As Roy Romanow can testify, Canada's health-care debate has not always been guided by rationality or public interest. He will remember how his political hero, Tommy Douglas, was vilified in the 1960 Saskatchewan election for daring to propose a public medical insurance plan. The Canadian Medical Association pumped $100,000 (in 1960 dollars) into the battle to nip "socialized medicine" in the bud. Its paid advertisements claimed that family doctors would flee the Prairie province, the populace would be treated by the "garbage of Europe" and health bureaucrats would commit women with menopausal problems to insane asylums.

These desperate efforts to poison the public's mind were no match for a good idea whose time had come. Mr. Douglas's Co-operative Commonwealth Federation government came back with another large majority and outlasted its opponents two years later in Saskatchewan's notorious doctors strike.

Again in the early 1980s, when the extra-billing crisis prompted Ottawa to introduce the Canada Health Act, public opinion rescued medicare from those bent on undermining it. Indeed, it wasn't until 1990 that the CMA finally dropped a constitutional challenge to the iconic public health-care system.

Medicare's detractors were never particularly adept at making a difficult case. In the early 1960s, Mr. Justice Emmett Hall led the royal commission that recommended a Saskatchewan-style medicare system for the rest of the country. Judge Hall was no socialist. A law-school classmate of John Diefenbaker, he was open to a continued role for private insurers in the health-care system of the future despite the fact that 7.5 million Canadians -- 30 per cent of the population -- were uninsured at the time. In the midst of his deliberations, Judge Hall turned 65. The private insurance industry, preferring the young and healthy, cut off his coverage. It wasn't a determining factor in his final conclusion, but it couldn't have helped.

Despite the trials and tribulations of the past decade, the values of a universal, publicly administered health-care system remain as firmly fixed in the contemporary public psyche as the Canadian Shield. But now medicare needs renewal. It seems to soak up more and more of our tax dollars every year while delivering less and less quality.

From 1975 to 1991, public spending on health care rose by 11 per cent a year. Then, for five years, the system was put on an austerity diet as the provinces and Ottawa reined in their fiscal excesses. Deficits were vanquished and taxes trimmed, but the health-care system went into cardiac arrest.

Once again, growth rates in public health spending have been averaging 7 per cent a year since 1997 as governments try to stabilize the patient. Yet waiting lists continue to grow. A diagnosis of a deadly cancer can take months to obtain; a patient may then wait months more for treatment. This is morally unacceptable.

Mr. Romanow, who was appointed back before Jean Chrétien lapsed into lame-duck status, faces no small challenge. As they await his report next week, Canadians will be looking for him to preserve medicare's universality while enhancing its quality -- and without making it unaffordable.

We've known Mr. Romanow as a nation-builder, a pragmatist and, once in a while, a bit of a political romantic. We hope the former two qualities prevail over the third in this particular inquiry, that he doesn't allow any sense of guilt over the tough decisions he was forced to take as Saskatchewan's premier -- closing rural hospitals, derailing a runaway pharmaceutical program -- impel him toward sentimental conclusions now. His understandable pride over what his home province wrought a generation ago -- what he likes to call Saskatchewan's gift to the nation -- cannot be allowed to deter him from pushing for reinvention where reinvention is necessary.

Over the next five days, The Globe and Mail will lay out the principles by which we believe medicare should be in some cases reformed and in others conserved. We will examine such questions as the financing of the system, the organization of front-line medical services, the gaps in the medicare system, the appropriate role for the private sector and the necessary mechanisms of accountability.

Canadians are disconcerted by their medical system, but, despite considerable provocation over the past decade, they have not given up on its ideals. What they seek is certainty: the certainty that high quality and timely care will be there for them when they need it.

Health-care users aren't terribly interested in which level of government pays what or the conditionality attached to funds. They couldn't care less about the details of primary care reform or regional health authorities. The vast majority do not even buy into the rhetoric of crisis.

What they are desperately seeking is assurance that when their health declines or catastrophe strikes, they will receive the best of care. And that until then, the aches and pains and niggles that impair the quality of their lives -- the bum knee that makes it tough to climb stairs, the bad hip that makes work painful -- will be looked after in a timely manner.

Our political leaders have known of these challenges for years, but our health system continues to flail and fail. And still there is no certainty. Successive ministers of health, provincial and federal (ministers who turn over at an alarming rate), have failed utterly to come up with a credible plan of action to assure the public.

In the mid-1990s, Finance Minister Paul Martin came up with just such a plan for overcoming the deficit. Canadians applauded (even though his cuts would contribute to our health-care woes). They could see a future in his prescription, even if it meant a tougher present. After Sept. 11, 2001, with our economic access to the United States badly impaired, Foreign Minister John Manley came up with a credible plan and proceeded to make gains on the border file that had eluded less willful and motivated players.

Yet health care -- the issue about which Canadians feel most passionate and most pessimistic -- has lacked for a man or woman with a plan. Health care, of course, is infinitely complex. It involves different levels of government and the interaction of all sorts of actors: nurses, doctors, technicians, unions, administrators, pharmaceutical companies and more.

It also involves a changing roster of patients. The war generation, accustomed to sacrifice and thankful for small mercies, is giving way to greying boomers, a cohort renowned for its high expectations and lack of deference. These patients will want Mayo Clinic quality without the bill.

Medicare is facing its last best chance. Public opinion will not protect it forever. The baby boomers are committed to a single-payer, universal system. But in a crunch between poor health care and paid health care, they will opt for certainty over universality.

In his report last month, Senator Michael Kirby posed an important question about the constitutionality of denying individuals in a free and democratic society the right to use their own money to purchase health services that are not being satisfactorily provided on a timely basis by the state. So it falls to Mr. Romanow to prescribe the cure that ensures our health-care system is one of increasing and not diminishing quality.

Next week, we will see whether he truly is a man with a plan in the mould of those other sons of Saskatchewan, Tommy Douglas and Emmett Hall -- a solid, pragmatic plan that not only reflects those values Canadians hold dear but leads all players in the health-care system to solutions appropriate to the challenges not of the 1960s, but of this day and age.
Tommy Douglas and Emmett Hall -- a solid, pragmatica solid, pragmatic plan that not only reflects those values Canadians hold dear but leads all players in the health-care system to solutions appropriate to the challenges not of the 1960s, but of this day and age.