Thursday, December 5, 2002
Halifax Chronicle Herald, the Moncton Times & Transcript and the Calgary Herald

Canadians won’t buy Romanow’s performance

By: Brian Lee Crowley

Not since the days of Edgar Bergen and Charlie McCarthy has ventriloquism enjoyed such vogue. But at least Edgar and Charlie were good at it, and it was purely for entertainment.

The stakes riding on today’s high profile ventriloquism act are far higher: the future of Canada’s $70-billion public health care system. What does ventriloquism have to do with Roy Romanow’s Royal Commission report on medicare? Everything.

From the very first Mr. Romanow made it clear that the foundation on which all of his work would be built would be the values of Canadians. That’s powerful: not many politicians want to be seen to be ignoring Canadians’ deeply held views on a topic as important as health care. Thus the title of Mr. Romanow’s report: Building on Values.

He invoked the values of Canadians up front to make his recommendations invulnerable to criticism and caviling by politicians and interest groups. But for this gambit to succeed, the methods the commissioner used for arriving at a picture of Canadians’ values on health care must be beyond reproach. Yet his methods were flawed and unprofessional. The report is a thinly disguised attempt to make Mr. Romanow’s own values, and those of his narrow little coterie of experts and bureaucrats, pass for the values of Canadians generally. We are the dummy, and Mr. Romanow is the ventriloquist. He shouldn’t be allowed to get away with it.

If this analogy seems extreme, consider what Mr. Romanow and his colleagues did. They organized focus groups across the country to find out what people were thinking about where they’d like to see health care go in Canada.

What they heard from these focus groups was pretty much what Canadians have been telling pollsters for the last several years. Canadians are a down-to-earth, non-ideological, practical people. They’re interested in what works and they’re interested in real solutions to the growing evidence of the accelerating decline of the health care system.

So in response to questions from the Commission’s people, they indicated that they were open to a wide range of options that needed to be tried if they might improve things. They were open-minded about things like user fees, allowing more private sector involvement in health care provision, and allowing people to buy health care in circumstances where they’re not permitted to do so today.

But that didn’t square with the views of Mr. Romanow and his merry band. So they marched their focus groups into a room, and presented them with “expert opinion” to show these poor benighted citizens why the things they were willing to try were bad ideas that wouldn’t work, that would harm people’s health and be hard on the poor. They presented these views as established facts, rather than the highly contested arguments of an elite of health policy makers, an elite whose ideas have been responsible for bringing our health system into its current state of disrepair.

Unsurprisingly, on being presented with what seemed to be an objective and authoritative debunking of ideas that had seemed practical and worthy of trying, the members of Mr. Romanow’s focus groups timidly gave in to the views of the “experts”. But the irony is that there is lots of evidence in the academic and policy literature that the practical, common sense things that Canadians were prepared to look at actually do make a difference for the better. The only real flaw with these ideas is that they didn’t fit the inflexible and narrow ideology of Mr. Romanow’s colleagues.

Now anyone in the university polling world can tell you how to avoid such charges of bias in determining what people think about emotional topics like health care. For instance, a reputable arm’s length polling expert would never have allowed people from Mr. Romanow’s own commission to be closely involved in the testing of public opinion. The risk of influencing people to say what the client wants to hear are too great. But the commissioner’s own people did work directly with the focus group organizers. And those organizers were themselves not members of an objective polling group, but representatives of a public policy group closely tied to the people guiding the work of the Commission and identified with their views. This “research” would never have passed muster in a rigorous review by the best university experts.

So by using a flawed process riddled with conflicts of interest and unprofessional methods, Roy Romanow was able to make it look like Canadians were ruling out of court any experimentation with the health care status quo he and his advisors favour. But for someone who made such grand claims about basing his recommendations on hard evidence, the core of the commissioner’s report is nothing more than his own prejudices transformed by the ventriloquist’s art into Canadians’ most cherished values. Good thing we’re not the dummies he thinks we are.