One week ago today, Roy Romanow released the interim report from his one-may Royal Commission on the Future of Health Care in Canada. Entitled Shape the Future of Health Care, the report - found at www.healtcarecommission.ca - is long on platitudes and short on identifying the extremes or real choices and tradeoffs that will likely have to be made when it comes to reforming health care.

But in fairness to Mr. Romanow, this was by design. He had to walk a tightrope and not be seen to prejudge the forthcoming public consultation process. However, in a CPAC interview he may have tipped his hat when pressed by host Peter Van Dusen, Mr. Romanow said, "… to be frank with you what I have a hunch about right now is that it's probably a combination of more money which I think is inevitable given the costs of technology which is coming … to a flood of new change which is going to hit us, plus reorganization."

Yikes. If this is the conclusion, let's just pack up the boxes and save Canadians $15 million right now because the debate over the future of the system is actually much more than this simple view. In scanning over 1,000 newspaper stories from major national and regional daily newspapers (in both languages) in the last 16 months, it is clear that many sub-issues or themes will also punctuate Mr. Romanow's hearings. Here are just a few of them …

Canada Health Act (CHA): The relevance of the Act and its principles will continue to be questioned. Defenders of the current health care system use it as a shield to repel all who dare to suggest improvements or modernization. The CHA is also raised in the context of federal intrusion into the provincial constitutional jurisdiction of health care.

The U.S. system: While some political leaders continue to suggest that the only option to our system is the U.S. system, thankfully, editorial opinion and public opinion is eschewing this myopic view of our health care reform options.

CHST Funding: The provinces continue to demand full restoration of the CHST transfers cut by Ottawa in 1996. While they have made some progress in recent federal budgets, this is still a point of friction between Ottawa and the provinces.

Demographics: Boom, Bust and Echo is here, specifically the strain that a burgeoning seniors population will place on our health care system in the next quarter century has been hotly debated. Those who favour top-down bureaucratic tinkering strategies for health care reform minimize the impact that an ageing population will have on our system.

Others point to actuarial projections, current cost trends, increased use of expensive technological interventions and treatments along with future workforce projections to sound a more urgent alarm about demographic pressures in the near, medium and long-term.

Diseases: With the ageing population comes the progression of the diseases of ageing. Included in this group are heart disease, cancer (expected to afflict one in three Canadians in the next 20 years), Alzheimer's and other brain protein related ailments. As well advocacy groups for kidney patients and arthritis sufferers have garnered a fair amount of media coverage in the last year.

The other areas of disease that have captured public (or will continue to capture) attention include HIV/AIDS, hemorrhagic fevers and superbugs with their resistance to aggressive antibiotics therapy.

Drugs / Pharmacare: The wide-scale use of pharmaceuticals and its impact on provincial insurance plans is cause for concern. As well, the length of patent protection granted to international manufacturers of medications is an ongoing debate. The delay in Health Canada Health Protection Branch approval for new drugs is also troubling, especially for those diagnosed with terminal or debilitating chronic ailments. Alternative or homeopathic pharmaceuticals (the regulation of and access to) is an emerging issue. Finally, a variety of advocacy groups including seniors, low-income advocates and Canada's political left are relentless in their push for a national pharmacare plan.

Hospital Closures/Mergers: Hospital closures and shifting of service centres continue to make headlines in communities across Canada. Affected stakeholders agree with the need to integrate health services to meet community needs and better serve the local population, however, paternalism takes over and all argue for saving "their" hospital and instead closing the "other" facility down the street or on the other side of town.

Hospital/Health Authority Deficits: In 9 of 10 provinces (except Ontario), a regional health board/authority model is employed for coordinating and integrating resources for health services delivery to large urban or rural populations. In several provinces, some health authorities (and in Ontario, hospitals) continue to run operational deficits.

Human Resources: Demographics and international poaching of medical professionals is a real problem. All provinces are trying to grapple with this issue which is endemic from doctors to nurses to radiologists to gerontologists amongst others. Shortages of professionals in rural areas is even more disconcerting than the urban dynamic of this issue.

Other areas where you can expect to see the health care debate take shape include access to technology (MRIs, PET scanners, etc.), the ethical dimensions of genetic research advancements, simply funding research will also be a hot issue along with shortages for organ transplants, the need for home care services and alternate-level-of-care beds, the never-ending push for primary care reform and international comparisons of best medical practices.

Suffice it to say it will be a complex and heated debate which must result in more than a simple - and dare I say irresponsible - conclusion that it is merely a matter of more dollars and some top-down reorganization.