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Finally, the Federal government believes that relying on the status quo is not a feasible option and have committed to investing money to stabilize the system in the short-term by enduring change in the long-term. The Provincial governments have similar objectives as the national government, yet they do not have the same unified vision in the successful reformation. To generalize, the Provinces are not interested in conceding control and sovereignty to the Federal government in order to achieve the goal of health care reformation.

Thus, on the Federal level there is the hidden agenda of helping reunify provinces and the ‘Canadian identity’. While on the Provincial level, they simply desire additional funding and support from the Federal government to improve on individual progress in order to meet the needs of constituents, despite the potential lack of equality and solidarity. From a non-governmental standpoint, there are many interest groups that are lobbying to promote various dimensions of the health care system. One specific example of a lobbyist advocating against the public system and a more privatized option is Pierre Lemieux.

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Before becoming an MP in 2006, he believed those who opposed the idea of some individuals being allowed to use money to purchase better health care and instead preferred everybody have less, provided equal care, are foolish[22]. He went further and claimed that while pursuing the highest moral standard of equality for the health care system we are inherently sacrificing individual liberty and property rights[23]. Yet, for every group or individual who is lobbying against public health care there are an equal number that are lobbying for an egalitarian system for all Canadians coast to coast.

Thus, this is an extremely broad and well excavated issue that is addressed from all sides. From the most individualistic standpoint, nearly two thirds (61%) of Canadians ages 12 and older said, “their overall health and satisfaction with the concept of a publicly funded system was very good”[24]. Furthermore, 78% of Canadian said that they have visited a family doctor in the last year, which demonstrates that a majority of Canadians utilize the service provided[25].

Thus, all Canadians are directly affected by any decisions and modifications made to the current system, and is in everyone’s interest to ensure that system is updated to meet current and future needs of the aging Canadian population. It is important to acknowledge the transition at this point in the report from dealing with broad issues pertaining to the health care system to more specific issues of reformation taken half way through the first decade of millennium. At the turn of the century the Canadian health care system was at a crossroads as reformation was needed.

The options included: continue, in post-modernist fashion, to use dialogue and roundtable discussions in cities across Canada to determine the problems and solutions for health care; absolve the governments responsibility for Medicare, whereby relegating their position to merely fund givers, which would have enables provinces to chart their own course and individually determine areas of problem and improve them as they see fit; continue on with the status quo and do nothing; move to a two-tier system, which would have allowed for private support for the ailing system, permitting the free market and other alternative pressures to define the future direction of the health care system.

As a final option the federal government commissioned Roy Romonov to compile a report outlining the future of the health care system in Canada. After analyzing all of the reformation options, the most feasible option was to follow the Romonov Report in order to ensure the future of the health care system was modeled after the egalitarian system that helped define and unify Canadians for decades. Much of the early attention was paid to the recommendations with respect to the financing of health care in Canada and especially transfers from the federal government to provincial and territorial governments[26].

The report set the stage for another round of federal-provincial/territorial bargaining leading to a significant agreement in September 2004 whereby the Government of Canada agreed to transfer an additional $41 billion over the next 10 years in support of Romonov’s action plan[27]. The report outlined 42 recommendations proposing sweeping changes to ensure the long-term sustainability of Canada’s health care system. One of the recommendations called for the creation of the Health Council (HC) to foster accountability and transparency by assessing progress in improving the quality, effectiveness and sustainability of the health care system[28].

Under the most prevalent goals of the Health Covenant, the objectives of universality, equity, solidarity, responsiveness, efficiency, accountability and transparency, were used to restore Canadian faith in the system and the system itself[29]. As a subset of the Health Covenant, the HC’s primary objective is to establish indicators to measure the performance of the health care system and establish benchmarks in order to improve quality, access and outcomes[30]. Thus, by properly utilizing this system the HC allows the Federal government, with support from the Provinces, to determine how serious the erosion of the health care system is in Canada.

