Medicare at 60: reasons to celebrate

Hey there, time traveller!
This article was published 01/07/2022 (1365 days ago), so information in it may no longer be current.

On July 1, 1962, Saskatchewan’s CCF/NDP government implemented medicare. More than 90 per cent of the province’s doctors went on strike, even refusing to deal with emergency cases. Hundreds of reporters rushed to Regina. The world was transfixed.

The physicians had some popular support and the American Medical Association provided financial and logistical support. But to others, medicare was “socialized medicine” and socialism was communism. Saskatchewan was a Cold War battleground.

On July 11, a demonstration by doctors failed to draw a fraction of the promised 40,000 to 50,000 people. The government imported 150 mostly British physicians to ensure medical services. Support for the strike support waned and the parties settled on July 23.

Alarmed by the developing events in his home province, prime minister John Diefenbaker asked Supreme Court justice Emmett Hall to chair a federal royal commission on health care. In 1964, Hall strongly recommended a national medicare program.

Pushed by NDP leader Tommy Douglas, the minority Liberal government of Lester Pearson passed the National Medicare Act in 1966. Liberal health minister Monique Begin championed the Canada Health Act in 1984.

As we have staggered through COVID-19, and as Canadians deal with waits for surgery, wait in ERs and even wait to get a family doctor, many wonder if we took the correct course.

The answer is unequivocally yes — medicare has been an overall success and we still must fix its original problems, which have become magnified over time.

If Saskatchewan had not implemented medicare, our system would look a lot like the U.S. health-care model, one of the world’s worst overall.

We pride ourselves on the differences from our American cousins and we overlook how similar we are. We aren’t Swedish. We’re North Americans. Health care evolved similarly in both countries, with lots of interchange. Canadian physicians are not regarded as foreign graduates, and many U.S. systems rely upon Canadian nurses.

In 1962, the U.S. and Canada had virtually the same health systems, spent the same, and generally had the same level of health. Fifty per cent of Canadians lacked medical insurance.

Sixty years later, 99 per cent of Canadians have hospital and physician coverage, while almost half of U.S. working-age adults either have no insurance or such inadequate coverage such that a major illness could lead to a financial crisis. Half of low-income Americans skipped some needed care last year because they couldn’t afford it.

Sixty years ago, both countries spent about seven per cent of their economies on health care. In 2019 the U.S. spent 17 per cent, compared to 11 per cent in Canada. Most of the difference in costs isn’t related to care; it’s paperwork. The U.S. spends about US$1 trillion per year on administering its red tape-driven private system. That’s half of Canada’s entire GDP.

Over the past 60 years, our lives have lengthened compared with Americans’, and our infant mortality rate has decreased Clearly, medicare has been good for our health and our pocketbooks.

Canada’s system does not compare as well to those in other wealthy countries, however. We have some of the longest wait times for family doctors, specialists and procedures, while being some of the highest users of ERs. Other countries with universal systems typically cover more services, including drugs, dental and home care, while spending about the same as Canada.

These problems are a legacy of 1960s medicare. We didn’t publicly cover dental services and drugs. Predictably, poor people have worse teeth and take fewer medications.

In the 1960s, health care meant hospitals. And because the Canada Health Act doesn’t cover community services, we still hugely over-rely on hospitals. Provinces cut hospital beds and offload community costs to patients and families, a form of “passive privatization.” Canada has among the fewest hospitals beds per capita of any wealthy country, and an institutionally focused system without enough beds is a prescription for gridlock.

And we have a doctor-focused system as well. The Canadian Medical Association opposed medicare in the 1960s and The Canada Health Act in the ’80s. Governments heard them, and have been agonizingly slow to move away from the centuries-old private-practice, fee-for-service model.

Most doctors are still paid a fee for each service, even though this incentivizes high volumes rather than high quality. Most young doctors want to work on salary in a team, but they can’t find the right openings.

This Canada Day, let’s celebrate medicare’s diamond anniversary. We have done well. But then let’s add coverage for drugs, dental and home care; it’s past time to remake the way we deliver medical care.

If we can accomplish that, then we could really celebrate medicare’s platinum jubilee in 2032.

Michael Rachlis is an adjunct professor at the University of Toronto Dalla Lana School of Public Health.