By NUPGE Research
Since the beginning of our campaign to protect and build Canada’s Medicare, the National Union of Public and General Employees has recommended that the different levels of government work together to reach ten objectives. We believe that these ten objectives are not only about the health of Canadians, they are also about the economic health ofCanada. Achieving these ten objectives is the best way to ensure that we have a sustainable health care system that reflects Canadian values and lives up to Canadian standards for efficiency. We also believe that these ten objectives draw on the courage of the original vision put forward by the pioneers ofCanada’s Medicare and fulfill that vision by restoring, rethinking, and reinvesting in public Medicare and the people who provide health services. This report card is intended to evaluate how well the final report of the Romanow Commission stacks up against the National Union’s ten objectives.
Adequate and stable public funding
Romanow Report Grade: A
The report recommends the federal government provide “adequate, predictable, and stable public funding for Medicare.” To do so, the report recommends a multi-billion dollar injection of federal funds until it reaches a 25% minimum cash floor of Canada Health Act insured services – $6.5 billion more per year by 2006 – $3.5 Billion in 03/04, $5 billion in 04/05, and $6.5 Billion in 05/06. NUPGE, the CLC, other unions and many of our health coalition partners have called on the federal government to increase its share of health funding to 25% of publicly insured services. The Romanow report clearly reaches this benchmark.
As equally important as proposing increased federal funds, the report recommends that the new federal cash be used to “buy change” by attaching strings (through earmarked funding initiatives) to the new funds. In addition, the report recommends that the CHST be abandoned and replaced with a separate fund for health care transfers to the provinces (called the Canada Health Transfer) with a built-in escalator provision so that federal funding would keep pace with economic growth. This is the kind of accountability and transparency that’s necessary to ensure that any new health dollars actually go to health care services rather than tax cuts or other areas and it is something the labour movement has called for over the last 8 years.
The Romanow report is much better that the Kirby report when it comes to increased public funding for Medicare. Kirby proposed what amounts to a permanent user fee, payable by all tax payers. Kirby’s proposal would not raise enough funds and it does not meet the test of fairness.
While we could argue that Medicare needs more money than what is being proposed, what is being offered is significant (particularly if the federal government gets to the 25% minimum, using the existing progressive income tax system and its revenues, with a built-in escalator) and this section of the report is positive and comes very close to meeting our Objective.
Never for profit
Romanow Report Grade: B
The report states that: ‘Medicare is a moral enterprise, not a commercial venture. Medicare is a right of citizenship … It is a far greater perversion of Canadian values to accept a system where money, rather than need, determines who gets access to care. ” The report concludes that private, for-profit health care runs the risk of being more expensive, providing worse care and undermining the value of fairness.
The report clearly states that Romanow challenged those advocating private sector solutions to provide the evidence but that evidence was not forthcoming. The answer to Canadian health needs, the report concludes, does not lie in the private sector but in a better funded public system.
The Romanow report also recommends decisive action to curb the growing number of private for-profit MRI and other diagnostic services clinics, concluding that these private clinics lead to queue-jumping and this violates the principles of the Canada Health Act. The report recommends that diagnostic services be explicitly included under the definition of insured services under the Canada Health Act. The report recommends that there be no user fees, facility fees or extra billing for MRIs and CT scans; thus, making it illegal for anyone to be charged an out-of-pocket fee for these services. The report recommends thatOttawapenalize any provinces that allow private delivery of diagnostic services. The report also states that the current status of injured workers (WCB claims) getting preferred access to care and being sent to private clinics violates the principle of equal access. Further, the report proposes a Diagnostic Services Fund of $1.5 billion over 2 years to improve wait times.
The report looks at Public-Private Partnerships and essentially concludes that they’re not a good idea and will end up costing taxpayers more than if the government had simply done the job itself in the first place. The report also notes that these arrangements can have the effect of hospital bed closures and a reduction in staffing levels.
The Romanow report also recommends that user fees, medical savings accounts, deductibles and tax-based co-payments continue to be banned by the CHA.
Clearly, this is much better than the Kirby report which has no problem with further commercialization, private for-profit ownership and delivery.
