 
Romanow takes up churches’ call for Health Charter
KAIROS analysis of the Romanow Report
Date
NOTE: The full text of the Romanow Report can be found at:
http://www.hc-sc.gc.ca/english/care/romanow/index.html
The first recommendation in Roy Romanow’s “Report on
the Future of Health Care in Canada” is that “a new
Canadian Health Covenant be established as a common declaration
of Canadian’s and their governments’ commitment to a
universally accessible, publicly funded health care system.”
This reflects the churches’ suggestion that our health care
policy be informed by a clear statement of the values which shape
how we care for each other.
Romanow himself acknowledged the influential and helpful input
he received from faith-based groups, input that was animated in
large part by the eighteen workshops on the future of the Canadian
health care system organized by KAIROS and the Faith and the Common
Good Project.
There were a number of other significant recommendations. Recognising
that health care is increasingly delivered outside of a hospital
setting, Romanow endorses an expansion of the medicare system to
include home care and pharma care. He also makes a compelling case
for rejecting privatization and for-profit—or two-tier—health
care, and sets out a number of recommendations that would help to
reverse this dangerous trend. In particular, he calls for an increase
in federal health care funding, that if heeded, would strengthen
the government’s ability to ensure provincial accountability
for and adherence to the principles of the Canada Health Act (accessibility,
universality, portability, comprehensiveness and public administration).
The Report addresses the impact of trade agreements on Canada’s
health care system and devoted a whole chapter to a discussion of
health care and globalization. Romanow notes that current exemptions
for public (social) services under the North American Free Trade
Agreement (NAFTA) are ambiguous (p. 236 & 237) but concludes
that our present medicare system is likely safe from challenge under
existing trade rules. He does, however, warn that problems could
arise if the system expands into new areas or if American-owned
private clinics and hospitals are permitted to set up here.
While the discussion of the trade- related health issues in the
Report is quite good, the recommendations are weak. Among those
recommendations is the proposition that governments prevent potential
challenges to Canada's health care system by ensuring that any future
reform is protected in any trade agreement under the definition
of ‘public services’. He further suggests that Canada
vigorously advocate its position that the right to regulate health
care services not be subject to compensation claims from foreign-based
firms. (p. 241)
This begs the need to change fundamentally the most problematic
parts of trade agreements, particularly the Chapter 11 provisions
in NAFTA that give foreign corporations the right to be treated
by national governments in the same manner as domestic firms and
the right to sue those governments for damages where they feel they
have been discriminated against. These provisions would include
such measures as the introduction of legislation banning environmentally
hazardous chemical or disallowing ‘for-profit’ hospitals.
Romanow notes that “there are very few foreign-based companies
directly involved now in delivering health care services in Canada.”
(p. 238) However, instead of arguing that trade agreements constrain
us, he suggests that if we choose to expand the range of services
in the public system, this should be done now, while the foreign
presence in health care is relatively minimal. He cautions against
opening up the delivery of for-profit medical services which might
be be difficult to reverse should we discover, down the road, that
they are less more costly and/or of a lower quality. (p. 238)
The Report recommends that Canada build alliances with other countries
in the World Trade Organization (WTO) to ensure that future trade
agreements on intellectual property and labour standards make explicit
allowance for public health care. (p. 241) However, it appears naive
to suggest that such an allowance would protect public health care,
since the over-riding framework of these agreements is deregulation
and market liberalization. It is also naïve to expect that
Canada's restating her position at trade tribunals will make any
meaningful difference.
The analysis in the report should have led to specific recommendations
for:
- reducing the years of patent protection for pharmaceuticals.
- removing Chapter 11 from NAFTA and stopping negotiations of
the FTAA, whose requirements would compromise public health care
further.
The churches had hoped that Romanow would address the social and
environmental determinants of health, such as eliminating poverty,
ensuring affordable housing and reducing air pollution. Addressing
such may have a much greater impact on improving population health
than would additional medical technology or new drugs. However,
the report did not make any significant reference to these issues.
On balance, there is no question that. Romanow offers a practical
but values-based blueprint for renewing Canada’s health care
system. Nevertheless, continuing pressure from Canadians is needed
to persuade political leaders to act on his recommendations.
To this end, KAIROS and the Ecumenical Health Care Coalition have
requested meetings with Prime Minster Chretien and Health Minister
McClellan and are planning to meet with regional church leaders
and health activists to urge them to press for meetings with their
provincial governments. Also planned are education and action resources
that support local efforts to push for the implementation of the
Report’s recommendations. Finally, KAIROS’s participation
in the “No
to the FTAA: It’s Hazardous to Your Health!” Campaign
centers on the impact of trade agreements on Canada’s public
health care system.
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