Roy Romanow says the federal government must rewrite the five basic principles of medicare to ensure the provinces are held accountable for the way they provide health care.

Canadian Press

ST. JOHN'S, Nfld. — Roy Romanow says the federal government must rewrite the five basic principles of medicare to ensure the provinces are held accountable for the way they provide health care.

The former Saskatchewan premier, in another revealing speech prior to the release of his report on the future of health care, said Wednesday new rules were also needed to stop the endless bickering between Ottawa and the provinces.

"Too many years of finger-pointing have left too few hands extended in partnership," Romanow told a packed auditorium at Memorial University in St. John's.

While all of the provinces say they are committed to the five principles set out in the Canada Health Act -- universality, accessibility, comprehensiveness, portability and public administration -- some have adopted vastly different interpretations, he said.

"How can some governments use these same principles to justify a significant expansion of private health-care delivery on one hand, while others use them to justify the opposite?" Romanow asked.

"Left unchecked, this situation will eventually mean medicare's demise."

That's why Romanow's report will call on the provinces and territories to draft annual reports to improve the transparency and accountability of a system that costs Canadians about $100 billion annually.

But the federal government will also be held to account for the way it helps pay for heath care, Romanow said. His report, which is expected before the end of next month, will recommend more stable and predictable funding arrangements.

"We've had stops and starts, ups and downs," he said.

"The debate has been unhealthy. To use medical jargon, it has been septic."

To repair the relationship and ensure the sustainability of a single-payer, publicly funded health-care system, governments and citizens must adopt a new mindset, he said.

"Canadians understand that illness and injury know few boundaries _ they afflict us all," Romanow added. "They recognize that organizing health care along constitutional lines or provincial boundaries makes little practical sense."

Romanow stressed that one streamlined, national system was needed to replace "13 increasingly uneven, disparate and potentially competing ones."

But the details of such an overhaul will have to wait until next month, he said.

Last week, Romanow delivered a similar speech at Harvard University in which he rejected greater private-sector involvement as a remedy for Canada's ailing health-care system.

He said publicly funded medicare should be expanded because it is cheaper and more efficient than the free-market approach used in the United States.

Still, Romanow didn't say which areas of medicare should be expanded, though he has made many references to a possible national drug plan and a home-care program.

That means his final report will likely recommend the federal government should inject a huge amount of cash into the system.

Prime Minister Jean Chretien has already said he is prepared to invest more, but it remains unclear where the money will come from and how much will be set aside.

Finance Minister John Manley has already said the government will not raise taxes nor introduce new ones to pay for a renewal of the health-care system.

Earlier this week, published reports suggested a Senate committee will recommend Friday that Ottawa give the provinces an extra $5 billion a year to expand hospitals, buy equipment and recruit doctors.

The committee, chaired by Liberal Senator Michael Kirby, was also expected to call for a new tax to pay for short-term home care, palliative care and a limited form of pharmacare, to cover the cost of prescription drugs.