The editorial suggests that comprehensiveness is potentially the most unsustainable of the CHA's 5 principles, largely owing to advances in medical technology and the resulting elevation of public expectations. A natural consequence of successful research is to increase our ability to care for our patients. Not surprisingly, these advances may cost more than the technology currently available. Should we maintain the status quo in order to contain costs? Obviously, this is not what Canadians want. The cheapest solution is not necessarily the most efficient one.

Although I agree that a better method of financing — both for medicare and capital investment — must be found, I disagree that this necessarily requires re-examination of the CHA's principles. The CHA embraces, ideologically, what many Canadians feel to be essential, both for health care and as an expression of our nationality. If changes are going to be made on an ideologic basis, there should be evidence that the national ideology has changed. If changes are going to be made on the basis of efficiency, there should be proof that such changes are for the better. At the moment, evidence is lacking on both levels.