Regulated by the Canada Health Act, the quality services to Canadians while balanc- medicare system in Canada—created 34 ing the costs of preventative health care with years ago—assures the provision of medical the costs of primary treatment. The Commis- services delivered by doctors and hospitals to sion has therefore initiated a dialogue with all Canadians. The cornerstone of the Act is Canadians on the future of the system but has the concept that all Canadians have the right also re-opened the debate over the funda- to any service available in the system when mental principles and values of medicare. As and where they require it. This inclusive well it has initiated a dialogue on new ways concept centres on five fundamental prin- to deliver primary health care—to remodel, ciples: universality, comprehensiveness, not to demolish, the medicare system. The accessibility, portability, and public adminis- Commission has shown that Canadians still tration. Although the cost and effectiveness highly value medicare—one of the defining of the system have often been the subject of features of our national identity—and want debate, Canadians in general have always the system maintained. Nonetheless, thou- believed that it works. However, concerns sands of written submissions and presenta- about primary health care and the effective- tions to the Commission have raised con- ness of the system have increased in recent cerns about how the system is working and years. And times have changed. Today, for have proposed a number of options for example, expensive drug therapies and home improving it, including: family health-care care have become a necessity, with neither networks, the increased involvement of nurse covered by the Canada Health Act. In rural practitioners, creating medical savings and outlying areas there is a shortage of accounts for Canadians to spend as they see doctors. In many urban settings patients rely fit, and allowing private clinics and services on walk-in clinics and hospital emergency in addition to publicly funded ones. rooms for medical treatment. In the aging But a parallel privatized system, the invest- Canadian population numerous secondary ment of more public money through taxes, procedures not covered by medicare are user fees, the reorganization of the existing increasingly required but at a cost that can be system without the infusion of more money, prohibitive to many Canadians. and the view of health care as an investment To address the debate over the current state as opposed to a cost are complex and contro- of health care in Canada, Prime Minister versial issues. And the fear that privatization Chrétien appointed former Saskatchewan is the beginning of the end of universal premier Roy Romanow to head the Commis- health care in Canada is a real concern to sion on the Future of Health Care in Canada. many Canadians. The Romanow Commis- The mandate of the Commission is to recom- sion has already suggested that the system mend policies and measures to ensure the cannot be all things to all people and that long-term sustainability of a universally Canadians must decide on the most impor- accessible, publicly funded health-care tant priorities in order for the health-care system. Romanow has been studying how to system to remain viable. revitalize a health-care system that can offer

News in Review — 5 — April 2002 MAKING THE HEALTH-CARE SYSTEM WORK New Directions

The Canadian health-care system has served as a model for many other nations. Unlike many areas in the world, Canadian citizens have access to high-quality health care. But increasingly Canadians say they are experiencing difficulties accessing the medical treatment they need in a timely manner. As well, governments warn that the costs of medicare are spiralling out of control as the cost of high-tech medical equipment increases, the sophistication of surgical procedures and other treatments improve, and as the population ages.

Two major studies of our health-care system by the federal government have taken place in the past five years: the National Forum on Health in 1997, and the current Commission on the Future of Health Care. Whatever the outcomes of the current study, the provincial governments in Alberta, British Columbia, and Ontario have said that they will move forward with changes even if the federal government does not.

First Issues As you watch this News in Review report, note statements, facts, figures, or other information that help you define how the following are essential to understanding this issue: • primary health care • comprehensive health care • universal health care • family physician services • local clinical services • hospital services • emergency services • doctors, nurses, and other health-care providers • government funding • costs to individuals • income to health-care providers • cost-effectiveness • alternative methods of providing health care • prioritizing • philosophical positions on health care • public versus privatized health care • a national and provincial issue Follow-up Discussion The Romanow Commission has not only engaged in fact-finding but has re-opened the health-care debate in Canada. In your opinion, what are the core principles at the heart of this debate? How urgent is the need to resolve the issues?

