Last week, former Saskatchewan Premier Roy Romanow was appointed to head a one-man Royal Commission to examine the future of Medicare. While reports varied on his thoughts concerning the five principles of the Canada Health Act, suffice it to say, like Jean Chretien, he is wedded to the status quo.

Well, if Mr. Romanow believes that the Canada Health Act (the Act) does not need modernization, he should just say so, deliver a quick one-page report, bill us for a day or two of work at his $750 per diem and save us the $15 million his Commission is budgeted to spend.

Just to recap, the five principles of the Act are universality, public administration, portability, comprehensiveness and accessibility.
But it should be noted that these principles only apply to hospital-based and physician services.

But with more health expenditures being consumed outside of hospitals (at 32.8% in 2000 down from 45% in 1975, according to the Canadian Institute for Health Information), the applicability of the Act is limited.

With the possible exception for the principle of universality, the rest of them are violated each and every day all across Canada. From private MRI clinics operating in four provinces to the federal Health Minister's cowardly inability to enforce parity in inter-provincial billing schedules, it is clear the Act does not work in many instances.

Shortly after Labour Day, the Canadian Taxpayers Federation (CTF) will release a comprehensive and ambitious analysis of our health care system. From its history to its problems to potential solutions, the CTF will leave no stone unturned in its search for positive prescriptions for a system that is truly in crisis!

If spending continues apace (even with 3% annual revenue growth), health care will consume the entire provincial budget in Manitoba by 2018, New Brunswick by 2025, Nova Scotia by 2027, Alberta by 2031 and Ontario by 2033.

Worse still are the human resource issues. Nationally, the average age of our nurses is 44 and the average age of physicians in Ontario is 50. In just a few years, these professions, not only in rural areas but also in cities, will drastically underserve Canadians. And we can't fill medical or nursing schools fast enough to fill these gaps. Nor will immigration meet this entire need.

All along, the advocates of status quo Medicare (Mr. Romanow being one of them) have stood by the Act as if it were a sacred icon and told Canadians that more money and better management will restore the system. If you think this is a sweeping generalization, wait for the Fyke Medicare Review report, due out of Saskatchewan tomorrow. Bet ya' the farm that it recommends more money and new management all within the confines of the existing Canada Health Act.

But Canadians have already dismissed this approach. An Ipsos-Reid/Canadian Medical Association poll last year found that only 47% of Canadians were confident lasting solutions to Canada's healthcare challenges could be found. Another 42% said things would get worse and 11% noted that "there are no lasting solutions to the challenges facing" our health care system.

Mr. Romanow should consider the modernization of the Act as one of his key priorities. Universality is a core principle, but new principles of public governance, accountability, quality, choice and intergenerational sustainability are warranted and long overdue.

In the coming months the CTF will lay out the clear facts on health care in order to give taxpayers a voice in this pivotal debate and ensure that our politicians listen to and act upon our wishes. Indeed, this would be a welcome change. So Mr. Romanow, EVERYTHING is on the table. With this caveat, please carry on -