Here’s the right way to reform health care

TheGlobeandMail.com – news/commentary/opinion
Published Tuesday, Apr. 19, 2011.   Michael Bliss

Everyone knows that action must be taken in the next few years to reform Canada’s health-care system. No one knows how to do it. As we are seeing, an election campaign is not the time to try to begin the discussion. Timid vote-seeking politicians are terrified of becoming off-side with public opinion, so they duck and weave and make impossible promises, and nothing happens.

What we ought to be doing is thinking about how to get a credible process in place that could lead to serious reform in the next electoral cycle. The government that emerges after May 2 should sponsor a major national inquiry into the future of Canadian health care and health insurance. That inquiry, in the form of a royal commission, would make recommendations that the government would use as the basis for a reform program that could become the central issue in the next election. With concrete proposals for change put in front of them, the voters could then decide yea or nay.

Canada has a tradition of making major reforms in public policy based on the recommendations of royal commissions, a tradition that goes as far back as the Rowell-Sirois Commission on federal-provincial relations in the late 1930s. It also includes the recommendations of the Royal Commission on Bilingualism and Biculturalism in the 1960s, the Carter Commission on taxation in the same decade, the Royal Commission on the Status of Women, the Macdonald Commission on the Economic Union (which, in 1985, laid the foundation for the free-trade initiative) and, most obviously, Emmett Hall’s Royal Commission on Health Services, which, in the 1960s, provided the fundamental approach that became Canadian medicare.

The overwhelming merit of a good royal commission is that it can supply governments and voters with well-thought-out policy recommendations. In recent decades, we’ve learned there are few other ways of generating major policy options. The tradition of looking to civil servants to develop policy pretty much ended more than a generation ago. And political parties have shown themselves to be quite incapable of stepping into the policy-making vacuum left behind by the extinction of the mandarins.

Neither our universities nor our think tanks seem to be able to command the broad basis of support to fill the void. Instead, they have a tendency to generate a cacophony of competing ideas, some good, some bad, but none with the heft and hope of swaying governments and voters that a distinguished, credible royal commission can command.

The peril is that the wrong kind of royal commission can waste millions of dollars and produce no useful recommendations. Many experts believe this is what happened a decade ago, when Roy Romanow’s Royal Commission on the Future of Health Care in Canada recommended little more than throwing more money at a system with which Mr. Romanow and his friends were basically content. Mr. Romanow had been neither neutral nor open-minded, and so a great opportunity was missed (even as Michael Kirby was generating a far more thoughtful study of the same subject, only to be undermined by the Senate’s lack of credibility).

As any physician realizes, the failure of one treatment is not a reason for giving up. We have to keep trying to come to grips with the health-care issue in ways that can lead to real national consensus. Otherwise, we doom ourselves to drift, incoherence, more demagoguery and an increase in both public apathy and anger. Just as the federal government, after widespread consultation, is able to make consistently good Supreme Court appointments and has given us the best qualified Governor-General in recent memory, we have to hope the politicians can again recognize the gravity of the challenge and do the right thing.

If our new government consults widely (especially with the provinces but also with stakeholders, think tanks and other experts), puts partisanship aside and thinks ahead to the medium and the long term (Liberal Leader Michael Ignatieff’s promise to address vastly complex care issues within 60 days is patently ridiculous), it could possibly launch another in the great series of national policy initiatives that, from time to time, have changed our country for the better.

What a splendid legacy that would be. At the least, it might cause us to have a serious discussion of serious issues the next time we’re asked to go to the polls.

Historian Michael Bliss’s most recent book is The Making of Modern Medicine.

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