At a time when our health-care system desperately needs a crash cart of
new ideas, yesterday's Romanow report mostly offers reheated leftovers
from the hospital cafeteria of past health-care reports.

To be fair, Romanow correctly identified the key themes of leadership,
governance, responsiveness, quality and strategic investments as
necessary elements integral to achieve meaningful health-care reform.
But his choice of policy instruments - most of them requiring more
central planning and an even larger health-care bureaucracy - to
implement his reforms is misguided and costly.

Of the commission's 47 specific recommendations, 20 are symbolic
declarations, 22 breed more bureaucracy, four require legislative change
and one deals with the financial fallout to deal with the other 46.

So what will all this new bureaucracy, targeted funds and increased cash
for the provinces cost? The short answer is $8.5 billion over the next
two years and a minimum of $6.5 billion - likely to be indexed for
inflation and population growth - starting in 2005/2006 and every year
thereafter. The Royal Commission is eerily quiet on where these funds
can be found and/or how they should be raised.

Adding a sixth principle of accountability to the Canada Health Act, is
long overdue but establishing a national Health Council to facilitate
accountability merely duplicates existing federal and provincial
reporting efforts (which continue to improve year after year). Moreover,
while health care is a national issue, needs vary widely in different
regions and one size does not fit all. Look for the provinces to be very
suspicious of the overarching theme of federal encroachment which is
rampant throughout Romanow's report.

Reworking the existing cash and tax-point Canada Health and Social
Transfer (CHST) into a direct cash-only federal transfer to the
provinces will all but eliminate federal-provincial squabbling over who
pays what and help taxpayers follow their money and see how it is spent.

A huge disappointment is found in Mr. Romanow's introductory Message to
Canadians where he addresses the public vs. private debate. In effect,
he relegates the private sector role in health care to dishwashing,
corridor maintenance, laundry services and food preparation. Not only is
this ideologically intransigent, it is also intellectually dishonest for
later in his report he trumpets telehealth, technological innovation and
other science driven advancements as part of his vision of future health
care. Who does he think will deliver these new technologies,
next-generation medicines and miniaturized diagnostic tools? The private
sector of course.

If the federal government plans to follow through on Romanow's work, two
basic options are available to finance this $6.5 billion tab. Option one
would require reallocation within existing federal budget envelopes and
potential elimination of business subsidy schemes, regional development
programs, discretionary HRDC and Canadian Heritage funding or heaven
forbid, further evisceration of our armed forces. Given the government's
past financial performance, it is axiomatic that this option of making
hard choices will not be followed.

Which leaves option number two, raising new revenues by keeping our tax
levels artificially high and pilfering the surplus of over-taxation -
Mr. Romanow's preferred course of action - and/or hiking taxes.
Coincidentally, or perhaps by design, it should be observed that hiking
the GST, either directly or under the guise of a dedicated health care
levy, from 7% to 8.5% would net a cool $6.8 billion in 2005/2006. But
Finance Minister Manley has already pledged to jump off the peace tower
before raising the GST.

So are Canadians to assume that all of the anticipated surpluses of
over-taxation predicted this past October for the next five years will
be used to implement Mr. Romanow's suggestions? And if so, then how will
the rest of Ottawa's ambitious and interventionist Throne Speech
commitments -- in aboriginal policy, urban regions, Kyoto commitments,
to name but a few -- be financed?

This dilemma is complicated even further. The royal commission ignored
the multi-billion dollar capital needs (read: bricks and mortar) for new
hospitals, long-term care homes and other chronic care facilities. In
Ontario alone, the annual capital needs of the health care sector
eclipse the province's entire capital budget. It is safe to assume that
this situation exists in all provinces.

Of course the answer to meet these needs is though public-private
partnerships and other private finance initiatives. Sadly, on this
point, Mr. Romanow expresses caution when courage and commitment are
needed.

On the down side, the Canada Heath Act is still in need of further
modernization. Public administration should be changed to public
governance, and new principles of quality, choice, and sustainability
were not recommended.

Fortunately, Canadians are preoccupied with universal access to timely
and quality medical services, they don't care who delivers them, as long
as their health outcomes are improved. And while Romanow is strident in
his swipes at the private sector, he is mute when it comes to recent
double-digit union wage settlements in health care, which constitute
extreme profit taking by organized labour for its members at the expense
of patient care.

Herein lies the real challenge for the federal government. Romanow
refused to explore generational pre-funding for health care. And his
ideological intransigence toward the private sector forestalls any
debate about finding the appropriate balance between the public, private
and not-for-profit sectors in health care ... something every other OECD
country has had the courage to tackle.

The federal government has proven itself incapable of reallocating
expenditures within existing budget envelopes. Equally problematic for
the Prime Minister is his - and that of Mr. Manley as well - stated
desires to avoid any tax increases. Finally, Ottawa's burgeoning surplus
revenues are already committed to various Throne Speech initiatives.
This isn't ideology, it is simple arithmetic; our health care future
doesn't add up.

So for $15 million, Canadian taxpayers effectively paid $27,332 for each
day of the commission's work or $42,857 for each page ($38,168 per page
if you read it in French) of the commission's report which the federal
government really cannot implement. Is this the best that we can do when
it comes to the nation's most pressing public policy issue?