By Tom Arnold

A major new report is harshly critical of Roy Romanow, head of the royal commission looking at the future of health care, calling him a prisoner of ideology who has avoided examining the best ideas to revolutionize the system

The Atlantic Institute for Market Studies’ research, billed as an alternative to this Thursday’s widely anticipated Romanow report, concludes that Canadians must take more responsibility for their health and pay more for services in a smaller, more competitive public system.

Entitled Definitely Not The Romanow Report, the study says what is needed is a blend of public and private medical services that are high-quality and cost-effective. It recommends:

– specialized, non-profit and for-profit clinics to deliver publicly funded services;

– medical savings accounts;

– an annual deductible of $325 to be paid by all citizens except those in the lowest income brackets;

– asking Canadians to rank in order of importance which health services should be publicly funded.

The report says it is providing an alternative to Mr. Romanow’s approach because it believes the former Saskatchewan premier “will do little or nothing” to deal with the fundamental challenges of Canadian health care.

“Many of Mr. Romanow’s concerns, far from focusing on making sure that Canadians get the best value from the health care dollar, are ideological and have little to do with the quality of care delivered within the public system,” concludes the report.

“He clings to a system that outlaws private spending on publicly insured services … while both objective and subjective international rankings show that a mix of public and private suppliers of health care services and multiple tiers of access are fully compatible with high-quality public systems.”

Brian Lee Crowley, lead author of the report and founding president of AIMS, added in an interview that Mr. Romanow is trying to set the terms for the public health care debate in Canada.

“I think he is excluding a lot of very important information and potential solutions to our health care problems, which need to be properly debated.”

The report, a copy of which was obtained by the National Post yesterday, says Mr.
Romanow is proposing a system that is “an old paternalistic one that has been overtaken by events, technology and rising public expectations. It suggests that bureaucrats know best which services should be available to each of us, how much they should cost and what are reasonable waiting times.”

The AIMS report is to be released today.

Last week, in his final speech before delivering his report, Roy Romanow offered his strongest-ever defence of publicly funded medicine and dismissed further private-sector participation, concluding it would “demolish” medicare.

He said that while Canada’s health care system is perhaps the best in the world, it needs more money and expanded publicly funded services, including home care and pharmacare.

“We are far less optimistic than he is about the sustainability of the system and why we think more money will only put off until later the real reforms that are needed,” Mr. Crowley added. “There is probably enough money in the system. We need to concentrate on getting better value for it.”

Don Mazankowski, the former deputy prime minister who led the Alberta Premier’s Advisory Council on Health, wrote in a preface to the 72-page AIMS report: “This report provides a refreshing insight into new approaches and alternatives that should be considered and evaluated by all policy makers and stakeholders.”

The AIMS report wants to concentrate funds on health services that provide the most benefit to Canadians, noting there are many other forms of spending that have a bigger impact on health outcomes than health care.

It also calls to keep the cost of publicly funded health care within certain bounds.
“Whatever the national budget can accommodate, the top priority of services, that’s what’s going to be insured,” Mr. Crowley said. “The system is driven by demand.”

The report says it wants to “end ideological preoccupation” with whether care is public or private, replacing it instead with a plan to focus on whether that care is high quality and cost-effective.

“In a world in which you can go to a surgical booth in Canada and be operated on by the best surgeon in the world, who may be at his office in London or Houston or Minneapolis, health care predicated on the notion of a closed national system in which people must take what public authorities decide they should have simply will not and cannot survive,” the report concludes.

The report also looks to “reward” Canadians for prudent use of the health care system, ensuring that they only consume health care services that represent a real benefit to them, still ensuring that no one is deprived of care on the basis of ability to pay.

The reports also states it wants to make Canadians more informed consumers of medicare, ensuring that the health outcomes achieved by all health care providers are audited and made public on a comparable basis.

HEALTH PLAN:

Definitely Not the Romanow Report is recommending to:

– Separate the functions of universal insurer, provider and evaluator of health care, making the public sector a neutral purchaser of publicly insured health care from all public and private providers;

– Introduce fee-for-service for hospitals;

– Debate a definition of “comprehensiveness” so that the public sector pools everyone’s
risk of sophisticated, expensive surgeries, or catastrophic coverage, leaving ordinary procedures, whose cost can be borne by the average person, supplemented by private insurance and subsidies for those on low incomes;

– Require governments and Canadians to determine what share of the gross domestic product be devoted to public health care. Publicly insured services would then be all the services Canadians give priority to, up to the cash limit imposed by the fixed GDP. All other services would be covered by individuals and private insurance;

– Ensure universal access to medically necessary pharmaceuticals in a separate plan.

tarnold@nationalpost.com