I have a bias that I want to share with you. I have had the opportunity to travel widely, and I believe that Canada has one of the best medical systems in the world. I also believe this system is a magnificent gift to medical practitioners in this country. We have access to extraordinarily sophisticated equipment to help with diagnoses. We can work in excellent health care facilities that will arm us with the apparatus to treat disease. We are be empowered to focus on prevention, not only cure. We have access to great universities who, with our practitioners, can forge medical discoveries. And for the most part, we get to do all of this, without ever, not even once, having to worry if our patients can afford to have us as their doctor. This is a remarkable gift. The fact that we treat the rich as we do the poor is a barometer of our civilized society.
You are hearing of my bias today, because July 12th, is an important anniversary. On this date in 1966, Allan MacEachen, former Cape Breton academic and new Minister of National Health and Welfare, introduced the Medical Care Act in Parliament, with these words, “The government of Canada believes that all Canadians should be able to obtain health services of high quality according to their need for such services and irrespective of their ability to pay. We believe that the onlypractical and effective way of doing this is through a universal, prepaid, government-sponsored scheme.” 1
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Alan MacEachen, Minister of National Health and Welfare in Lester B. Pearson’s government, shown shortly after he introduced the Medical Care Act in July 1966 [2]
Despite passing the first reading, there was substantial opposition to the Act. Philosophically, some felt health care was the responsibility of the provinces and, in the extreme, federally supported healthcare bordered on communism. There were issues within the Liberal Government. Minister of Finance and Acting Prime Minister, Mitchell Sharp, made a public declaration that medicare would have to be abandoned or delayed because of the country’s financial situation.[3]
of both the public and the anti-medicare lobby when
Finance Minister and Acting Prime Minister Mitchell
Sharp declared that medicare would have to be
abandoned or delayed because of Canada’s dire
financial situation. [4]
Of course, the Medical Care Act was enacted on July 1, 1968. But seeing Mitchell Sharp’s concerns one might sense some “deja vu” with our current fiscal woes. Current financial realities leading up to the 2014 Health Accord coupled with the massive deficit in the Province of Ontario have once again raised the spectre of whether Canada can afford a national healthcare system. Most would agree that substantial changes in how we manage and practice medicine are on the horizon.
No matter, I believe that all of us in the healthcare professions, the legislators and the law-makers have a responsibility to work together, to make every effort possible, to sustain the magnificent gift of our healthcare system.
If you have any thoughts about my bias, our healthcare system and our responsibility, please comment on this blog, or better yet…please stop by the Macklem House, my door is always open.
Richard
P.S. – All Canadians should visit the Canadian Museum of Civilization “Making Medicare” section of their website. It is a wonderful resource and provides a fascinating and informative insight into the history of universal healthcare in Canada.
http://www.civilization.ca/cmc/exhibitions/hist/medicare/medic00e.shtml
P.P.S – I would like to acknowledge the assistance of Peter Aitken, our Communications Coordinator and Awards Officer in preparing this blog.
1 Canada, House of Commons Debates, Hansard [July 12, 1966], p. 7605
2 Library and Archives Canada, PA-117121. Photographer: Duncan Cameron
3 http://www.civilization.ca/cmc/exhibitions/hist/medicare/medic-5h24e.shtml
4 Library and Archives Canada, Acc. No. 1991-26-239, C-143095.© George Shane
Hi Richard – you are largely right that Canadians have an excellent health Service. However there is certainly not equal access for all. Our Aboriginal population have different (and in my view inferior) access to certain drugs therapies, and I often have to campaign for medication that our non First Nation population can get through differing criteria. In addition for a specialty like mine, it is very clear that in the absence of additional insurance access to physiotherapy, orthotics etc is almost impossible. Hence one regularly cares for patients who miss out on custom footware, hydrotherapy etc precisely owing to inability to pay. Inequity remains rife in our system despite first appearances, and whilst we have something wonderful to celebrate we should guard against complacency by continuing to advocate for those in most need
Henry
Henry,
Points very well taken. You correctly point out that it’s ostensibly only a portion of health care that is public ally funded.Most notable among the things we do October well, are pharmaceuticals.
Richard
You are absolutely right. As of 1969 I was never required to speak to a patient about money.
However we have a challenge. Prioities are required. In making these choices it is important that the public and the current generation of health care professionals understand how we got here. History is important
Thanks Jim,
And thanks for ongoing reminders about the necessity for understanding the past in creating to orrow’s destiny.
