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Making Medicare

Making Medicare: New Perspectives on the History of Medicare in Canada

Copyright Date: 2012
Pages: 336
  • Book Info
    Making Medicare
    Book Description:

    This collection fills a serious gap in the existing literature by providing a comprehensive policy history of Medicare in Canada.

    eISBN: 978-1-4426-6241-4
    Subjects: Political Science, History

Table of Contents

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  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. Foreword
    (pp. vii-viii)
    Patrice Dutil

    I write this on the 50th anniversary of the end of the Saskatchewan doctors’ strike, an unprecedented action in the annals of this country and, for all sorts of unfortunate reasons, not the last of its kind. The doctors in that province walked off their practices on Dominion Day, 1 July 1962, to protest the coming into effect of the SaskatchewanMedical Care Insurance Act. They raised arguments about patient rights, about funding, and about accountability. The prairie doctors made their point in the summer of 1962, but so did Saskatchewan, and so did Canadian society. Within a decade, prompted...

  4. Editor’s Preface and Acknowledgments
    (pp. ix-2)
    Gregory P. Marchildon
  5. 1 Canadian Medicare: Why History Matters
    (pp. 3-18)

    Fed by profound ideological divisions as well as hard-nosed calculations of gains and losses in the event of policy changes, the debate on the future of the Canadian system of universal health care seems never-ending. In the early to mid-1990s, provincial governments either cut or slowed health-care expenditures, and some (most notably, Saskatchewan and Ontario) closed hospitals.¹ As a consequence, satisfaction with public health care, once the highest in the industrialized world, fell precipitously.² In response, governments reversed course by investing more in public health care. They also established commissions and advisory committees to recommend ways in which to fix...

  6. Part One: National History of Medicine

    • 2 The Foundations of National Public Hospital Insurance
      (pp. 21-40)

      According to Robert Putnam,¹ “history matters.” Increasingly social scientists point to the need for a historically informed view of social policy. Historical institutionalists demonstrate that national health policies can be best explained through historical analysis which outlines the sequence and timing of major shifts, particularly at critical junctures, in health policy.²

      These theorists also state that major changes in national health policy, such as the establishment of a public health insurance system, will occur infrequently.³ Furthermore, the rare windows of opportunity which allow these “earthquake” sized health policy events to occur will usually open under the pressure of a much...

    • 3 Into Thin Air: Making National Health Policy, 1939-45
      (pp. 41-70)

      On 27 June 1941, at the end of a letter thanking Dr. Gregoire Amyot for sending him information about British Columbia’s health insurance legislation, Dr. John Joseph Heagerty, the long-serving Director of Public Health Services in the federal Department of Pensions and National Health commented: “I do hope the whole thing doesn’t end in thin air.”¹ The “thing” was the federal government’s first attempt to create a national health insurance program. Heagerty was prescient in his observation because the proposal that he and his minister, Ian Mackenzie, a Liberal from British Columbia, were formulating would undergo significant modification because of...

    • 4 The Liberal Party and the Achievement of National Medicare
      (pp. 71-88)
      P. E. BRYDEN

      To understand the origins of government-funded medical care in Canada it is impossible to ignore the role played by successive administrations in Saskatchewan. Historians of that province have rightly emphasized the development of ideas of health insurance from their roots in agrarian populism and farmer militancy, through the organization of the municipal doctors scheme and the Swift Current model, to the now-legendary clash between Saskatchewan doctors and the state in the summer of 1962.¹ Broader examinations of health insurance in the Canadian context have also paid close attention to the Saskatchewan model.² This emphasis on the events in Saskatchewan, and...

    • 5 Political Cartoonists Respond to Medicare
      (pp. 89-109)

      Debates about health-care policy have been and continue to be a rich topic for editorial cartoonists. The subjects of the debate are competing ideas about Canadian Medicare. By the early 20th century, national health policy was a fact or a subject for debate in industrialized countries. But what kind of plan would Canada adopt? Would it be based on social justice and collective security or on individual freedom and minimal state intervention? What about professional autonomy? How would each province implement federal policy?

