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The 47 recommendations made by Roy Romanow in his long awaited report on the future of health care provide a solid framework for reform.

The strength of Romanow’s report lies in his steadfast promotion of publicly-funded health care as the best model one that is clearly sustainable and in his recommendations to expand and strengthen the Canada Health Act. The weakness of his report is that he does not provide policy instruments to keep the for-profit sector out of health services.

There are other problems, but Romanow’s most significant concession to the private sector is in his statement that there must be a clear line drawn between direct health services and support services and that only direct health services should be free from private, for-profit delivery. This conclusion will embolden employers and provincial governments to contract out dietary, laundry and cleaning services. The consequence will be a transfer of well-paying, unionized jobs with benefits to lower paying, non-union jobs with few benefits. The livelihoods of women, minorities and immigrant workers are being sacrificed to save money in the overall system.

On the positive side, Romanow recommends that federal funding be increased to 25 per cent of total health expenditures and that a separate health transfer be created. The federal government should inject $6.5 billion over the next two years to ensure that recommendations are implemented.

Romanow reflects CUPE’s critical analysis of public private partnerships and says that they are not a panacea. However, he fails to rule them out absolutely as a viable alternative in some areas of health care including health information systems.

User fees, extra billing, and medical savings accounts are all rejected as alternative funding mechanisms.

Home care services (palliative care, post acute care and mental health) are to be incorporated into the Canada Health Act and covered as insured services. This is a significant step forward but does leave preventative care, care for people with disabilities and long term care out of the equation.

The creation of a National Drug Agency and a national formulary will be major steps forward in monitoring and controlling drugs, the fastest rising cost in the health care system.

Romanow is recommending that MRIs and other medically necessary diagnostic services be clarified and included in the Canada Health Act. This is welcome but does not represent a substantive change from the current situation. Under Romanow’s suggestion for-profit clinics are still likely to exist but may see their funding flow dry up. Romanow is recommending the inclusion of workers’ compensation injuries as a Canada Health Act insured service. WCB is currently a major revenue source for private clinics.