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What is perhaps most striking about Duncan Sinclair's rethink of medicare is the familiarity of his proposed approaches:

-More management, not more dollars.
-Managed waiting lists for rational rationing.
-Integrated health systems with capitation and other incentives that distinguish need from demand.
-Increased cost awareness through year-end financial statements and a return to true insurance models.
-An end to federal-provincial wrangling.

These ideas are not radically new, having been front and centre in the health policy world for years, if not decades. Yet we continue to debate them as almost the sole solutions to our periodic crises in medicare. This should be of concern if you believe, as I do, that medicare will confront quite different issues in the next decade compared to those it has faced in the last few decades. If we are not careful we will become victims of the lengthy transmission process from ideas to policy -implementing policy solutions of the 1980s with only a partial fit for the issues of the 21st century. Although some of these issues will undoubtedly stay the same, many will transform into problems of a different kind, and emerging technologies and pressures will generate as yet unthought of problems. It is this world that should guide the rethinking of medicare.