      The cartoons are from the period 1944 to 1986, which covers the implementation of the three major...

    • 6 After Medicare: Regionalization and Canadian Health Care Reform
      (pp. 110-134)

      Canadian health policy witnessed three overlapping transitions in the postwar era. The first, roughly from the close of World War II to 1971, was marked by the steady expansion of federal grants-in-aid for provincially administered health services and successive political victories for universal hospital and medical insurance in both provincial and federal parliaments. National health insurance brought in its wake a second transformation, beginning in the early 1960s and continuing through the 1970s. This was the dramatic growth and reconstruction of ancillary health services: community health clinics, mental health services, nursing homes, home care, public health and prevention services, specialpurpose...

  7. Part Two: Individual Provincial Histories of Medicare

    • 7 Four Precursors of Medicare in Saskatchewan
      (pp. 137-150)

      In 2004, when 1.2 million Canadians voted in a Canadian Broadcasting Corporation competition to choose the Greatest Canadian of All Time, the audience chose Tommy Douglas, who was also known as the “Father of Medicare.” What most people do not know is that Douglas and his team built on the phenomenal successes of several bold rural initiatives that were in place before he came to power in June 1944. These initiatives led to the phenomenally successful Swift Current Health Region (HR#1) two years later, and were important precursors of provincial Medicare in 1962.

      These bold initiatives came out of the...

    • 8 The Road Not Taken: The 1945 Health Services Planning Commission Proposals and Physician Remuneration in Saskatchewan
      (pp. 151-182)

      The instrumental role of the Saskatchewan Co-operative Commonwealth Federation (CCF) government of 1944-64 in the development of Canadian Medicare has overshadowed the interpretations of many historians that the universal medical services plan introduced in Saskatchewan in 1962 was not what the CCF had intended when it first came to power in 1944. In his classic study of the Saskatchewan CCF, Seymour Martin Lipset states that the “party leaders originally envisaged a medical system in which all doctors would work on a salaried basis….”¹ Frequently based on Lipset’s work, subsequent historical accounts of the establishment of Saskatchewan and Canadian Medicare often...

    • 9 The Hoadley Commission (1932-34) and Health Insurance in Alberta
      (pp. 183-206)

      Medicare was a centennial gift to Canadians, but its formative steps go back at least another 40 years, to the first provincially conceived health insurance program in Alberta. It was to be a voluntary and comprehensive program, with the provincial government contributing to its funding. Alberta’s Hoadley Commission proposal of 1932 to 1934 became a national one after its principles were included in the Canadian Medical Association’s (CMA) Health Insurance Plan of 1934 to 1935, and the services to be insured (medical, hospital, dental, drugs, essential nursing) and citizens to be insured (all), were re-proposed by the Heagerty Advisory Committee...

    • 10 From Bennettcare to Medicare: The Morphing of Medical Care Insurance in British Columbia
      (pp. 207-228)

      As demonstrated by the 1962 Saskatchewan doctors’ strike, the introduction of public health insurance in Canada has not been smooth. It was far from inevitable that Canadians would adopt a compulsory, universal model of public health insurance more closely associated with Western European and Australasian countries rather than a voluntary, categorical model of a mixed private-public system associated with the United States, most Asian countries, all of Latin America, and (currently) most of Central and Eastern Europe. Among the many factors leading to this development, two are particularly significant.

      First, the federal-provincial history of hospitalization in which a compulsory, universal...

    • 11 Newfoundland’s Cottage Hospital System: 1920-1970
      (pp. 229-248)

      In the 1930s, pre-Confederation Newfoundland¹ began a unique experiment in health services delivery that represents one of North America’s earliest efforts at publicly funded health care. In 1936, the first of 23 so-called “cottage hospitals” were established in Newfoundland to provide publicly funded hospital and medical services to the rural population.² By 1956, one year before the introduction of the federal government’sHospital Insurance and Diagnostic Services Act(1957) that provided cost shared funding to provinces with their own hospital insurance plans, 47% of the population received medical and hospital services coverage through these hospitals.³

      The so-called Newfoundland Cottage Hospital...

