Malcolm Taylor’s account stands as the definitive history of the birth of Medicare in Canada. Taylor provides details of the negotiations and the politics - federal, provincial, and federal-provincial - of Medicare over the quarter century from the end of the Second World War to the adoption of a plan in each province. A large part of Taylor’s analysis focuses on the political leadership at both the provincial and the federal levels of government. While public, singlepayer, universal health care systems might have eventually developed in several provinces acting alone (Saskatchewan under Tommy Douglas was clearly the leader), Taylor is...

IT WAS 10 A.M. ON AUGUST 6, 1945 and in the House of Commons Chamber borrowed for the occasion all was ready. Months of feverish activity of committee meetings piled upon meetings, of draft reports mutilated and revised, torn apart and revised again had reached their climax. There on the conference table, fresh from the King’s Printer in their green covers, neatly arranged in front of the four federal ministers and the nine provincial premiers, were copies of the Dominion government’s design for a new post-war world for Canada the famous “Green Book Proposals.”

The delegates were there as the...

THE FIRST ACT of the drama of health insurance had witnessed the failure of the Dominion-Provincial Conference to agree on the reallocation of tax resources and, with its collapse, the crumbling of the foundations of the hoped-for edifice of a national program of social security.

For the second act, the scene shifted to western Canada, a new cast of actors came on stage, and the action began in what seemed at the time to be merely a sub-plot but which, in the perspective of hindsight, came to be seen as the first decisive action in the long chain of events...

As the curtain went up on the next major act of the drama of health insurance, at first glance the stage seemed remarkably similar to that of the first act in 1945. The time: ten years later; the setting: a committee room of the House of Commons; the scene: a federal provincial conference; the characters: the same, the prime minister and the provincial premiers, with one additional player, Mr. Joey Smallwood, the premier of Newfoundland.

One felt a sense ofdéjà vu,but that was quickly dispelled, for between 1945 and 1955 there had been a remarkable change of actors....

IT WAS LATE on an April evening in 1957 and on Ottawa’s Parliament Hill the long debate had ended. The Speaker put the main motion and the division bells began to ring. In one of those rare occasions, every member present that night in the House of Commons, representing four political parties, voted aye to adopt unanimously the motion on third reading of “Bill 320.” Two days later, on April 12, almost as anti-climax, the Senate concurred with the same unanimity, and on May 1, the Hospital Insurance and Diagnostic Services Act was proclaimed the law of the land.

It...

FOR THE SECOND TIME in the unfolding drama of health insurance in Canada, the action shifted from the main plot to a sub-plot, the scene again set in the province of Saskatchewan. The chief governmental actors were those who had also participated in Act II, although, as we shall see, midway through this act, a major change occurred in the lead role. The other starring roles were taken, however, by an entirely new set of actors, the leaders of the Saskatchewan medical profession.

The act opened on the evening of December 16, 1959, with the premier announcing on a radio...

AS THE FIRST SCENE of the next major act of the health insurance scenario opened on July 19, 1965, the audience might well have felt again a sense ofdéjá vu.There was the same setting: a committee room of the House of Commons; the scene: another federal-provincial conference; the leading roles: also the same, the prime minister and the ten provincial premiers. The time, however, was different—ten years since the conference that had produced the hospital insurance program, twenty years since the federal offer to the provinces in 1945. Moreover, the tolls of time, the vagaries of elections,...

THE FINAL MAJOR ACT of the thirty year drama of national health insurance had reached its climax on the inaugural date of the federal medical care insurance program—July 1, 1968. The drama would not be complete, however, until eight more sub-plots—the provincial government decisions—had been resolved. Saskatchewan and British Columbia had qualified with only minor adjustments to their existing programs. In all the other provinces, as noted in chapter 6, there were serious political decisions to be faced, complex administrative arrangements to be made, and new revenue sources to be found. The decisions in Alberta and Ontario,...

IT WAS, AGAIN, one of those dramatic episodes in the legislative history of health insurance in the Canadian House of Commons—the date: April 9, 1984; the occasion: the vote on Bill C-3, whose short title, “The Canada Health Act,” was, as many claimed, a misnomer, for its main focus was accessibility to services rather than health services as such. And, while the vote signified a landmark in the development of Canada’s health insurance system, it was also anti-climactic: everyone knew that the Bill would pass. And so the clerk tallied the votes, and at 5:00 p.m. the Acting Speaker,...

TO THIS POINT we have examined the economic, political, and social forces that resulted in the passage of the Hospital Insurance and Medical Care Insurance legislation in the 1950s and 1960s and the major problems attendant upon the introduction and operation of the two national-provincial programs. We have also reviewed the two major changes in the programs introduced in the 1970s and 1980s—the shift to block-funding and the banning of extra-billing and user charges. It is now desirable to shift our perspective from what has been accomplished in the past to major problems and opportunities that will confront Canadians...

WE HAVE BEEN CONCERNED throughout this work with two major themes: the substance of the decisions that created and shaped the health insurance system in Canada, and the process by which the decisions were made. Let us reflect on these in turn.

As these words are being written, the Canadian health insurance system, whose tortuous history generated so much federal-provincial conflict, is being drastically altered by the passage of the Established Programs Financing Act.¹ In a sense the new arrangements mark the end of thenationalprogram as the format of the conditional-grant-in-aid is abandoned. Federal funds will continue to...