Medicare stands firm on its foundations of shared Canadian national values. (Reports For Romanow).

Proposals to reform medicare do not constitute an attack on Canadian values because those values are only loosely associated with the actual structure of health care programs, says a discussion paper prepared for the Romanow Commission.

At the same time, some proposed reforms are a threat to core medicare values, says the authors of National Values, Institutions and Health Policies: What do they imply for medicare reform? Two of the authors are from Yale University in the U.S. while the third is from Queen's University in The Netherlands.

Values in and of themselves do not dictate preferences for particular institutional structures at any level of detail, the paper suggests. The authors cite data showing that residents of most OECD countries have a shared value orientation when it comes to health care. That orientation exists side by side with substantial differences in the administration, policies, and rules of European medical care systems. Within Canada, there are differences in the way provinces deliver health care in the context of the principles--or values--embodied in the Canada Health Act.

Values are not a policy straightjacket yet, the paper says, but they do rule out certain choices. The authors refer to Michael Ignatieff's description of core Canadian values: "We think that public taxation should provide for health care and that it is wrong for decent medical care to depend on the size of our bank balances."

Some suggestions for medicare reform challenge that fundamental value. Still, the paper concludes, medicare stands firm on its foundations of still-shared Canadian national values. The question for reformers is simply how best to embody those values in 21st century.