can move forward. In the last 6 months I've seen more accord and participation than ever. The environment is better than it has been in the last decade."

Saskatchewan Premier Roy Romanow added that, given the input from providers and consumers, "I don't think the government will have the guts to destroy this consensus."

Rock pledged to include physicians in the renewal plans and to ensure that the renewal takes place within the principles of the Canada Health Act.

Unfortunately, many physicians didn't appear as optimistic as Rock. Their questions following his address indicated that they are fed up and disgruntled over the length of time renewal has taken.

Rock acknowledged it has "taken too long. The process of working with 13 governments is cumbersome but we are on the verge of putting things into place and acting on them."

Indeed, Chrétien recently announced the government's willingness to increase health care funding according to a "shared vision and plan."

To fund or not to fund

No matter what the funding arrangement is between the federal and provincial governments, Scully and Romanow said one thing is clear: not everything can be paid for.

Rock did promise that "essential services will be supported," adding that the public will have to identify what is "essential and what isn't essential." But he added: "I do not believe that delisting of currently insured programs is called for. What I'm talking about is future listing."

Both Scully and Romanow said the public should be involved in making these decisions and urged Ottawa to launch a national review of the health system — the first of its kind since Justice Emmett Hall headed the commission that led to the introduction of medicare in 1966. Rock politely agreed to consider this review option.

System under siege

The stresses facing the existing system was the theme of the inaugural address by the CMA's new president, Saskatoon urologist Peter Barrett (CMAJ 2000;13[3]:325). He warned that Canada's health care system is "under siege and in danger of coming apart if we don't take significant action now." Barrett lamented the widespread "passive privatization" taking place in Canada. He emphasized the need to act on crucial issues, such as ensuring stable funding and an adequate physician workforce, and determining which medical services are essential.

New CMA President Peter Barrett laments passive privatization

The Ontario-based Medical Reform Group, which acknowledges that it has "seldom" sent congratulatory messages to leaders of any medical organization, announced its "enthusiasm" for Barrett's address in a press release. Its members strongly support publicly funded health care. "It seems that we may now have a CMA president who will call not only for more money, but also for ensuring a system that benefits all Canadians by ensuring equitable access to care," stated Dr. Gordon Guyatt, the group's spokesperson.

CMA plans sustainability

The CMA set a blueprint for sustaining Canada's health care system by passing 16 resolutions calling for everything from cash transfers to a national dialogue among physicians, government, the public and others to decide what services will and will not be covered under medicare.

Scully urged governments to stop bickering and develop a long-term agenda for health care, but some physicians viewed a motion calling for governments to "rise above political differences" as unrealistic. "It ain't going to happen," said Dr. Ian Warrack of Vanier, Ont.

The approved resolutions related to sustainability and included a call for health-specific federal cash transfers to the provinces and territories. To prevent any further erosion of federal funding, the CMA wants an escalator mechanism to increase funding according to factors such as the aging population and improved technology. — Barbara Sibbald, CMAJ

© 2000 Canadian Medical Association or its licensors