Private Practice, Public Payment

Private Practice, Public Payment: Canadian Medicine and the Politics of Health Insurance, 1911-1966

Copyright Date: 1986
Pages: 320
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  • Book Info
    Private Practice, Public Payment
    Book Description:

    Naylor's particular concern is with the nature and extent of the medical profession's opposition at both the provincial and federal levels. He details various developments in medical politics and policies, including the dispute over state health insurance plans in British Columbia during the depression, the national health insurance program drafted by the King government, the doctors' strike in Saskatchewan, and the development and eventual governmental rejections of prepayment plans sponsored by organized medicine.

    eISBN: 978-0-7735-6111-3
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-vii)
  3. Tables
    (pp. viii-viii)
  4. Acknowledgments
    (pp. ix-x)
  5. Abbreviations
    (pp. xi-2)
  6. CHAPTER ONE Introduction
    (pp. 3-7)

    One hundred years have elapsed since Chancellor Otto von Bismarck began organizing a state-sponsored sickness insurance program for German wage-earners. Over the past century, universal health care systems have been implemented with varying degrees of state involvement in the vast majority of industrialized nations. Canada has followed suit. As of April 1972, when the Yukon Territory inaugurated its medical services insurance plan, Canadians in all ten provinces and both northern territories were insured against basic medical and hospital expenses through a set of publicly administered programs generally referred to as medicare.¹

    The evolution of Canada’s health insurance system has occurred...

  7. CHAPTER TWO The Canadian Medical Profession: Theoretical and Historical Background
    (pp. 8-25)

    In 1960 Professor Malcolm Taylor aptly summed up organized medicine’s reactions to government intervention in the health services market as typical of any group in society responding to a “presumed threat to its control over its physical and social environment.”¹ Yet the medical profession is, in certain respects, far from a typical social group. A minimum of seven or eight years post-secondary training is required before one can apply for a general licence to practise medicine in Canada today; specialization can add three to six years to the training period. Medical incomes are reported by Statistics Canada to be the...

  8. CHAPTER THREE Canadian Medicine and Health Insurance: Pre-Depression Ambivalence
    (pp. 26-57)

    In state health insurance Canada and its medical profession were subject to strong international influences from the outset. The first European health insurance law was passed in the German Empire in 1883 and was the brainchild of that master ofRealpolitik, Chancellor Otto von Bismarck. Bismarck did not dissemble about his motivation: increasing support for the German socialist movement led the chancellor to implement sickness insurance that would “bribe the working classes” and help undermine political opposition.¹ The 1883 Sickness Assurance Act legislated compulsory contributions to an insurance fund by workers in industry and their employers but did not affect...

  9. CHAPTER FOUR Depression Developments: The British Columbia Health Insurance Feud
    (pp. 58-94)

    As already suggested, the economic collapse of 1929 sharply lowered the ability of a large fraction of the Canadian population to pay for life’s necessities–including medical care. Every Canadian province was hit hard. Because of drought conditions and a deflated world price for wheat, Saskatchewan and Alberta suffered the largest declines in per capita income during the Depression. But national data indicate that the industrial provinces shared fully in the disaster: average per capita money income across the nation fell by 48 percent between 1928 and 1933, with small businessmen and professionals of all stripes registering a 36 percent...

  10. CHAPTER FIVE War Years: Pressure Group Politics in Ottawa
    (pp. 95-134)

    The Depression was an important watershed in the political life of Canadian organized medicine. In the 1920s systematic state mediation in health care had been a matter for academic debate. But in the 1930s commissions of inquiry in some provinces and an acrimonious dispute over the BC health insurance plan forced organized medicine to formulate clearly defined policies designed to protect the profession’s socio-economic position. An unprecedented variety of pressure group activities was also undertaken by organized medicine. The profession’s policies, as we have seen, reflected two major concerns: to restore medical incomes by winning payments from the state on...

  11. CHAPTER SIX Post-War Developments: The Private Alternative
    (pp. 135-175)

    During the late 1940s and 1950s the tenor of Canadian medical politics changed, as continuing suspicion of state mediation in the health care market combined with the spread of private prepayment mechanisms to heighten professional resistance to any universal tax-funded plan. These changes dovetailed in some measure with the mood the nation. Canada found itself embroiled in the Korean conflict, and defence expenditures soared. Social security naturally remained a concern, but international security seemed rather more important in a period when the Cold War cast a chill over global politics. Especially in the 1950s, the ideological climate was less favourable...

  12. CHAPTER SEVEN Medicare in the Crucible I: The Saskatchewan Dispute
    (pp. 176-213)

    Political scientists have argued that the well-known dispute over the introduction of Canada’s first universal medicare plan¹ should be seen not simply as an example of medical pressure group activity but rather as a full-blown “community conflict.”² The escalation of the dispute to the point of actual strike action by the majority of Saskatchewan doctors can of course be attributed in part to a fundamental ideological disagreement between a tightly knit professional body and a government emboldened by a decade and a half in power. However, it is also plain that the medicare issue – and the medical profession itself...

  13. CHAPTER EIGHT Medicare in the Crucible II: A National Plan
    (pp. 214-243)

    As the conflict in Saskatchewan intensified, the federal Royal Commission on Health Services began its hearings. The commission’s chairman, Mr Justice Emmett Hall, was the son of a dairy farmer who had graduated from the law course at the University of Saskatchewan in 1919 alongside John Diefenbaker. A Progressive Conservative politically, Hall’s distinguished legal career took him to the position of Chief Justice of the Saskatchewan Court of Appeal and later to the Supreme Court of Canada.¹ Joining Hall on the commission were Dr Leslie Strachan, a dentist; Alice Girard, dean of the University of Montreal School of Nursing; and...

  14. CHAPTER NINE Historical Reflections and Continued Controversies
    (pp. 244-258)

    Almost two centuries ago Hegel remarked that the only lesson of history was that people and their governments had never learned anything from history. Hegel’s assessment has weathered well, if only because social and technological changes have been so sweeping that the lessons of history often become irrelevant by the time they are written. In the case of this study the implementation of medicare by all the provinces and territories has sharply transformed the structure of the relationship between the medical profession and government, with the result that generalizations about the 1980s based on the pre-medicare era must be made...

  15. Notes
    (pp. 259-304)
  16. Index
    (pp. 305-324)