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ared to other nations. The primary reason for Canada's success in constraining expenditures is that a single payer, the government, is responsible for the provision of physician and hospital services. Single-payer funding allows administrative efficiencies and the necessary redirection of spending (quote). Nevertheless, sustainability issues have the public wanting to know the value of their taxpayer money.

The challenge of what is thought as an increasingly unsustainable healthcare system has been created by various factors, including population aging, inflation, increases in size of population, enrichment of health care services and cost of dying. These challenges have further lead to Canada's restrained spending, producing long waits in emergency departments for unavailable hospital beds; delays in cataract, joint replacement and cardiac surgery; and the unavailability of needed home care services. Solving these problems will require increased commitment of resources to health care. Yet, a declining tax base is creating, especially under the tax cuts during the 1990's, is working counter intuitively with the problem. Without the necessary resources to counteract the increased 'loads' placed on the healthcare system, we can expect to encounter a doomsday scenario. This will include lack of timely access to family physicians and specialist care/treatment, lack of ER access and an aging population with end-of-life issues and lack of access to palliative care (quote).

As stated in the Romanow Commission, the system is sustainable, but only if the system changes in some very important and crucial ways. However, one strategy that could have strikingly profound effects would be to see the federal government matching new health expenditures by the provinces, in some fixed proportion. Currently, both levels of government accuse the other of being responsible for health care delivery problems and for inadequacies in funding, while failing to address the problem. For instance, in 1995, the federal government unilaterally instituted large cuts in the health care funding available to the provinces (quote). At the same time, provinces can avoid committing increased resources of their own to healthcare and effectively use the federal money to fund tax cuts. This resistance of both federal and provincial governments to committing adequate funds to health care in a planned and consistent fashion represents a serious threat to sustainability (quote).

A solution would begin with the provincial and federal governments agreeing to establish the current funding levels as a base situation and instituting mechanisms to ensure that base funding committed to healthcare is actually spent on healthcare. A solution must also ensure that both levels of government acknowledge their responsibility to provide adequate funding for universal access to needed physician, hospital and other health services, without imposing on patients financial barriers to care. Further, provincial governments must acknowledge that the federal contribution to spending entitles the federal government to have a say in how the money is spent. Finally, any workable solution will make transparent the relative contributions of the two levels of government to health care spending. In return, the federal government would place conditions on the transfer of funds, one of the stipulations of the original medicare plan. Thus, this funding formula would re