Furthermore, the HC does not strictly evaluate the system itself, but rather evaluates the mechanisms that facilitate the operation of the system, such as dysfunctional intergovernmental relations and lack of mechanism for public input[31]. The HC was created by the provinces, excluding Alberta and Quebec, the territories and the federal governments and functions as a regime which operates not-for-profit at arm’s length from government[32]. While the council officially reports to its members – the health ministers of the participating jurisdictions – it provides an independent assessment of health care renewal in Canada. The HC acts as the middle man between the Canadian government and its citizenry. It monitors and reports governments’ progress in meeting their commitments to health care renewal agreed in 2004[33].

The HC is composed of: 3 representatives from the public, 4 representative of the provider and expert community, 7 governmental appointees (1 appointed by consensus by the Territories, 1 appointed from the Western Provinces, 1 appointed by Ontario and 1 from Quebec, 1 appointed by the Atlantic Provinces and 2 from the Federal government), summing a total of 14 members[34]. These representatives are accountable to the public through reports to both the provincial and federal health ministers and in an Annual Performance Reports. These are designed to determine the net result of the year’s reformation efforts[35]. Finally, 10 million was set aside to fund the operation of the council[36]. Since the release of Romonov’s Report, there have been many challenges to the creation of the HC.

The most prevalent issue is the transformation of the Romonov concept of a 14-member board existing at arms length, to a 27-member board consisting of a chairperson, 13 members from inside various levels of government and 13 from outside. This change prompted ex-premier Ralph Klein to back Alberta out of the deal, claiming “the health council is not a representation of what was discussed and agreed upon by the PM and Premiers last February [2003]”[37]. Furthermore, many other analysts have criticized this change because its unwieldy size facilitates failure and due to the fact that the non-governmental seats are handpicked by the government, transparency and governmental control could prove to be problematic[38].

To compliment this critical problem, issues of public mistrust of government exists as the creation of the commission and HC can be seen simply as means for the Federal government to lessen responsibility for the health care crisis. However, despite such interpretations, the HC in actuality has helped create a viable plan to retain the viability of the health care system in Canada. By enacting this policy laid out in the Romonov Report, the Canadian government sent many messages to their citizens. Firstly, that Canada is a nation with a well-developed welfare state and is unwilling to allow its citizens to live in an environment where the citizenry’s well being is compromised by a lack of commitment on the part of the Federal government.

Secondly, the creation of the HC helped resolve has since been called a ‘democratic deficit’ in Canada. Thus, by creating more transparency the government has encouraged more participation and focuses on the actions of the government on the part of the citizenry.

Bibliography JOURNAL ARTICLES Maioni, Antonia. Romanow – A defence of Public Health Care, but is there a map for the road ahead. Policy Options. February 2003. 54. Romanow, Roy J. Statement on the release of the Final Report of the Commission on the Future of Health Care in Canada. Commission on the Future of Health Care in Canada. 28 November 2002. 3-55 St-Hilaire, France and Lazar, Harvey. He Said, She Said: The Debate on Vertical Fiscal Imbalance and Federal Health-Care Funding.

Policy Options. February 2003. 61- 63. Health Care in Canada – 2008. Canadian Institute for Health Information: Statistics Canada, 2008 Raphael, Dennis. Addressing the Social Determinants of Health in Canada: Bridging the Gap Between Research Findings and Public Policy. Policy Options. March 2003. Pg. 35 Yalnizyan, Armine. Paying for Keeps: Securing the future of public health care – Beyond Romonow: Why $3. 5 billion is not enough. Canadian Centre for Policy Alternatives. 16 December 2002 Kreptul, Andrei. Canadian Health Care. Ludwig von Mises Institute. 30 August 2000 About the Health Council of Canada. Health Council of Canada. 2008. 1-2 NEWSPAPERS.

Kirkey, Sharon. “Hospital Waiting Times Jump 7% in One Year”. The National Post. 14 November 2004 “Health Ministers Agree to Form National Council”. CTV. ca. 5 September 2003. http://www. ctv. ca. 1 “Ottawa and Provinces Reach Agreement on National Health Council”. Canadian Press Newswire. October 2003 ________________ [1] “Raphael, Dennis. “Addressing the Social Determinants of Health in Canada: Bridging the Gap Between Research Findings and Public Policy”. Policy Options. March 2003. Pg. 35 [2] ibid. 36 [3] Maioni, Antonia. “Romanow – A defence of Public Health Care, but is there a map for the road ahead. Policy Options. February 2003. Pg. 54.

