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How much is our medicare system worth to you?

Six months ago we reported that medicare was in critical condition, and we promised to provide a prescription for nursing it back to health. On Friday, our committee's final report concluded that Canadians need to contribute an additional $5-billion a year if the publicly funded system is going to survive.

The new money itself will not resuscitate medicare. It must be used to buy the changes that will.

To raise this revenue, we prescribe a National Health Care Insurance Premium, the amount of such a premium to be determined by an individual's taxable income bracket. For lower-income Canadians, the premium would be 50 cents a day -- half the price of a lottery ticket. For those with more than $103,000 in taxable income, the premium would be $4.00 a day.

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These new revenues would be spent on the health care of Canadians and health care only. Under our proposal, the Auditor-General would report annually to Canadians on how their health-care dollars are being spent, making the process transparent and accountable.

What can Canadians expect from it? Health-care security and peace of mind. This is what Canadians told us that they want most -- the knowledge that the health-care system will be there when they need it. That means no more interminable waits. Canadians would receive an iron-clad assurance that after a clearly specified, clinically determined waiting time, they will get the treatment they need -- in another province or another country if necessary.

Our current hospital-and-doctor safety net has large holes in it; too many Canadians are falling through. Roughly 600,000 people in this country have no protection against "catastrophic" prescription drug expenses, when an individual's prescription drug costs exceed $5,000 per year. In many cases, drug costs far exceed that amount with the result that families are being made financially destitute.

This is wrong. Our report recommends that the public health-care insurance be expanded to cover the catastrophic cost of prescription medicine and that the federal government pick up 90 per cent of these expenses.

Much more must be done for people requiring home care after surgery or help in caring for a dying relative. Ottawa and the provinces should share the cost equally of expanded coverage for acute home care and palliative care in the home. These programs are more responsive to patients and cost less than hospital care.

An important point: Any new money given to the provinces and territories for health care must buy change; it must not be used to support the publicly funded health-care system in its present form. And if the reforms are to have a chance, everyone in the health-care community -- hospital administrators, health-care providers, governments and, yes, patients -- will need to modify their behaviour and attitudes. Incentives need to be introduced to change behaviour.

We recommend a new funding mechanism for hospitals, based on service and performance outcomes. Such funding will spur competition between institutions to provide the best services. It will also encourage the establishment of centres of excellence, and it will make the insurer (government) neutral with respect to the ownership structure of a health-care institution.

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The committee proposes the creation of primary-care health teams, multi-disciplinary in scope and operating 24/7. We recommend that primary-care physicians be paid primarily on a capitation basis (a fixed annual amount for looking after a patient) rather than by the current fee-for-service arrangement. Primary care reform will mean "one-stop" shopping for patients and continuity of service across the full range of a patient's health-care needs.

How will Canadians know if the system is more efficient? We recommend the creation of a Health Care Commissioner. With complete independence from all governments, and a national mandate, the commissioner would audit the progress of health-care reform and report annually to Canadians through Parliament, on the use of their health-care dollars and the results these dollars are producing.

There is a real chance to reinvigorate medicare in this country. Are Canadians prepared to pay for it?

If not, it is likely that the courts will be asked to move in. For if governments cannot ensure that patients get timely access to medically necessary health care, then Canadians cannot be denied the right to buy private health-care insurance.

In the face of such a court decision, it won't be long before a parallel private health-care system emerges. Canadians have told us they don't want this. But it's the inevitable consequence of failing to reform the system now. Senator Michael Kirby is chair of the Senate standing committee on social affairs, science and technology. Senator Marjory LeBreton is deputy chair.

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