Perhaps you've heard the old joke that being asked to work on a political campaign is a thankless task but being asked to sit in the Senate of Canada is a taskless thanks. Now don't get met me wrong, I'm not out to dump on the Senate even though the actions of some of its less esteemed members have brought its value as an institution into serious question.

Actually, I'm out to praise the work - especially on health care - that has emanated from the body of sober second thought in recent months. If there ever was an issue that deserved sober second thought, it most definitely is health care.

This past Thursday, the latest report from the Standing Senate Committee on Social Affairs, Science and Technology entitled Volume 5: Principles and Recommendations for Reform - Part 1 was released to the public. This report is one in a series of reports that has been released by the Kirby committee - named after its chair Sen. Michael Kirby - over the past three years.

The committee's final volume which will cost out recommendations to fix our health care system is due out this October, one month before Roy Romanow is to report on what his Royal Commission recommends.

This timing is probably not accidental. 2002 is the year of Medicare and having another process to shadow Mr. Romanow and a report by which Canadians can benchmark the Romanow commission's work is ultimately helpful. But the real key will be in what Ottawa (and the provinces for that matter) do or do not do with the work of Mssrs. Romanow and Kirby.

While some of the Kirby committee's recommendations should be discarded, one cannot discount the thought, research and brainpower behind its work. Along with Senator Kirby who brings years of senior private sector experience to the table, the committee is co-chaired by Tory Senator Marjory Lebreton who happily admits to playing the part of layperson amongst her colleagues. The committee also had amongst its members a former premier, a former provincial Minister of Health, a former Dean of Medicine and Ottawa's own Senator Wilbert Keon from the Ottawa Heart Institute.

Health care consumers (which we all are) should be pleased that the Kirby committee has joined the overwhelming chorus of public and expert opinion concluding that our health system - as currently structured and funded - is "not fiscally sustainable."

Yours not-so-humble scribe has pointed this out repeatedly and and it was a principal conclusion in the CTF's acclaimed research and position paper entitled The Patient, The Condition, The Treatment, released last September.

Another area where Kirby and friends move the debate forward is in the realm of roles and responsibilities. The committee astutely notes that when government plays the role of system funder, provider and evaluator, it finds itself in a blatant and unaccountable conflict of interest situation.

Regrettably the committee falls short - in listing its twenty guiding principles for reform - to adequately redress this problem. Modernizing the Canada Health Act (CHA) by changing the public administration principle to one of public governance would go a long way to minimizing this conflict.

Speaking of modernization, the only principle that should remain in the Act should be that of universality (encompassing elements of accessibility, portability and comprehensiveness). Then along with public governance, new principles of quality, choice, sustainability and accountability should be added.

The other area short-coming of the Kirby committee falls is that its solutions are focussed too much on supply-side, bureaucratic intervention. Yes, consistently refining if not overhauling production strategies and management structures is appropriate in both the private and public sectors, but when it comes to health care, we must also focus on the patient and demand side of the system.

For example, placing greater emphasis on patient pre-funding for - at a minimum - our primary care needs through health care savings allowances and accounts should be tried, with, of course, the appropriate measures to deal with low- and fixed-income situations along with pre-existing medical conditions. Other options for reform include testing the private and not-for-profit sectors and their capacity to build facilities, furnish equipment, etc.

On balance, while the Kirby committee's latest report is not as ambitious as previous volumes, it does pose tough public policy questions and offers up some outside the status quo box solutions. Dear Senators, please continue with your effort towards October.