    • 12 The Partnerships between the State and For-Profit Hospitals in Quebec, 1961-1975: A Disappointing Experiment
      (pp. 249-274)

      In the area of hospitalization, the establishment of partnerships between the state and the private sector is presently the subject of debates in Quebec and elsewhere in Canada. There are two opposing points of view regarding the place of the private sector in health care: (1) health care viewed as a service provided by the public sector and where the quest for profit is contrary to the collective interest, and (2) health care viewed as an economic sector where business enterprises hold a legitimate place.¹ Beyond these debates, however, the door is already open to public-private partnerships, particularly in Quebec.²...

  8. Part Three: Oral History and the Birth of Medicare

    • 13 The Struggle to Implement Medicare
      (pp. 277-281)

      The Saskatchewan provincial election of 1960 was fought on the issue of introduction of a single-payer type of medical care insurance in Saskatchewan. It was a bitterly fought campaign, the most bitter that I have experienced in my eight campaigns, and in three or four other election campaigns when I was not a candidate, but which I followed with interest. What made it so hotly contested was the intervention of the organized medical profession. Operating under the name of the College of Physicians and Surgeons, they spent more money on electronic and print media than any political party. Their campaign...

    • 14 Working for Medicare
      (pp. 282-283)

      I lived during the hungry thirties on a farm on the edge of the Dust Bowl. Being the seventh child in a family of ten, I learned the advantages and disadvantages of being poor.

      I joined the RCAF Women’s division when I became of age. I was able to go to the University of Guelph and graduate as a chef to serve in the air force for three years. During that time I became aware that there were no shortages of anything. Why did it take a war to make this happen? After the war, I came home to find...

    • 15 A Physician on the Front Line of Medicare
      (pp. 284-287)
      JOHN D. BURY

      I qualified as a physician in England on 30 March 1948 and started my internship just three months before the National Health Service started on 1 July. I graduated a little later from the London Hospital Medical College, University of London. After internship, I performed my National Service for two years in the Royal Army Medical Corps. Then, when three and a half years as a resident in O and G convinced me that I would never be a great gynaecological surgeon, I entered a partnership with an established general practitioner in a mixed urban and rural practice 30 miles...

    • 16 My Experience in the Medicare Battle and the Woods Commission
      (pp. 288-290)

      In the 1960-62 period of the Medicare debate, I was still a student at the College of Law at the University of Saskatchewan. Like the province as a whole, the campus community was sharply divided over Medicare. Some of the divisions sprang from pure political forces of difference; others feared change from the known to the unknown; and still others, favoured choice and competition over public payment and delivery of healthcare (a political, but also a philosophical divide). When Premier Tommy Douglas came to campus during this period to explain and defend his policy, the meeting room—at the upper...

    • 17 A Brief Retrospective on the Royal Commission on Health Services
      (pp. 291-294)

      In many parts of Canada, but categorically not in Saskatchewan, Justice Emmett Hall is thought to be the father of Medicare. This is because the enlightened solution to the provision of medical services that we enjoy came as the result of the recommendation of the Royal Commission on Health Services of which Hall was the Chairman. There is another reason to introduce Hall in this setting: he and Tommy Douglas were good friends. To illustrate this, Fr. Anthony Hall, his young brother, told a cute story at the inaugural Justice Emmett Hall Memorial Lecture, in 1997. It seems that Tommy...

  9. 18 Conclusion A New Prescription: Adding Historical Analysis to Health Policy
    (pp. 295-306)

    Why draw on history and historians for policy input? As the noted British social historian Simon Szreter points out,

    Policy-makers in the health field are subjected to a plethora of forms of knowledge from the bio-medical, health economics, management and policy science fields, which appear to be able to predict in advance specified outcomes …, regardless of local contexts, and which purport to be sufficiently “scientific” and powerful as to be relied upon for guidance by decision-making funders, officials and ministers so they can set targets and deadlines for policy delivery … Such forms of context-free policy science promise interventions...

  10. Contributors
    (pp. 307-310)
  11. Index
    (pp. 311-322)
  12. Back Matter
    (pp. 323-323)