April 2002 — 6 — News in Review MAKING THE HEALTH-CARE SYSTEM WORK The Commission

Roy Romanow was appointed in April 2001 by Prime Minister Jean Chrétien to review the state of medicare in Canada. Romanow says his job is “to engage the Canadian public in a more fundamental debate about where the country wants to go with its health system.” The commission will cost $15-million and will last 18 months. The first phase of the Commission involved meetings with experts and a review of health-care-policy studies and literature. At the conclusion of this phase, the Commission produced an interim report, which it released in February 2002.

The interim report stressed that the five basic principles of the Canada Health Act must be respected. Those principles say that health care should be universally available, whatever one’s income, available to all residents, publicly administered, comprehensive enough to cover medically necessary services, and available to Canadians even outside the province or territory in which they live. Romanow, however, said that Canadians may want to narrow the range of what these principles provide for, or even add new ones to broaden what a publicly funded system should cover. Examples of the latter are: home care, pharmacare, and prevention and wellness programs, all of which are currently not covered by our government health- care programs.

The interim report outlines four options to be considered for remodelling the health-care system, and these four options are being discussed at public hearings across the country. The first option involves reforming the health-care system so that it is more efficient and focuses on prevention rather than just the treatment of disease. The second option calls for more private-sector companies to provide health-care services. The third involves attaching user fees to certain services as a way of providing more money to the system. And the fourth calls for increasing government spending on health care through tax increases. According to a February 2002 Decima poll, 44 per cent of Canadians favour the first option, 19 per cent favour the next two options, and 13 per cent favour the fourth option.

In the public hearings in 18 cities across the country the Commission is also meeting with certain groups in private. A final report will be generated and presented in November 2002; however, the federal government is not bound to implement any of the recommendations that will be made by the Commission. Critics of the review procedure point to the fact that a comprehensive review of medicare was completed in 1997 and although its report highlighted a number of problems with the system, none of the recommendations were implemented.

Activities and Discussion 1. A Royal Commission is an official inquiry into matters of public concern. Re- search the process of such a Commission and suggest why it is or why it is not an effective way to remodel a national health-care system. 2. Access and read “The Future of Public Health in Canada,” a discussion paper (available as a PDF file) from the Canadian Public Health Association (www.cpha.ca/english/policy/pstatem/future/page1.htm). How does this report correlate with the mandate of the Royal Commission?

News in Review — 7 — April 2002 MAKING THE HEALTH-CARE SYSTEM WORK Options

As the members of the Romanow Commission made their way across Canada, it became clear that Canadians value medicare and want the system preserved. There was also no shortage of suggestions and theories regarding what needs to be done to improve it. The Commis- sion will eventually make recommendations to the federal government, but ultimately it will be up to the federal government to determine if or how various options are implemented.

Four prime options have been identified by the Commission. Study each option summarized below and suggest the impact you think each would have on the current health-care system in Canada.

1. Putting More Money into the System One option is to put more money into the public system. Proponents of increased public spending suggest that this would have the additional benefit of reducing poverty and its concomitant health risks, improving child nutrition in a similar fashion, and bettering the living conditions of Native people, all of which would be ways to improve health and actually save money through investment in preventative health care. Supporters of this option say putting money into one area often saves money in another. Mildred Kerr, a Saskatchewan social worker, cited the example of a parent on welfare who could not afford medicated cough syrup for her sick child. The child became so ill that it had to be admitted to hospital. The result, Kerr said, was that the public system ended up paying $26 000 in hospital costs. Simi- larly, vaccinations to help prevent disease when Canadians travel are not covered by the current system, yet hospital care and treatment for Canadians who do not get these vaccinations and get sick are covered by the system. Again, vaccinations are much cheaper than treatment for illness.

However, opponents to increased public funding of the health system argue that putting more public money into the system would not ease waiting lists for procedures ranging from heart surgery to cancer treatment. Nor would it improve the access Canadians have to high-priced equipment such as CT scans and MRI machines. Furthermore, they argue that public hospitals should be able to offer services for direct payment from private citizens and for-profit clinics should be alternatives in order to reduce demand.

