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Medicare reform
This is the seventh and last in a series of essays in which notable Canadians give their perspectives on the future of medicare.
lthough countless technical issues must be tackled in shaping the future of Canada's health care system, the interim report of the Romanow Commission on the Future of Health Care in Canada' has correctly situated the question of values at the heart of the matter.
Public opinion in the year 2002 echoes what Canadians have been telling pollsters for over 3 decades: we are committed to health care equity. We should indeed be proud of this commitment. The principle of universal access based on medical need rather than on ability to pay speaks both to our sense of fairness and to our sense of community. Canadians have accepted a vision of social justice that sees health care as a fundamental human right. Within this tradition every citizen, regardless of ability to pay, is viewed as part of the same social community. The principle of social justice in health care was incorporated into the UN General Assembly Covenant on Economic, Social and Cultural Rights,2 which Canada ratified in 1976. Artitle 12 of the Covenant affirms "the right of everyone to the enjoyment of the highest attainable standard of physical and mental health," in part through "[t]he creation of conditions which would assure to all medical service and medical attention in the event of sickness."
It has been repeatedly noted that we Canadians regard our public health care system as a defining attribute of our national identity. Our perhaps somewhat idealized self-- assessment emphasizes that, in achieving quality care, we have preserved universal access. However, in ensuring the provision of services we have not lost sight of the other determinants of health. When the influential Lalonde Report,' released in 1974, emphasized the importance of not only biological factors and health care, but also of lifestyle and the environment, it was heralded internationally as setting a framework that advanced our understanding of how to preserve and promote health in Canada and internationally. Canada has continued to play a leading role in the discussion of health determinants, a role that was evident in the drafting of the Ottawa Charter'- the outcome document of...