However, the report does have a major weakness on the issue of privatization. It offers reasons and suggests there is evidence that contracting-out of non-medical services such as food preparation, laundry, maintenance and cleaning is okay. This is not the right thing to recommend or the smart thing to recommend and therefore the report, on this point, is extremely disappointing.
Further, while the report gives strong rationale for opposing private for-profit care, the report is missing a specific recommendation of a specific mechanism for banning private, for-profit delivery of health services.
In addition, while the report is critical of P3s it stops short of recommending they be banned completely and even suggests that they might be useful in non-direct health areas such as “health information systems.”
This section of the report went far, but could have and should have gone even further. In any health care institution, germ-free environments, properly sterilized laundry and food safety are critical to the well-being of patients – we can’t afford to cut corners with for-profit laundry, dietary and maintenance services. The report should have said this but it didn’t. Therefore, this section of the report does not completely meet our Objective.
Debunk private health care myths
Romanow Report Grade: A
The report is an eloquent defence of public Medicare. It offers unqualified support for the principles underlying public Medicare. It dismisses the myth that public Medicare is on the brink of collapse. It debunks the myth that public Medicare is unsustainable or unaffordable. It also challenges the myth that private, for-profit care is more efficient, would shorten waiting lines, and provides better care (except when it comes to support services and this is a problem with the report). It also concludes that ‘innovations’ such as user fees, medical savings accounts, P3s etc. are nothing more than standard right-wing nostrums that will do nothing to improve Medicare.
This part of the report is very positive and meets our Objective.
A comprehensive national health human resources strategy
Romanow Report Grade: B
The report suggests the need to look at changing the scopes and patterns of practice of health providers.
The report argues for a national database to analyze relevant human resource information, and track and forecast trends.
It also suggests that governments stop recruiting health care workers from third world countries.
The report calls for a Rural and Remote Access Fund ($1.5 Billion over 2 years) to attract and retain health care providers, including opportunities for health professionals to train and gain experience.
There are not enough substantial recommendations on this subject – i.e. it does not make specific suggestions for training and upgrading skills of existing health professionals and other workers. Most of the details of a national health human resources strategy are left to be developed by a new Health Council of Canada. We were hoping for more substantive recommendations and a national fund for a human resource strategy. We were also looking for a proposal to promote and market the various health professions.
On this subject, the Romanow report only partially addresses the Objective we set out.
Primary Care Reform – Develop a system of blended care
Romanow Report Grade: A
The report recommends a common national platform for primary care reform.
It recommends a $2.5 billion investment over 2 years through a Primary Health Care Transfer in order to remove barriers to change and kick-start reform. Of course, service delivery is provincial jurisdiction, so Romanow recommends the federal government link the new funding to provincial pursuit of the community clinic model.
The changes it proposes include: full-service community health clinics where patients can access a team of health professionals 24-7and receive everything from a doctor’s prescription to nutritional advice to physiotherapy and psychiatric help.
There is also an emphasis on the need for cultural diversity and removing language barriers to improve access to care.
The report also talks about the need to put more emphasis on wellness and disease prevention programs – tobacco, obesity and physical activity are good choices to start with for health promotion.
In some ways this section of the Romanow report is similar to Kirby’s proposal of creating primary-care groups of different types of health-care providers. However, Romanow’s recommendation is better in that it calls on the federal government to use any new money to ‘buy the changes needed in primary care reform’ and it talks about wellness and prevention programs being critical to good health.
The focus on primary care reform, integrated with health promotion and disease prevention is long over-due. This section of the report and its related recommendations are very positive and come very close to meeting our Objective.
Add home care to the Canada Health Act
Romanow Report Grade: B
The report recommends that Ottawa kick-start a process (and provide the foundation for) a national home care program by covering all priority home care services – i.e. intervention services, home mental health services, palliative care, post-acute home care – through a Home Care Transfer of $2 billion over 2 years.
It is not clear what the report suggests should be done with home support / personal support services. It has no specific recommendation on bringing these services under the CHA so we must assume it is okay with those services, for the most part, being left out of the Act and therefore becoming out-of-pocket expenses for all intents and purposes. This would not be the right thing to do or the smart thing to do. These are services that allow people to live with dignity in their own homes. That both improves care and saves money by keeping people out of hospitals.