2. User Fees Although Roy Romanow has kept quiet about the recommendations he believes may be forthcoming from the commission in its final report, he has made a few public comments to indicate he supports the idea of user fees, which are currently not permitted under the Canada Health Act. Originally on record as being against the idea, Romanow now seems interested in what he calls the Swedish model of user fees. Under such a system of user fees, Canadians who are deemed able to afford it would pay out of their own pockets for certain services that were not covered by the health-care system. A national panel would have to be struck to determine which services should or should not be covered, in what manner, and who would qualify as being unable to pay the user fees. Critics of user fees argue this would lead to a two-tier health system because although basic services would be covered for all Canadians, wealthier citizens would have greater access to additional and “better” services.

April 2002 — 8 — News in Review 3. More Private-Sector Involvement The one option that probably generates the most controversy is the call for more private sector involvement in the Canadian health-care system. This would mean that for-profit companies would be able to provide certain services to Canadians that patients would have to pay for out of their own pocket. Supporters of this idea believe that private facilities are in a better position to pay for expensive medical equipment and can deliver the services in a more timely, efficient manner than can the public system. As well, proponents argue that because of current expensive high-tech procedures it is simply no longer reasonable to expect that these costs can be funded from tax dollars alone.

Again, opponents to privatization believe that if more private-sector involvement is allowed into the public system Canada will end up with a two-tier system of health care. One level, the public level, will provide basic services to all Canadians, while the other, the private-level, will provide the latest services and access to the best equipment and specialists only to those who can afford to pay for them. In their view, this would mean the end of universality in Canadian health care. One opponent, federal NDP leader Alexa McDonough, argued in a brief to the Romanow Commission that in the public sector, health-care dollars go to health care alone while in the private system, dollars are spent on marketing campaigns and advertis- ing, investor relations, and mergers and acquisitions.

4. Reorganizing the System to Deliver Services in Other Ways This option would require a different use of public funding. Many groups have argued before the Commission that expanding medicare to cover health-care providers such as chiropractors, naturopaths, and psychologists rather than just doctors and hospital services is actually a cost- effective measure. Supporters believe expansion would actually end up saving money because Canadians would take better care of their health if these options were available to them for free. Even some economists have argued that the system should be expanded to include a national pharmacare program because that is the only way escalating drug costs can be con- trolled. (Currently, more money is spent on drugs than medical procedures each year.)

Opponents argue that the more options available to Canadians the more they will avail them- selves of the options with no concern for costs. In other words, the only way to save money is to make Canadians pay for more services out of their own pockets so that they consider carefully whether minor ailments or concerns could be taken care of in other ways than accessing expensive services such as doctors and hospital emergency rooms.

Health-care-policy analysts, nurses, and some doctors support the idea of increasing the use of nurse practitioners to treat minor conditions. The idea is that doctors would then be free to deal with the most serious cases. Some analysts estimate that three-quarters of patients at doctors’ offices could be treated by a nurse practitioner. They also claim that doctors’ organizations have attempted to block such a change in order to retain control over the health-care system.

The concept of Medical Savings Accounts, pioneered in Singapore and promoted in Canada by the conservative Fraser Institute, has also been suggested. This would involve governments in essence giving every Canadian a lump sum of money each year to spend on health care. Those who need more health care than provided by their individual account would have to pay out of pocket. Those who visited the doctor infrequently in a year would be able to keep

