Roundtable on the Kirby and Romanow Reports

By Caroline Pitfield

On December 10, 2002, shortly after Roy Romanow released his Report on the Future of Health Care in Canada, the Faculty of Law hosted a roundtable discussion to consider whether this Report, and the previously published Senate Committee Report would actually instigate real change in the Canadian health care system.

The panel of speakers consisted of four experts in health care policy, two from government backgrounds and two academics from the University of Toronto community.  While levels of optimism varied between the panelists, there was consensus with respect to the significance of one issue in particular; without exception, all four agreed that real change in the management and delivery of health care in Canada would have to involve the adoption of provisions or principles to hold those that run the health care system more accountable.

After brief introductions by Professor Sujit Choudhry of the Faculty of Law, Carolyn Tuohy, Vice-President, Policy Development and a professor of political science at the University of Toronto opened the discussion.  She described recommendations in the Reports as not particularly "revolutionary" and suggested that present circumstances may represent a  "window of opportunity" for the implementation of at least some change in the health care system.  She noted, for instance, that it would be politically risky for politicians not to react to the Reports, given public expectations, and that the current fiscal climate should allow for re-investment in health care.  Professor Tuohy concluded by underscoring the significance of acting immediately, while the window is open and before political circumstances change. 

Like Professor Tuohy, Michael Decter, Chair of the National Board for the Canadian Institute for Health Information and former Deputy Minister of Health for the Ontario Government, spoke about high levels of public expectation, in part born of unprecedented, widespread understanding about the significance and complexity of the issues involved in health care reform.  Mr. Decter also drew the audience's attention to the question of what real change in health care would look like. He suggested that such change would involve the adoption of accountability provisions and incentives that would achieve some sort of continuing improvement in the system, as opposed to a simple infusion of untied, untargeted cash into the system.  He was ultimately not convinced that real change, as he defined it, would actually follow the release of the two Reports.

Hugh Segal, President of the Institute of Research for Public Policy, opened his comments with the assertion that the worst possible scenario for real change would be a deal - especially a "cash for silence" deal where money is transferred to the provinces without the imposition of accountability mechanisms.  As Mr. Segal argued, such a deal might very well represent the dilution, if not the destruction, of any real debate on the fundamental principles according to which our health care system should operate. 

Last to speak was Professor Colleen Flood of the Faculty of Law, who shared Michael Decter's feeling that real change in the health care system was unlikely to occur. Professor Flood suggested that governments would probably spend new monies in the short-term on homecare - the "apple pie of health care reform"  -- and diagnostic technologies, the increasing demand for which represents a huge political "pressure point".  As she argued, such initiatives would please the public and thus take off some of the political heat, but they would also decrease the chance that the more important recommendations in these Reports, particularly those related to accountability, would ever be implemented.  Professor Flood also highlighted the importance of addressing patient and citizen satisfaction (what she referred to as a first-order matter) before responding to issues raised by providers and governments.

The discussion ended with a question and answer session, during which audience members commented and sought clarification on some of the more particular issues raised in - or omitted from - the two Reports.  In closing, an audience member made the suggestion that televising the upcoming First Ministers' meeting might exert the necessary pressure on governments to make real changes to the health care system, a simple but inspired solution which seemed to please all four of the panel members.

L-R: Prof. Choudhry, Prof. Tuohy, Hugh Segal, Prof. Flood, Michael Decter

L-R: Prof. Sujit Choudhry (podium), Prof. Carolyn Tuohy, Hugh Segal, Prof. Colleen Flood, Michael Decter