From an irate teenager's cry that “corporate health care sucks” to squabbles between consumer groups and the pharmaceutical industry, usually staid Ottawa was uncharacteristically impassioned during Roy Romanow's eighth public consultation on the future of medicare in Canada in April.
Despite the crazy-quilt nature of the consortium of 29 speakers and groups that appeared — feminists, coalitions, unions, nurses, physicians, an industry association, First Nations — all delivered the same basic message to Romanow's one-man commission: We don't want privatization.
Why? The Canadian Public Health Association (CPHA), Assembly of First Nations, the National Council of Women and the Canadian Labour Congress (CLC) all said that it would exacerbate poverty and further diminish access while increasing inequity. Paying for health care privately would also be more expensive than a private system because of the need to turn a profit, said the CLC's Nancy Riche. “If we can't afford to pay publicly, we can't afford it privately either.”
The Canadian Health Coalition's (CHC) Shirley Douglas commented: “There's an $82-billion golden egg that politicians are willing to hand over. That's not what we fought for all these years.” Douglas says private industries don't come to Canada to help. “They come to make a profit. Privatization is more expensive in every way.”
Many groups, including the CPHA, advocated for stable funding; the CHC wants a 50–50, federal–provincial split. “The provinces are running amok right now,” said Douglas, whose impassioned speech earned her a standing ovation.
The other crowd pleaser was 16-year-old Allison Miller, who adamantly opposes privatization and urged Romanow to “stop talking about medicare and do something. We think corporate health care sucks.”
The pharmaceutical industry also supported medicare, although the primary messages contained hints of self-interest: the generic drug manufacturers want access to a bigger piece of the pharmaceutical pie, while the research-based companies want a national pharmacare program.
After establishing that privatization is not welcome in Canada, Romanow asked many presenters 2 questions:
· How far should coverage be extended?
· How do you define core or essential services?
No one seemed to have any clear idea of where to draw the line on coverage. Union groups and various coalitions want a national home care program, and some also want pharmacare coverage. But the Royal College of Physicians and Surgeons of Canada sounded a note of caution. “What technology can provide may go beyond what any country can pay for,” said President Bernard Langer.
There were a couple of proposals to stop the bickering between Ottawa and the provinces. The National Council of Women proposed a dispute-resolution or avoidance mechanism, although the CLC fears it could endanger the Canadian Health Act.
The CMA, on the other hand, proposed a new Canadian Health Charter to define the rights and responsibilities of patients, health care professionals and governments, and Romanow said it had a “lot of merit.” CMA President Henry Haddad said the charter would “reaffirm the basic social contract that is medicare” and define the roles of various governments and set national standards.
Some speakers had narrower goals. Retired rural physician Denise Bowes urged Romanow to consider more preventive measures to save money — and possibly the system. She also demanded that the fast-food industry bear an additional health tax, accusing it of causing an epidemic of obesity and diabetes.
Romanow's final report isn't due until November, but it's already clear that a lot of people want to talk to him. In Ottawa the demand to speak was so strong another hearing had to be added. — Barbara Sibbald, CMAJ
Figure. The Raging Grannies are among the groups delivering messages during Roy Romanow's cross-country crusade. Photo by: Canapress