News in Review — 9 — April 2002 any money left over in their account. Supporters argue that this would encourage Canadians to use the health-care system less often because they would be aware of the true costs of going to the doctor. Critics, however, argue that this would simply result in the punishment of the very ill. Despite these concerns, Alberta Premier Ralph Klein is considering introducing medical savings accounts in his province. The Angus Reid Group conducted a poll on Canadians’ attitudes toward medical savings accounts four years ago. The results seemed to suggest that the concept had significant support in Canada. Sixty-seven per cent of Canadians reported that medical savings accounts would promote better health for Canadians because Canadians could use their allowance to pay for therapies not currently covered by medicare. As well, 72 per cent of Canadians believed that giving individuals these allowances would make them more aware of the true cost of health services and result in them using the services more carefully. Furthermore, Canadians with incomes of less than $30 000 per year supported these two concepts to an even greater extent than middle- or upper-income Canadians, revealing a rich-poor gap in this area. The researchers explained this difference by suggesting that lower-income Canadians tend to feel intimidated by their doctors and believe they would have greater power in the doctor-patient relationship if they were paying for services on a cash basis.

A Patient’s Charter of Rights Another option for the future that Romanow seems to support is the idea of a patient’s charter of rights. Such a charter would benefit the system by clearly defining priorities. However, academic health expert Noralou Roos of the University of Manitoba warns that patient guarantees can put governments in impossible binds. Britain, she points out, has been forced to transport patients to Turkey for care because of its failure to meet arbitrary wait-time guarantees, increasing health-care costs. Dr. Heidi Oetter, president of the British Columbia Medical Association, has said a charter does not necessarily have to result in more public money being spent, particularly if patients who do not receive treatment within the guaranteed period are allowed to purchase care privately outside the public system. However, this raises concerns that only the wealthy in Canada would be able to purchase such private services.

Follow-up Discussion Britain’s patient’s charter of rights has the following core principles: The National Health Service will provide a universal service for all based on clinical need, not ability to pay; will provide a comprehensive range of services; will shape its services around the needs and preferences of individual patients, their families and their careers; will respond to different needs of different populations; will work continuously to improve quality services and to [minimize] errors; will support and value its staff. Public funds for [health care] will be devoted solely to NHS patients; will work together with others to ensure a seamless service for patients; will help keep people healthy and work to reduce health inequalities; will respect the confidential- ity of individual patients and provide open access to information about services, treatment and performance.

Canada already has a Charter of Rights and Freedoms. Discuss whether a similar health charter based perhaps on principles like those above would improve our national medicare system.

April 2002 — 10 — News in Review MAKING THE HEALTH-CARE SYSTEM WORK Historical Perspective

Debate over Canada’s health-care system is not a recent phenomenon; there has always been considerable disagreement over how health care should be delivered in this country. The timeline of events listed below shows how the issues have been an ongoing source of conflict between the federal and provincial governments. As you read this chronology of events, consider how each has had an impact on the medicare system as it currently exists in Canada today.

1867 Under the British North America Act the administration of health care is made a provincial responsibility. (Health care itself, as we know it today, was much different in the 19th century. In addition to medical doctors, people frequently consulted such health-care providers as hypnotists and hydropaths; the latter believed drinking water to be a cure for most things. In terms of medical procedures, anesthesia had just been discovered.)

End of the 19th century As medical doctors become the most common health-care con- sultants, the question of payment for medical services becomes a hotly debated topic; both a moral and a practical one. The Hippocratic Oath obliges doctors to treat all sick people but, as is the case today, the poorest tend to be the sickest. Often then, a physician following the oath who treats all patients in need earns little money, and sometimes is not paid at all. As a pos- sible solution public health insurance is first considered at this time.

1919 The federal Liberal Party is persuaded by future prime minister William Lyon Mackenzie King to add public medicare to its election platform.

1933 The new socialist Co-operative Commonwealth Federation (CCF— today the New Democratic Party) makes medicare one of its central political goals.

1945 Prime Minister Mackenzie King proposes the idea of a national medicare scheme, but it is defeated because of opposition by the provinces.

1947 The CCF government of Saskatchewan Premier Tommy Douglas begins providing universal public hospital insurance.

1957 Most of Canada’s hospitals are now publicly funded, and very costly for local and regional governments. The provinces turn to the federal government for cash, which Ottawa agrees to provide as long as certain conditions are met. For the first time, the fundamental principles enshrined in the Canada Health Act are enunciated. Ottawa declares that any provincial plans must be universal, portable, comprehensive, publicly administered, and accessible to all residents.

