The Roots of the Medicare Crisis

By Ken Collier

Briarpatch

May 2006

“Medicare’s history provides us with fertile ground upon which to consider opportunities for improving and expanding public health care.”

WHILE ALBERTA STAGES PROVOCATIONS aimed at privatizing at least part of medicare, the rest of Canada watches and wonders whether provincial programs elsewhere may meet a similar fate. Much argument is made about how to defend medicare, how to keep it public, how to cure ills such as long waiting times and uneven distribution of resources. This debate falls unevenly and haphazardly across the country, usually in response to some external event such as the Quebec Supreme Court rulings on timely access to treatment.

In these circumstances, medicare could very easily become a casualty of the reactive, defensive nature of this debate. No political party has stepped forward to propose anything much beyond defending existing health programs.

Merely defending public medicare, however, is a very limited (and limiting) goal. Medicare’s history provides us with fertile ground upon which to consider opportunities for improving and expanding public health care in bold and innovative ways.

I attended the Saskatchewan Co-operative Commonwealth Federation (CCF) conventions in 1958, 1959 and 1960. Saskatchewan Hospitalization, the provincial plan that paid for hospitalization expenses largely out of general taxes, was introduced in 1949. The idea of medicare, which would cover the costs of physicians, kept recurring at these conventions as a natural addition to existing coverage. Each year resolutions to that effect passed resoundingly.

Medicare was a central issue in the provincial election of 1960. Once the votes were in, the CCF government set to work planning how to institute the medicare program. In October 1961, at a special session of the legislature, medicare was introduced and passed, and formally began operation in July 1962, after some delays to accommodate administrative planning and organizing. During that delay, the Saskatchewan College of Physicians and Surgeons, which had opposed medicare in the form legislated, mounted an expensive campaign, partly orchestrated from outside the province, to stop the program. When they failed to do so, the College instructed its members to withdraw their services – the so-called Saskatchewan “doctors’ strike.”

The history of that contest over medicare has been recorded elsewhere. Our current issues, however, arose from its resolution. Two weeks of “doctors’ strike” forced the CCF government, and the party, to make some difficult decisions. Some options hinged on a call to complete the “march toward comprehensive health insurance that will cover all our people and will insure a high standard of medical care to every citizen of Saskatchewan,” as promised by Premier Tommy Douglas in the legislature in 1960. Other aspects of the crisis hinged around electoral politics. Many CCF Members of the Legislative Assembly heard loud complaints from politically hostile or frightened constituents.

By 1962, Douglas had moved into federal politics becoming leader of the CCF’s successor, the New Democratic Party. Also by that year, the CCF-cum-NDP was halfway through its term, and reelection was on the minds of most MLAs. Complexities also arose for MLAs who had relatives working in the health field, some of whom were doctors or others whose professional associations fought medicare.

With Tommy Douglas gone to Ottawa, the new Premier, Woodrow Lloyd, led the government into the struggle over medicare, but the governing MLAs were not firmly behind the process. They largely wanted a way out of the conflict, though Lloyd and a few other cabinet ministers took strong positions to back medicare in the form they had promised during the election. After some further squirming, the wavering government members and the medical profession finally settled on a mediator: Lord Stephen Taylor, a British doctor with a background in helping set up the British National Health Service. On July 23, 1962, Lord Taylor announced the terms of the Saskatoon Agreement. Those of us who had organized in favour of medicare, waiting outside the Bessborough Hotel in Saskatoon as the negotiators emerged, were shocked to learn of the concessions given by the government.

Many of the proposals for consultative bodies representing stakeholders in health services fields (including patients), whose aim was to maintain standards and prevent problems in medicare, were cancelled. The relevant professions, dominated by the College of Physicians and Surgeons, would resume their old ways of speaking on behalf of others with less power.

Medicare provisions to uphold “quality of care” and gradual improvement of quality standards were cancelled. Government would be prevented from doing anything about quality issues that affected professional privileges, especially those of doctors.”…(T)he public agency responsible for disbursing enormous sums of money could make no serious effort to guarantee that the money was well spent,” wrote Stan Rands, author of Privilege and Policy: A History of Community Clinics in Saskatchewan.

The agreement also prevented the Medical Care Insurance Commission from making any regulations aimed at improving quality in the practice of medicine or health care in general. The medical profession would reassert its sole right to interpret its mandate.

As a result, even before medicare was legislated, many of the hopes of pro-medicare forces in the CCF/NDP were quashed by party and government bureaucrats. Motions to include government support for healthy living, nutrition, early childhood development, prevention of disease and health hazards, healthy workplaces (and thus medicare’s relation to Occupational Health and Safety rules), health programs for women, community treatment of mental illness, and so forth, never made it into legislation, regulation, or even political party discussion papers. Additionally, research into non-traditional medicines and other methods of healing—-such as chiropractic, herbalist remedies, and acupuncture—-was proposed in many locales. But in the 1960s, these practices were controversial and normally overruled by the medical profession; the government signed away its right to encourage them.

The Saskatoon Agreement provided the foundation for national medicare in Canada, and tragically, the bulwark against any improvement of it. Medicare wound up being little more than an insurance program to pay for health services, which are mostly about treatment for illnesses and injuries. Though medicare is government-run and operates under the five principles of the Canada Health Act (Public Administration, Comprehensiveness, Universality, Portability and Accessibility), these are the results of compromises that began in Saskatoon in July 1962. Many of the humanistic health concerns of progressive citizens who fought for medicare in the early years were suppressed by bureaucratic and administrative inertia, political weakness and compromise, and powerful, well-funded forces marshaled against them. Consequently, we have inherited a medicare system that was hobbled from the very start.

“The Saskatoon Agreement provided the foundation for national medicare in Canada, and tragically, the bulwark against any improvement of it.”

My own conclusion is that while the medicare we have is worth defending, we need to renew it from the roots up. The debates of the 1960s and earlier need to be infused with new energy and should be re-stated in light of medicare’s history. Medicare needs not only to be defended: it needs thorough re-working, re-thinking, updating and upgrading. New political organizations willing and able to carry the march toward comprehensive and high quality health programming, not just insurance, are needed.

Ken Collier taught Social Work at the University of Regina for 23 years, then moved to administrative roles at Athabasca University, from which he retired in 2005. He continues in progressive activism in Red Deer, Alberta.

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