Richard
Yes, you are indeed biased. You think the system is great because as a dean, you have a secure source of income, dental, and malmractice insurance, and a pension plan. Your office and practice expenses are paid for by the goo people of Ontario. Your private practice colleagues, however, do not have any of those things conferred upon them. They are forced to work for a government impose fee schedule that is at least 40% behind the rate of inflation since I left my Ontario practice 21 years ago. Income is retricted by the Canada Health Act, but expenses are not. The same applies to hospitals who have ever burgeoning expenses due to increasing costs of labour, construction and technology. Only provinces who have had a gas/oil windfall can afford to be fair to doctors and hospitals. Anyone who lives in a “have not” locale (like Ontario) is simply living in a fool’s paradise if they think their system is not on the verge of collapse.
Dear Edward,
Thank you for bringing your perspective to the discussion. I do believe, however, your data does not actually reflect that Ontario’s doctors have actually done quite well financially in the last decade.it is certainly my understanding that their revenues have improved beyond their expenses over this time period. That, to me, doesn’t condone one way or another what is happening during the current negotiations, but rather just represents the facts.
Richard
Get your researcher to get you a copy of “the First Ten Years” by Mr Ken MacTaggart and published by the CMA in 1972. I will try to send a letter I wrote to Dr. Anne Doig following a discussion on how to improve Medicare.message:%3C357C6302-0934-4E04-AD8A-66BBFEEB747E@myaccess.ca%3E. Thanks
Dear Murray,
Thanks for this suggestion and I will source the document. I look forward to receiving further communication from you.
Richard
Dear Dr. Reznick,
Yes, indeed we do have a basically sound medical system. No one is forced into bankruptcy because of very large medical charges, and there is a good safety net for all. We are not the gold standard for care. None of my medications were covered until I turned the magic 65. And there are very long wait times for specialist consults, surgery, mri scanning. And people are chastised for going to the U. S. for their care, because timely care was not available. There was a recent article on the editorial page of the Whig about two patients who went to the U. S. for back surgery and are not at odds with the province of Alberta over insurance. In any case I like your blog project.
Best regards from John Arber, Queen’s Medicine 1971
Dear John
Thanks for your comment. I agree with you, we need to strive to improved in a number of areas, but believe structurally, we have a sound system.
Richard
Dear Dean Reznick
Thanks for your comments about Canada’s health care system. They bring a refreshing sense of perspective to what is becoming an increasingly myopic view by many observers who have individual gripes about their experience with it.
Canada’s health care plan was developed by the Liberal Party in the late 1950`s and early 1960`s when it was the Official Opposition in Ottawa. I met with the late Tom Kent and Walter Gordon many times over a period of years to help develop the plan. It came before the Kingston Conference in 1960 and was ratified at a national policy conference in Ottawa in the winter of 1961, I was the English Co-Chair of the health care debate which lasted from 9 am to 9 pm for two consecutive days before the resolution was approved to proceed to legislate a national health plan when we next took office federally.
The debate was spirited. Ex-pat English doctors threatened to leave Canada if the plan was implemented. `We didn`t leave socialized medicine in the UK to become part of socialized medicine in Canada“ was the thrust of their argument.Others felt the plan would be too costly and the country could not afford it.
Ontario did not become a participant in the national plan until 1969. The government of the day finally had to join because, as Health Minister, Dr. Matthew Dymond told the media “As a province we cannot forego the $14,000,000 a month which joining the plan will bring to the provincial treasury“
When Ontario did join the plan 95% of the population was already covered by AMS, PSI, Windsor Medical Services and the OMA Welfare Plan — all doctor-sponsored, pre-paid medical care programs initiated and administered by doctors.
Doctors played a major role in pioneering health care plans in Canada. Indeed, their pioneering demonstrated that a national plan was desireable and feasible.
I think the medical profession should be devoting a lot of time these days to working out the changes and improvements that this great plan will need for its continuing success in future.
Boyd Upper, Meds 53
Dear Boyd,
What remarkable reflections. It is so helpful to have someone like yourself, put aspects of this debate into perspective. I wonder what the annual transfer of 1.7 B would equate to in 2012 dollars!
For our readers, I found this “blog report” of a visit by Dr. Upper to Manitoba. It speaks to Dr. Upper’s contributions, which have been many. “Boyd Upper visited with Manitoba Liberals over the weekend. He is an inspiration. He was involved in the move to have a Canadian flag – being one of the young Liberals presenting a resolution to this effect at a convention in Winnipeg in about 1956. He was involved in the effort to bring in our Canadian medicare system. He attended a crucial Liberal on in about 1961 – at which a resolution was passed, after intense debate, to support bringing medicare into Canada. He was there, in the Ontario election in the early 1960s in which the idea of a Canada Pension Plan was pushed forward to much opposition. For all your work on these initiatives, we thank you Boyd.” (http://manitobaliberals.blogspot.ca/2010/01/boyd-upper-tribute-and-thank-you.html).
Richard
“There are between 9,000 and 24,000 deaths in Canadian hospitals
annually due to preventable medical error (3)”
http://www.chsrf.ca/migrated/pdf/news_events/CEOforum_S2_Brown.pdf
Please explain!