Over the next year or two, Canadians will have an opportunity to start building a revitalized public health care system that is strong and flexible enough to meet the challenges of the 21st century – all that’s needed is the political will.

That was the message delivered by former Saskatchewan Premier Roy Romanow on Nov. 28 when he unveiled the long-awaited final report of his royal commission on the future Medicare.

"The changes I’m proposing are intended to strengthen and modernize Medicare and place it on a more sustainable footing for the future," said Romanow, after his 356-page report, entitled Building on Values: The Future of Health Care in Canada, was tabled in the House of Commons in Ottawa.

"Now it’s up to the (federal and provincial) governments and the people of Canada to decide what to do."

The report is the culmination of 18 months of research and public consultations – the most exhaustive in Canadian history. Romanow commissioned more than 40 expert studies and heard from literally tens of thousands of ordinary Canadians.

Based on all this input, Romanow made 47 recommendations aimed reforming the way Medicare is organized, delivered and financed.

On the funding side, Romanow calls on the federal government to add an extra $6.5 million to the amount that provinces get each year to administer health care. This increase would be phased in over three years – with federal funding jumping by $3.5 in 2003 and by another $1.5 billion each in 2004 and 2005.

Ultimately, Romanow says the federal government should cover 25 percent of the overall health tab – up from about 15 percent today. And he says that an automatic "escalator" should be introduced to ensure long-term funding stability.

In addition, Romanow calls for the creation of five special funds (worth $8.5 billion over the next three years) that would be used to "kick-start" major structural changes.

For example, there would be a special fund to improve access to diagnostic services such as MRIs; another fund to hire staff and improve service in rural and remote communities; and a fund to promote primary care reform.

At the same time, Romanow is calling on the federal government to expand Medicare to cover homecare services for the mentally ill; the dying and patients recently released from hospital. And he says $1 billion dollars should be transferred to the provinces to establish a new national plan for prescription drugs – one that would cap the amount that individual patients have to pay for drugs at $1,500 per year.

Ultimately, Romanow says Medicare should be expanded to cover all prescription drugs and homecare services – but he says we can afford to make such a dramatic move immediately.

In addition to the big ticket money items, Romanow says the federal government should amend the Canada Health Act to include a new core principle of accountability and to specifically include homecare and diagnostic services such as MRIs and CT scans on the list of publicly insured services.

In an effort to further promote accountability and transparency, Romanow is also calling on the federal and provincial governments to sign a Health Care Covenant – a document that would outline in detail what Canadians can expect from their health care system.

And Romanow says the federal government should establish a new national agency, called the Health Council of Canada, to monitor spending and make regular reports on the successes and failures of health delivery in all provinces and territories.

"Our reform agenda is an ambitious one," said Romanow, when releasing the report. "But, at a time when one of our most cherished national programs is at a crossroads, Canadians expect no less than an ambitious plan."

Romanow says the federal budget surplus can be used to cover the cost of his reforms. The surplus is expected to exceed $3 billion next year and increase to about $15 billion per year within six years.

The budget increase of $6.5 billion each year proposed by Romanow may sound large at first – but it is still only a fraction of the $173 billion in revenues the federal government collects each year. It is also slightly smaller than the $7 billion increase proposed by the Premiers – and only somewhat larger than the $5 billion annual boost proposed by a recent Senate committee report on health care.