Yesterday, the Standing Senate Committee on Social Affairs, Science and Technology (aka: the Kirby committee) released its final report on health care reform entitled Volume 6: Recommendations for Reform. Senator Kirby and his colleagues (including local Senators Wilbert Keon and Marjorie LeBreton) have now completed a two-year review of our health care system.

Next month Roy Romanow will release his Royal Commission report on health care. Yours truly is willing to bet that the Kirby Committee's six volumes will stack up very well against the Romanow report in terms of scope, costing, and feasibility. And the effort from our Senators will have been delivered at a fraction of the cost of Mr. Romanow's $15 million pricetag.

To be fair, the Kirby committee is bang-on in stating that our health care system as presently structured is not fiscally sustainable. On this issue, Roy Romanow is way offside. Sadly, many of the Kirby Committee proposals simply perpetuate the present system and - to use the committee's words - do not "buy change."

For example, proposals for a National Health Care Commissioner and National Health Care Council while well intentioned are misguided. One of problems in health care now is over governance; we have too many competing oversight bodies providing no accountability to taxpayers. Yes we need our Auditors General - both provincial and federal - to report annually to taxpayers, but this can be done within existing, if not, streamlined governance structures.

Moreover, Senator Kirby and his colleagues backed away from advocating substantive changes to the Canada Health Act. The current principle of public administration (which relates only to funding, not service delivery) must give way to public governance, universality must be clarified and new principles of quality, choice, accountability and sustainability must be built into the act.

Proposing that regional health authorities should be able to choose between providers - individual and institutional - in contracting for services based on price and quality is welcome. A system of managed competition where public, private and community-based providers must compete for funding is long overdue.

Another recommendation from Kirby is to designate maximum waiting times for medical procedures. This acknowledges the painful reality of waiting lists, which our politicians have wilfully discounted for over a decade. However, this "health care guarantee" drops us into the classic wage and price control dilemma where setting a price ceiling ensures that it becomes a price floor. Why deliver a surgical procedure in four weeks when you don't get penalized until week eight?

Our esteemed Senators are to be commended for sub-dividing home care into component parts. I support their suggestion of extending EI benefits - or some form of assistance - to family members caring for terminally ill individuals in their final weeks. But the costs of this worthy initiative must be borne mostly through reallocation.

Tightening of EI eligibility, diverting funds from failed retraining programs and charging higher premiums to repeat EI users should finance the costs of compensating individuals for lost wages when caring for a dying family member.

Another area for praise is Kirby's identification of critical health care infrastructure shortages. We come close to third-world standards in access to diagnostic imaging technology and our crumbling hospital facilities have been given scant attention in the health care debate. But these needs are best met through public-private financing initiatives; an issue on which Kirby remains silent.

So how much will it all cost? Brace yourself: An extra $5 billion per year, funded by either hiking the GST or a instituting a national system of health care premiums. Of course yours truly is opposed to both ideas. As long as the feds continue to blow $4 billion annually on failed corporate welfare and regional development schemes along with $13 billion in discretionary grants and subsidies, tax hikes, even for health care, are out of the question.

Financing present and future health care needs should be met through reallocation from existing budget envelopes. Now if only we could find someone with the political will to make these tough, but necessary choices.