Health care policy has been a topic of discussion for media outlets worldwide since President Trump considered repealing Obamacare and introducing the controversial American Health Care Act. The bill was pulled on March 24th, but as a Canadian moments like this are a wakeup call for me. When my brother was rushed to the E.R and needed stitches in his forehead, there was no discussion about expenses because they were non-existent. If we lived in America, those stitches could have cost my family thousands. Free health care is a right that Canadians are lucky to have, and the historical events that lead to Canada’s current universal health care are tragic and shocking, yet still inspiring.
The Influence of the Great Depression
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Health care in Canada was traditionally a commodity where patients paid their doctor at the time the service was provided. How much they paid was dependent on their financial status; most doctors assessed the patient’s ability to pay and charged them accordingly. At hospitals, prices depended on the ward the patient chose to stay in: general wards were the least expensive, followed by semi-private wards and private wards, which cost the most.
The Great Depression (1929-1939) sparked a high demand for a public health care system in Canada. In 1929, substantial amount (about 60%) of Canadians were not earning enough to afford adequate health care. Thus, many people did not use medical services. In the 1920s medical technology and diagnostic tools like X-Rays were being used more often, and health care became more difficult to afford. Prime Minister R.B. Bennett’s government did not increase spending for social welfare, but there was an extremely high demand for access to health care. Several sick people even sent letters directly to Bennett desperately pleading for help.
Dr. Kenneth MacKenzie spoke on the issue at the Medical Services Conference that year: “If there is an evil there must be a remedy, and that remedy, as I see it, must be some form of distribution of cost among the people at large.”
Unfortunately, this was not feasible. During the Great Depression, one in five people depended on the government for financial relief and survival. Although the Canadian government was unable to fund a public health care system at this time, the possibility of publicly funded health care funding was brought to the forefront.
The First Hospital Care Plan
The first province-wide, universal hospital care plan was introduced nearly two decades later in 1946. This plan was called The Saskatchewan Hospitalization Act, and it guaranteed full hospitalization coverage, paid for by the government, to every resident. It was passed by Thomas Douglas, the Premier of Saskatchewan at the time. In 1949, a survey of all Canadians was conducted that asked if they would vote on a government-funded health care system, and 80 per cent said yes.
In 1957, the Hospital Insurance and Diagnostic Services Act (HIDS) was passed. This system financed 50 per cent of provincial and territorial hospital care expenses, and by 1961 every province had HIDS Act programs in place. HIDS was a major stepping stone to Canada’s current universal health care plan, and Saskatchewan would later establish the very first public health care program for physician services. However, this progression did not come without hardship.
The 1962 Doctor’s Strike
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When the Saskatchewan Medical Care Insurance Bill was introduced in 1961, members of the College of Physicians and Surgeons of Saskatchewan (CPSS) strongly disagreed with it. The Act would provide medical care insurance based on pre-payment and universal coverage. Members of the CPSS said that they refused to comply with a government-controlled scheme as it would be too regimented and would interfere with the doctor-patient relationship. In May 1962, they said that they would not practise if the Bill was passed. On July 1, 1962, the bill was passed despite the doctors’ unwavering disagreement.
Most physicians closed their offices immediately. Some chose to take holidays, and some left the province altogether, leaving Saskatchewan in a state of emergency. Doctors from Britain had to be brought in by the Medical Care Insurance Commission, and local citizens groups opened medical clinics and hired doctors to work in them. People who strongly disagreed with both the Act and socialism in general formed committees known as Keep Our Doctors (KOD) Committees and campaigned against it. This event is known as the Saskatchewan Doctor’s Strike, but it didn’t last long. Within a few weeks, KOD support had decreased greatly and doctors were starting to return to work.
On August 2nd, 1962, just a month after the Strike began, amendments were added to the Act. It was changed so that government payments would make up 85% of the CPSS fee schedule, and some sections were omitted altogether to reduce interference. Doctors returned to work, and a survey in 1965 found that majority of doctors favoured the plan.
Medicare and The Present Policy
The Medical Care Insurance Act, or Medicare, was introduced in 1966. Medicare allowed each province and territory to initiate a universal public health care plan and this system is still in place today. There are 13 provincial and territorial health care insurance plans, not just one national plan. Under this system, all Canadian residents have access to hospital and medical services when necessary without having to pay out-of-pocket. In 1984, the Canada Health Act bill was passed. This plan prohibits physicians to charge any additional fees and requires all health care insurance plans to meet specific standards, including public administration, comprehensiveness, universality, portability, and accessibility. Doctors get paid on a fee-for-service basis when they bill the government. For example, doctors in Ontario bill the Ontario Health Insurance Plan a standard amount for every service provided.
Many other countries have adopted the term Medicare, but it does not necessarily mean universal health care. In the U.S., Medicare is a health insurance program exclusively for people aged 65+, people with disabilities, or people with End-Stage Renal Disease (kidney failure requiring dialysis or a transplant). Free health care is one of Canada’s greatest assets, and it took a great deal of struggle among citizens compromising between science and politics to achieve.