1961 The province of Saskatchewan passes legislation aimed at extending medicare to cover physician services. Despite vehement opposition from doctors, the bill becomes law. Saskatchewan is now the first jurisdiction in Canada to implement medicare.

News in Review — 11 — April 2002 1963 Alberta Premier Ernest Manning’s Social Credit government states there will be no medicare in his province. Instead, the government declares that private insurers will sell Albertans health coverage but at regulated prices. The government will subsidize up to half the cost for low-income families. (The debate moved on to the idea of nationalized medicare before Manning could actually implement his plan.)

1964 This year is a watershed for the country as Justice Emmett Hall’s Royal Commission on Health Care recommends the establishment of Canada-wide public health insurance. As well as hospitals and physicians, the Commission recommends that any national program cover prescription drugs and home care, in addition to dental and eye care for everyone under 18. The report splits Prime Minister Lester B. Pearson’s Liberal Cabinet.

1965 After much debate, Pearson proposes a sweeping plan that will cover not only doctors and hospitals but drugs and dental services. However, Alberta and Ontario have serious concerns about this plan, which delay the implementation of medicare.

1966 Parliament passes The Medical Care Act, a much less ambitious version of medicare than Hall or Pearson envision; it is limited to doctors and hospitals. Ottawa commits itself to financing half the cost of the program but announces that it plans to withdraw entirely within five years, arguing that the federal government should not be involved in an area of provincial jurisdiction as determined by the Canadian Constitution.

1968-1971 Medicare in all of Canada officially begins on July 1, 1968, but only British Columbia and Saskatchewan join the plan at this time. Manitoba, Nova Scotia, Newfound- land, Alberta, and Ontario join in 1969, Quebec and Prince Edward Island in 1970, and New Brunswick is the last province to join, in 1971.

Discussion Under the Canada Health Act, the federal government provides a portion of the funding for health-care delivery to each of the provinces. In turn, it also places certain restrictions on how the provinces should spend the money. In the current debate over health care the provinces want the federal government to pay a greater portion of health-care costs but want to retain close control over this provincial matter guaranteed under the Constitution. What problems might arise if each provincial government delivered health care as it saw fit? What advantages might ensue? How does this health-care debate illustrate the constitutional conundrum that Canada has faced since Confederation?

April 2002 — 12 — News in Review MAKING THE HEALTH-CARE SYSTEM WORK The Public Response

Roy Romanow has stated that one of the main goals of the Commission on the Future of Health Care is to generate debate in such a way that Canadians identify the values they most want preserved in the health-care system. If, for example, it is made clear that most Canadians believe that health care is a right, not a privilege, then the Commission will in all likelihood stress the preservation of the universality of the system. But what do Canadians want in a health-care system? The following statements are a sample of submissions made before the Commission and opinions shared in various media across the country. As you read the quota- tions summarize the principles or values each statement expresses.

“I believe the power provincial governments currently have over medicare and health-care resources should be removed. If the rights and freedoms granted to Canadians are consistent no matter where in Canada they live, then a person’s rights concerning medicare and health- care issues should be the same regardless of what province they live in. Health issues are intimate issues, and the rights involved in these issues should be protected equally across Canada.” — Kelli Ralph-Campbell, Toronto

“Some argue that denying citizens the right to purchase medical services is an infringement of the right ‘to life, liberty and security of the person’ guaranteed under the Canadian Charter of Rights and Freedoms. Even if true, minor infringements of the rights of a few is a justifiable means of protecting the interests of many. Compelling the affluent to participate with the poor in a national health-care system guarantees for those without money a standard of care ex- pected by those who would purchase that same standard of care in a private system.” — Philip Berger, medical director, Inner City Health Program, Core Services, Toronto, and chief of the department of family and community medicine, St. Michael’s Hospital, Toronto

