Ottawa —
The man charged by Ottawa to fix medicare pledged yesterday to embrace the solutions in a report that recommends tax increases, smart cards and a health-expenditures watchdog.

Roy Romanow, a former premier of Saskatchewan and head of the Commission on the Future of Health Care, warned yesterday that politicians who ignore the sweeping report do so at their peril.

"I think they'll be punished at the polls," Mr. Romanow said yesterday in unveiling the study, which culled its recommendations from a dozen daylong focus groups of rank-and-file Canadians.

The groups said that people are willing to pay more for health care, provided they know that such taxes are earmarked specifically for medicare.

They said they want a health auditor to ensure money goes where it is supposed to. And they backed a number of other ideas, including computer information cards, limited user fees and the establishment of teams of medical professionals to save money by eliminating duplication.

"This is a very, very scientific, thoughtful academic exercise," Mr. Romanow said. ". . . This carries a heck of a lot of weight with me."

Mr. Romanow said that the report's importance is illustrated by so many people expressing the same views.

Mr. Romanow would not say which recommendations he would accept, but he added that the idea of a health-system auditor-general is worthy of deep study and that designated health-care money conforms with that desire stated by Canadians at earlier hearings.

"I think the notion of earmarking it is one which conforms with what they want: Accountability, transparency and effectiveness."

Ottawa funnels health-care money to the provinces without receiving guarantees on how it will be spent.

One of the study's most controversial findings is the acceptance of user fees in certain cases -- patients seeking second opinions, for example.

However, Mr. Romanow said that participants generally are negative toward user fees and would consider them only after exploring other options.

Participants spent little time considering the system's expansion to areas such as pharmacare and home care, two ideas the federal government may examine.

Judith Maxwell, whose Canadian Policy Research Networks helped produce the report, said that there is room for more study, but Canadians want the core services of health care protected, and they want action now.

"They were giving a mandate for change. They were not giving a mandate for more study."