The Kirby report called for a national home care program that would cover only those just released from hospital or those near death.
This part of the report does not go all the way and recommend a new national program immediately, and not mentioning home support services is disappointing, but it does propose a good step forward in the direction of including all home care services under the CHA. It doesn’t completely meet our Objective but it brings us a closer to a national home care program.
Add long term care to the Canada Health Act
Romanow Report Grade: D
The Romanow report is a dismal failure on this Objective. The report does not make any recommendations at all for institutional care.
It assumes, for the most part, that through home care reform and increased coverage of acute and palliative home care services under the CHA, you would be able reduce the demand for beds in long-term care institutions.
The report does not recommend national standards for long-term institutions and it does not recommend new immediate public funding for long-term care.
The total lack of recommendations in this area is clearly a major win for the huge private corporations involved in the long-term care industry i.e. Extendicare.
Add a national pharmacare program to the Canada Health Act
Romanow Report Grade: A-
The report concludes that the short term priority should be to provide public funding for “catastrophic drug costs” with the Canada Health Act eventually covering the cost of prescription drugs.
It recommends the establishment of a National Drug Agency and a National Drug Formulary as a national strategy for dealing with soaring drug costs, providing comprehensive coverage and objective and accurate information on drugs.
The Romanow report also calls for a review of current drug patent laws inCanada.
The Romanow recommendation is better than Kirby’s proposal which calls for public coverage after $5,000 and does nothing to address the root causes of soaring drug costs (patent law).
This recommendation falls short of our Objective of a National Pharmacare Program but it offers a huge step in the right direction, especially on the recommendation to review patent laws.
Exclude health services from all international trade deals
Romanow Report Grade: A
The Romanow report offers a strong message on this issue. The report issues a ‘warning flag’ on globalization and trade deals and their impact on the future expansion of public health care.
It recommends that governments must not delete from trade deals any of the current protections and exemptions for health care and it states thatCanadashould work with other nations to protect public health care from trade agreements.
It also states that any future efforts to expand public Medicare must also be protected from trade deals.
It also states that the right to regulate health policy should not be subject to claims from foreign companies.
The Romanow recommendation is better than the Kirby report which ignores altogether the risks posed by NAFTA and other trade agreements that further privatization of health services would open the door to US and other foreign corporations to penetrate our Medicare and take over its services.
The report could have called for a renegotiation of trade deals which would provide even stronger protection for public health services. There should have been a recommendation that the Canadian government take TeleHealth technology off any trade negotiation table.
On the whole, the Romanow report is strong on this subject and comes very close to meeting our Objective.
Women’s equality in health care
Romanow Report Grade: A
The report recommends that governments provide some kind of financial aid to those (overwhelmingly women) who have to stay at home to care for sick, elderly or disabled relatives. On principle this is an excellent recommendation and it takes us into any area governments have not yet ventured. Of course, the devil will be in the details with respect to how the assistance is provided – likely through the EI system
The recommendation of increased public funding and reversing the trend of privatization is also very helpful for health care workers the majority of whom are women. Contradicting this, however, is the section of the report that offers reasons for contracting-out support services. This would unevenly affect women workers and so this aspect of the report could have been better.
The report does not offer enough to address the unique health needs of women and related access issues.
The Romanow recommendation is much better than the Kirby report which ignores the uneven burden faced by women when it comes to unpaid care giving in the home. Further the Kirby endorsement of private for-profit ownership of facilities and services would actually exacerbate the uneven burden and unequal access to health services faced by women.
The report goes further than any other to address the uneven burden faced by unpaid care-givers (mostly women) and comes close to meeting our Objective.
Other Important Recommendations
· A new Canadian Health Covenant is proposed to express Canadians collective vision for health care and updating the Canada Health Act.
· A New Health Council of Canada to foster collaboration amongst governments and stakeholders.
· The report recommends that a 6th principle of “accountability” be added to the Canada Health Act.
FOR MORE INFORMATION:
Contact Mike Luffat