Ralph Klein has gone and it is time to retire Ralph's World. Thanks to all of you who have supported this venture by contributing material and through your comments. It has been fun.

Should we get another blog underway? Let me know your thoughts by e-mailing me at johnnyslow@gmail.com.

John Slow
January 1, 2007

Sunday, May 30, 2004

Three Choices for the Future of Medicare 

A colleague who has worked many years in the health field said to me the other day.
"If you want to get a clear understanding of how our provincial and federal governments are determining the future of medicare for us, read this paper. It's not very long, it's very readable, and it was written by someone who has attended most of the first minister's discussions on healthcare. He's a sort of fly on the wall with brains."

The fly on the wall is Gregory P. Marchildon. The title of his paper is Three Choices for the Future of Medicare and you can get it by clicking here. (You will need the Adobe Acrobat Reader.) He is a professor of public administration at the University of Regina and was Executive Director of the Romanow Commission.

Here are some quotes from his paper which may tweak your interest.

"Deep down, they [Canadians] know that unless their governments arrive at a workable consensus for change, the Canadian brand of medicare is not likely to survive for long."

"From this position, I observed how health care eventually became hostage to a crass struggle over money and power and, at critical points, a much more profound clash between contending visions of the country."

"The solution to the ‘sustainability problem’offered by the opponents of medicare - that of shifting costs from the public purse to private pockets is simple but illusory from an economic policy standpoint [Evans 2004]. It is also highly inequitable from a social policy standpoint. And it is neither bold nor innovative – ‘out of the box’ – thinking since it generally involves old nostrums such as user fees , co-payments and health premiums (occasionally dressed up in modern garb such as medical saving accounts) that were the norm prior to the introduction of universal medicare."

and finally . . .

"Medicare is too important to continue to be held ransom by both orders of government in an increasingly sterile debate over fiscal transfers. For most Canadians, medicare is an integral part of their citizenship and identity. They want their First Ministers to quit playing the blame game and instead to work at improving medicare on the ground, including reducing waiting times and improving the quality of care. At the same time, they want both orders of government to come up with a common game plan that will address growing costs and ensure the sustainability of medicare for the future. Most want the principle of ‘access based on need’ preserved.

For a vocal minority, however, nothing less than greater privatization and decentralization, attractively dressed up as patient choice, is required to fix medicare in Canada. Though well financed, visible and powerful, we should always remember that this view is a minority view, and should not be allowed to dictate what the majority of Canadians actually want for themselves and future generations."

This paper is all about politics, money, power, and idealogy. Sorry, no sex.

Have a read.

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