Q&A

‘LONG-DISTANCE HOLLERING’

A ‘puzzled’ former premier lashes out at a dysfunctional political system

ROY ROMANOW October 27 2003
Q&A

‘LONG-DISTANCE HOLLERING’

A ‘puzzled’ former premier lashes out at a dysfunctional political system

ROY ROMANOW October 27 2003

‘LONG-DISTANCE HOLLERING’

Q&A

A ‘puzzled’ former premier lashes out at a dysfunctional political system

ROY ROMANOW

NEXT MONTH, it will be a year since former Saskatchewan premier Roy Romanow released his blueprint to address the well-documented shortcomings in Canada’s healthcare system. His 47 costed recommendations were aimed at making the system more effective and more accountable. Romanow’s report, 18 months in the making, spoke of an urgent need for funds to improve access to diagnostic equipment, home care and other services. What has happened to it since then? On the plus side, it just earned Romanow the 35-nation Pan American Health Organization’s award for public administration. But as for implementationnothing. There’s not even a hint that the first step—establishing a Health Council of Canada to broker consensus among Ottawa, the provinces and health providers on health reform—is about to take shape. Now a senior fellow in the department of political studies at the Universities of Saskatchewan and Regina, Romanow discussed his frustration over the lack of action with Assistant Managing Editor Robert Marshall.

Surely three decades in provincial politics, including 10 years as premier, taught you that the decision-making process takes time in our cumbersome federal system. Was there ever a period when you thought your commission could push the right buttons, and real reform would take place promptly? Yeah. It was actually dominant in my thinking, because it was obvious to me that reform of the system could be done. But then you watch the debate going on here, and voices that still persist in saying, “You have to have more competition and more choice, and that’s the world of today.” Maybe so. That’s a legitimate point of view. But I didn’t find that in the hearts of Canadians. There are moments of discouragement, all right, but I had a lot of hope, because this report was tabled with solid public support for the recommendations. That’s not to say they read it, but they understood the major themes and thrusts through the press. And it still has the support of about 70 per cent favouring the Health Council of Canada, for example. It’s just such a big puzzle to know why governments that have been given a national report backed by the voice of Canadians wouldn’t say, “Hey, this looks like a clear run for the goal line, let’s go for it.”

You’d think it would have helped that, in federal-provincial politics, it’s hard to find a better-based relationship than the one you’ve had with the Prime Minister.

Well, that was one relationship, and I don’t want to blow my own horn, but I even have a very good relationship with those premiers who would differ. Ralph Klein and I probably would have some differences on health care, but this is a man who tries very hard to have a very good health-care system for his province. I knew a lot of the players, and that was good. What really pleasantly surprised me was the tremendous turnout in Quebec. We had overflows in Montreal and in Quebec City. We started at 7:30 in the morning and it lasted until 9 in the evening—and we still couldn’t accommodate all the people. So it made it really a truly national exercise. I don’t want to overstate the importance of the report— there are things I wish I would have changed, and there are some people who have some legitimate criticisms of it—but I think it landed on the desk of governments with good evidence, plus the support of the Canadian public.

We know the problems in health care. In many cases we know the solutions. What are the obstacles to putting them in place?

There are many obstacles, but start with the federal system of government we have. Health care in all its manifestations—from population health right to acute care—is primarily a provincial responsibility but involves a high level of federal support, financially and legislatively through things such as the Canada Health Act. Over the years we have provided our health care in kind of individual silos—doctors do their job, nurses do their job, the acute-care system is or isn’t plugged into the population health issues, and so forth. The system has become more integrated in recent years. Now the fundamental necessity is to develop mechanisms that will do more to perfect an integrated set of policies. And to do so urgently, given the fact that illness and disease know no boundaries, particularly in today’s globalized world. And that is the big challenge. All it takes is for people to look around in terms of the debate about the Health Council of Canada. That was the purpose behind it—to attempt to get a mechanism for a common meeting place, at least to find common standards, measure outcomes, pursue issues of primary health-care reform and the like. That we can’t even get that established yet is a big indicator of what the problem really is here.

You’re painting a picture of a dysfunctional political system.

SARS was a huge wake-up call, and now we’ve got to act on it—and it looks like we’re going to be acting on it. The question is whether we’ll let the chance for broader reform slip away.

So you’re seeing a tremendous amount of support for the idea of a health council?

As I’ve already said, it is a huge puzzle. I’m puzzled greatly that in a democracy where there is a consistently strong feeling for this kind of reform—the national health council plus other aspects of reform that were set out in my report—somehow the political people whose job it is to respond to these wishes have been unwilling and/or unable to do so. I just don’t know why the leadership has not been forthcoming to break through, to punch through, and to get some of these things established. Because this process is going to take quite some time. It’s not going to be easily solved overnight with one bill, or one body, or one set of funding rules. It’s going to take a purposeful leadership role to effect change quickly.

Just the establishment of a national health council won’t in itself bring improvement overnight.

No, but consider two important things. It would be a demonstration to Canadians that all the participants are prepared to cooperate and put a little water in their wine. Plus, it would greatly improve the current system, which is long-distance hollering.

Do you think the delay’s because of the interregnum in Ottawa, and the distraction of eight provincial elections this year?

That is one possible explanation. Emmett Hall tabled his report on health care for Mike Pearson in 1964, and it took a full seven years before it was implemented nationwide. But now I worry that time may be the enemy. The nature of the delivery of health care has changed dramatically since those last big reforms. At that time, health care was basically thought to be hospitals and doctors; in fact, those are still the only things covered under our publicly insured system. Today,

there is such a proliferation of new technology. It’s the age of biology and new medications and pharmaceuticals, the Internet, globalization, travel—as we saw with the SARS outbreak—and the like. Canadians have gone through a decade of sustained cuts to health care. They’ve put up with long waiting lists, long delays, and no reforms— and they’re still giving it time, still hoping there’s going to be action. Yet at some point, they’re going to ask, “Well, what’s the sense?” And then the public health program will be very much in jeopardy. lifl