Needful things

Issue: BCMJ, vol. 45, No. 2, March 2003, Page 66 Editorials

I remember speaking with the former editor-in-chief of the New England Journal of Medicine just prior to her presentation to the assemblage at the BCMA’s Centenary Congress in Victoria on 1 July 2000. Dr Marcia Angell professed to be a long-time admirer of Canada’s publicly funded medical system. As she had been identified as one of America’s 10 most influential people by Time magazine the previous year, her opinion carried some weight. Dr Angell recognized that there were significant problems with the Canadian system, but she felt they were economic and easily solved by Canada’s federal politicians. She stated that all that was needed was a commitment by Ottawa to fund the system to a level that allowed it to fulfill the promise of the Canada Health Act.

When I politely asked how much she thought the contribution should be, she replied, “whatever it needs.”

I have thought about her statement frequently since that brief encounter and wondered how we could figure out how much tax money Canadians need to dedicate to their health care system to satisfy what appears to be, potentially, a “need” of infinite size. 

Well, we now have the Romanow report, which, after a number of extremely expensive fact-finding years, managed to adroitly provide us all with the expected ideologically driven preamble. However, much more importantly, Mr Romanow’s report has delivered a set of conclusions that has enabled economists to place a price tag on the survival of medicare.

Apparently, if all the components of the Romanow report are instituted, it will cost us all approximately $26 billion in additional funds over the next 5 years. An enormous amount of money by anyone’s standards, but it’s nice that someone has finally put a price tag on something that most Canadians seem to feel makes them different from their neighbors to the south. 

There are a number of “motherhood” recommendations in the Romanow report and, as with most politically driven reports, the specifics of implementation are left to our imaginations. However, the obvious problem areas in the Romanow report were identified by political writers and pundits across the country, as follows:

• The dollar value of Mr Romanow’s identified level of funding “need” was obviously well beyond the comfort level of Ottawa’s bean counters

• The requirement that the money have federal strings attached to it so a proper federal monitoring of distribution could be guaranteed would be anathema to the “have provinces” (BC, Alberta, Ontario, and Quebec have already said something like, “in a pig’s eye”)

• The guarantee of ongoing adequate funding by the federal government is particularly unappealing to the Treasury Board

So, however all this shakes out, Mr Romanow attempted to provide us all with a dollar definition of “medical need,” for which we should all thank him. However, the more I think about our population’s infinitely variable medical needs, the more it becomes clear that there is no realistic way to satisfy something that appears to be insatiable. If we continue to fund all that is “needed” in health care, this fiscal black hole will bankrupt us. Instead of what is needed, we have to determine what is essential.

Governments, both federal and provincial, should selectively filter out the useful, easy-to-implement recommendations from Mr Romanow’s report, adequately fund what is necessary, discard the ideologically driven premise, and move quickly to update the Canada Health Act. These things should be done as rapidly as possible to ensure Canadians can once again trust that their health care system will be there to care for them whenever necessary.


James A. Wilson, MD. Needful things. BCMJ, Vol. 45, No. 2, March, 2003, Page(s) 66 - Editorials.

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