[4] “Health Care in Canada 2008”, Canadian Institute for Health Information: Statistics Canada, [Journal Online] 2008; available from http://www. cihi. ca. pg. 15 [5] ibid. 8 [6] ibid. 8 [7] ibid. 8 [8] “Health Care in Canada 2008”, Canadian Institute for Health Information: Statistics Canada, [Journal Online] 2008; available from http://www. cihi. ca. pg. 10 [9] Romanow, Roy J. “Statement on the release of the Final Report of the Commission on the Future of Health Care in Canada”. Commission on the Future of Health Care in Canada. 28 November 2002. pg 3. [10] Yalnizyan, Armine. “Paying for Keeps: Securing the future of public health care – Beyond Romonow: Why $3. 5 billion is not enough”.

Canadian Centre for Policy Alternatives. [Journal Online] 16 December 2002; Available from http://www. policyalternatives. ca/publications/payingforkeeps1. html. 1. [11] Ibid. [12] St-Hilaire, France and Lazar, Harvey. “He Said, She Said: The Debate on Vertical Fiscal Imbalance and Federal Health-Care Funding”. Policy Options. February 2003. Pg. 61-63. [13] Romanow, Roy J. “Statement on the release of the Final Report of the Commission on the Future of Health Care in Canada”. Commission on the Future of Health Care in Canada. 28 November 2002. Pg. 3. [14] Romanow, Roy J. “Statement on the release of the Final Report of the Commission on the Future of Health Care in Canada”.

Commission on the Future of Health Care in Canada. 28 November 2002. pg 48 [15] Ibid. 48 [16] ibid. 48 [17] Kirkey, Sharon. “Hospital Waiting Times Jump 7% in One Year”. The National Post. 14 November 2004 [18] Kirkey, Sharon. “Hospital Waiting Times Jump 7% in One Year”. The National Post. 14 November 2004 [19] ibid. [20] ibid. [21] Romanow, Roy J. “Statement on the release of the Final Report of the Commission on the Future of Health Care in Canada”. Commission on the Future of Health Care in Canada. 28 November 2002. Pg. 4 [22] Kreptul, Andrei. “Canadian Health Care”. Ludwig von Mises Institute. [Journal Online] 30 August 2000; available from http://www. mises. org. [23] ibid.

[24] “Health Care in Canada 2008”, Canadian Institute for Health Information: Statistics Canada, [Journal Online] 2008; available from http://www. cihi. ca. pg. 6 [25] ibid. 6 [26] Romanow, Roy J. “Statement on the release of the Final Report of the Commission on the Future of Health Care in Canada”. Commission on the Future of Health Care in Canada. 28 November 2002. pg 14 [27] Romanow, Roy J. “Statement on the release of the Final Report of the Commission on the Future of Health Care in Canada”. Commission on the Future of Health Care in Canada. 28 November 2002. pg 48 [28] Ibid. 48 [29] Ibid. 48 [30] Ibid. 52 [31] ibid. 54 [32] “About the Health Council of Canada” Health Council of Canada.

[Journal Online] 2008; available from http://healthcouncilcanada. ca/en/index. php? option=com_content;task=view;id=235;Itemid=3. Pg. 2 [33] ibid. 2 [34] Romanow, Roy J. “Statement on the release of the Final Report of the Commission on the Future of Health Care in Canada”. Commission on the Future of Health Care in Canada. 28 November 2002. pg 55 [35] ibid. 56 [36] “Health Ministers Agree to Form National Council”. CTV. ca. 5 September 2003; Available from http://www. ctv. ca. 1. [37] “Ottawa and Provinces Reach Agreement on National Health Council”. Canadian Press Newswire. October 2003; available from http://8590-webspirs. micromedia. ca. proxy. lib. uwo. ca:2048/western. 1.

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