“It’s fine to say that public medicare is cheaper, but people don’t want to pay taxes indefi- nitely. And medical savings accounts can be designed to protect the chronically ill. In any case, the health system is on the verge of collapse and to profess otherwise is to turn a blind eye to growing waiting lists for diagnostic imaging, cancer treatments and to refuse to ac- knowledge the attrition rates and absenteeism among front-line health-care workers. Canadi- ans should be free to choose to go outside of medicare for treatment if they wish and can afford it.” — Walter Robinson, Canadian Taxpayers Federation

“Our humanity has been exchanged for the bottom line. I’ve witnessed a serious erosion of care. The nurses and doctors are so stressed that medical mistakes are made.... I have been given incorrect medication. If we become more Americanized, people like me will suffer and die—literally. It’s frightening to be in hospital now.” — Deborah Zerr, a Saskatchewan woman who suffers from congestive heart failure who was given the wrong medication while in hospital

“The current system shuts out low-income Canadians who can’t afford drugs. Medical savings accounts, low-income Canadians well understand, would give them the right to drugs and

News in Review — 13 — April 2002 other essential medical services that the government does not now provide.” — Lawrence Solomon, executive director, Urban Renaissance Institute, a division of Energy Probe Re- search Foundation

“There’s no point in taking out our anger on hospital administrators who, much like Ontario’s school boards, are doing the best they can with ever-diminishing resources.... One thing seems certain. Canadians can’t leave the fate of medicare to provincial premiers the likes of Ralph Klein, Mike Harris and Gordon Campbell. As a reporter once said after being told his paper’s lawyer would also represent him in the joint defence of a libel case: ‘No thanks. He doesn’t have my best interests at heart.’” — Jim Taylor, freelance writer, London, Ontario

“We constantly hear that we need to reform, or perhaps scrap, our health-care system before we lose it, that privatization is today’s reality and that big money is required to keep the system up and running.... The fact that privatization is already happening for some services does not mean that this is the way to go. On the contrary, this may be a wake-up call to the Liberal government to bring back to the table the expansion of public coverage for essential services such as home care and prescription medications.” — Andres Leon, Nepean, Ontario

“As Mr. Romanow admits in his interim report, medicare’s ‘iconic status [has made] it virtu- ally untouchable by any politician.’ For decades, the system has escaped reform despite the presence of an elemental flaw—that patients bear no direct costs for the medical services they receive and thus have no incentive not to overconsume.” — from an editorial in The National Post, February 8, 2002

Follow-up Activity 1. As a class, design five key questions regarding the future of health care in Canada. Be careful to word the questions in such a way that they are neutral and objective.

2. Each member of the class will then informally poll five people using these questions.

3. Strike a committee to tabulate and summarize the results. As a class, discuss your findings.

April 2002 — 14 — News in Review MAKING THE HEALTH-CARE SYSTEM WORK The Commissioner

Some see Roy Romanow as the perfect person to head this Royal Commission. Others, however, have questioned his suitability. Toronto Star columnist Thomas Walkom, for example, believes that Romanow is not suitable for the position because, in Walkom’s view, Romanow is reluctant to take a strong stand and share his own views. Walkom calls him “a master of ambiguity.” On the other hand, Ben Mulroney, writing in The Calgary Sun, suggested that Romanow, the former NDP premier of Saskatchewan and head of the NDP in Saskatchewan, was appointed by Prime Minister Jean Chrétien essentially to counter the claims made by provincial premiers that the health-care system is in crisis. Mulroney also postulated that since Romanow is a former leader of the NDP Party, Chrétien appointed him so that if the Liberals do introduce a second tier in health-care delivery—a level of health-care services that Canadians would have to pay for on their own—this message would be accepted more easily if it came from a person who in the past would have strongly opposed the idea. David Gratzer, a physician and author, is even more critical of Romanow’s appointment. He believes that it was wrong to appoint a politician to study the issue at all. He believes health care is a policy issue not a political issue.

Romanow, on the other hand, has fiercely defended his neutrality and independence and states that he will submit a full and accurate report, no matter how controversial or difficult the findings may be. “I am going to call it as I see it. I am not running for political office and this is my last go. As a royal commissioner under the Inquiries Act, I am not responsible to any government.”

Born, raised, and educated in Saskatoon, Romanow graduated from the University of Saskatchewan with degrees in Arts and Laws. He was first elected to the Saskatchewan legislature in 1967, and between 1971 and 1982 he served as deputy premier of the province. In 1987 he was acclaimed leader of the Saskatchewan NDP party and in 1991 won a majority government, becoming premier. During his political career, Romanow served as Saskatchewan’s attorney general and was responsible for the introduction of a provincial legal aid plan, the Saskatchewan Human Rights Code, and the creation of the provincial Ombudsman’s Office. In 1979, Romanow was appointed Minister of Intergovernmental Affairs, where he became one of the key players in the federal-provincial negotiations that resulted in the Consitutional Accord of November 1981.

Dr. John O’Brien-Bell, a general practitioner in Surrey, British Columbia, and former president of the Canadian Medical Association, believes Romanow was an excellent choice. O’Brien-Bell believes that Romanow is truly rooted in socialism. He points out that Romanow spent his youth campaigning for medicare and that his relationship with doctors has always been good. In addition, in 1983 Romanow was a member of the Canadian Medical Association’s task force on the Allocation of Health Care Resources. This gave him another 18 months of experience into the problems doctors face. O’Brien-Bell describes Romanow as authoritiative, intelligent, and a natural leader, and says, “If anyone can rescue medicare and return professional satisfaction to those who work in it, it is he.”

Discussion In your opinion, is Roy Romanov an appropriate choice to head this Royal Commission?

News in Review — 15 — April 2002 MAKING THE HEALTH-CARE SYSTEM WORK Discussion, Research and Essay Questions

1. After consulting a dictionary, express in your own words in written form the five principles of the Canada Health Act: universality, comprehensiveness, accessibility, portability, and public administration. Share your interpretations with those of a classmate. Are your definitions the same?

2. The Canadian Health Coalition is dedicated to preserving and enhancing Canada’s public health system for the benefit of all Canadians. Founded in 1979, the coalition includes organizations representing unions, seniors, women, students, con- sumers and health-care professionals from across Canada. The coalition has an extensive Web site, on which a great deal of time is devoted to reviewing and commenting on the progress of the Romanow Commission. Visit the Web site at www.healthcoalition.ca and make a list of the coalition’s concerns. Working with a partner prepare a short report for the class on one of the following topics ad- dressed by the site: for-profit health care, health-care funding, defending medicare, medical savings accounts, the pharmaceutical industry.

3. The Commission on the Future of Health Care has a comprehensive Web site. Visit the site at www.healthcarecommission.ca and identify one submission from individual Canadians to the Commission that you find particularly convincing. Summarize the submission in your own words and present the viewpoint to the class.

4. Most Canadians feel very strongly that the health-care system in Canada is much better than the system in the United States. Research the U.S. system and prepare a short report that highlights the strengths and weaknesses of that system.

5. Interview a senior citizen about his or her experience with Canada’s health-care system. What are his or her perceptions of the health-care system of today com- pared with the one that was in place during the youth and young adulthood of the person you are interviewing?

6. One area of medicine facing a particular shortage of practitioners is in the area of obstetrics. Pregnant women routinely have long waits every time they visit their obstetrician, and the doctor they receive their prenatal care from is rarely the doctor who delivers their baby in hospital. Midwives provide a viable alternative to a traditional obstetrician in the management and delivery of a low-risk preg- nancy. Conduct research to determine the state of midwifery in Canada. How many midwives currently practise? Are midwives licensed in all provinces? What is the relationship between midwives and traditional health-care providers? What reforms to the health-care system would midwives like to see?

April 2002 — 16 — News in Review