/* Written 12:21 PM May 14, 1998 by jshell@netcom.com in igc:labr.all */ /* ---------- "Canada's healthcare system" ---------- */ Subject: Canada's healthcare system (fwd)
From: Luke Murphy
On the subject of the Canadian health-care system: A friend here in Toronto with an excellent knowledge of Canadian politics and history wrote up a note on the subject for me. So here it is: how universal health care was achieved in Canada, and how it might be achieved in the U.S.
* Social Origins: The 30's: A quasi-leftist Canadian populist party grew out of the desperate state of regional economies, and bloomed in the turbulent pre- and post-war period. It spread like prarie wildfire. The Co-Operative Commonwealth Federation (CCF) had as one of its central policies making effective medical care available to all, regardless of wealth or privilege. This was a key issue for many people; they were denied humane care because of their social status or wealth, or lack thereof. The CCF quickly controlled the Saskatchewan provincial parliament. Soon, government-funded hospitals were set up, with angry medical and corporate resistance. The doctors saw their elevated position (rightly) being threatened. Medical schools were opened; communities sponsored students who would then (presumably) return. With coherent, conscientous leadership, the party's consistency and devotion was very well-respected even by its foes. The Saskatchewan CCF held out against doctor's strikes, and was able to finally establish a system that minimally satisfied the well-off doctors and brought free medical care to the masses. Over the yeras, it was fine-tuned, and eventually the monopolistic and extortionate powers of the elite medical establishment were reduced.
* Spread of CCF Ideals: With the popularity of the CCF growing across the country, medical associations in other provinces began to be concerned. The mass of the country was what could be considered lower-middle or lower-class, and was predominantly rural or rural-urban. As such, there was ample room for the growth of populist/activist politics. Despite the deliberate sabotage and infiltration of these groups by mainstream organizations, such as the federal government and Mackenzie King's Liberal party, the CCF thrived. Open harassment was very similar to the witch-hunts of the American McCarthy era; the CCFers had to be extremely cautious with their rhetoric. In the early 1960's, the party modernized. It merged with the Canadian Labour Congress and became the New Democratic Party (NDP). Because of the special character of Canadian decentralization, most citizen-consumer level policies fall under the jurisdiction of the provinces. This has traditionally allowed for a great deal of social experimentation and diversity. Bad ideas and those designed for purely regional concerns tend not to travel very far. Successful models have frequently been adopted across the country, whether in education, housing or health policy or in any other field of social concern. This decentralization has given the country a great deal of room to invent and re-invent itself, while avoiding many critical errors being repeated on a cross-country basis. Because of this decentralization and lack of heavy-handed centralized control, the provinces could act on their own to bring into reality many different univeral healthcare delivery schemes. None were failures, and many lessons were learned.
* Far-Reaching Influence: It's important to note that the common-sense, anti-corruption, anti-bureaucracy and pro-small business policy platforms the NDP generated were immensely popular even among the class of smaller investors and business people, at least in their components if not their entirety. Together with the rural and urban masses, these groups made up the vast majority of the nation's population. This fact wasn't lost on the Liberal party, known as Canada's "Natural Governing Party" due to their status as the dominant element in the country's political history . They systematically mined the NDP's proposals for the next 40 years, until the mid-1980's, when they lost a key election to Brian Mulroney's newly reconstituted Progressive Conservative party.
* Medicare on the Ground: In the heady 1960's, Lester B. Pearson's left-leaning Liberals brought Medicare to the national stage. Since most of the provinces had independently adopted various versions of this highly successful programme, he introduced a new federal Medicare assistance scheme. A special fiscal transfer was established. All provinces that conformed to the conditions as set out in the Federal act were to be given a block amount of funds to be used exclusively for medical care. Any province could opt out at any time, of course, as general health policy is a matter of provincial jurisdiction. But if any province did opt out, it also lost all transfer funds designed for that purpose. Even conservative Ontario, the most populous and easily most wealthy province in the country, couldn't hold out against that tempting offer; it signed on. Along with the block transfer of funds, strict regulations were established. These included what could and could not be charged to patients, how procedures were to be delivered, minimum profrssional standards and service levels, and a bevy of other concerns. Needless to say, despite some viciously vocal opposition, mainly from the medical establishment and the privileged, including doctor's strikes, walkouts and work stoppages, the government persevered and Canada's universal and free medicare system was born.
* Medicare in Ontario At first, the Ontario Health Insurance Plan (OHIP) required each employed person to pay a nominal insurance premium, which was heavily subsidized. There were no private-sector alternatives for services insured publicly. This policy guaranteed equal care for all; the rich and the poor had the honour of each other's presences in the waiting room. In the early 1980's, a business employee tax was introduced, which replaced the minimal insurance premiums fee. Some things were (and remain) notoriously absent from Medicare coverage. Dentists had avoided having their services socialized. As such, only emergency dental care was covered, a fact that has never been corrected. Workplace and private insurance remains the only dental coverage to date. Other medical services were also covered in odd patterns. Optician's services, for example, are fully covered, but aside from those receiving general welfare assistance, prescription eyeglasses are not. The same is true for prescription medicines. In this, there was a "Service, not Hardware" philosophy that has had momentous social effects in an age of expensive medicines and multinational pharmaceutical corporations bent on huge profits. As a side-note, this was presumed to be one of the reasons that the odd Canadian pharamceutical industry, based on reverse-engineered "generic" medicines, was so deeply protected by the national government and so intensely resented in U.S. business circles. Canada deliberately ignored U.S.-led international rules regarding the length of medical patents and intellectual property rules, giving corporations only 5 years to maintain their monopolies on the production of drugs.
* (Limited) Opposition to Medicare Today: With the disaster that the U.S. represents right on our doorstep, it's immensely difficult for elitist reformers to attack medicare. The programme has captured a loyalty in the masses that little else can mimic. Due to the rise of neo-conservatism, and the seeming popularity of pro-big-business and elite concerns, some right-wing commentators found it expedient to criticize this centrepiece of social legislation. However, in every case and without exception, any attempt to reduce or attack medicare has resulted in quick tail-between-legs retreats. No party that has suggested creating a two-tier system of medical care delivery (ie better access for those who can afford it), has been able to survive the almost unanimous scorn heaped upon it. Having an efficient, excellent and freely available medical system has become a touchstone for Canadians, a key element of their national self-esteem and identity. The only real resistance to medicare today comes from the ultra-rich and the upper classes, for whom elite access would be within reach and realizable, but for that damnable Medicare and its overwhelming popularity. Every government that has tried to cut back medical services or has threatened medicare has suffered; not even the ultra-conservative parties will touch the issue, and those who have gained power have found themselves faced with near-universal opposition.
* Interesting Characters in Canadian Medicare: The CCF movement had a distinctly prairie, Christian-socialist flavour, and was lead by one of this country's most revered politicians, "Tommy" Douglas. He's well remembered, and considered one of the greatest statesmen this country has ever seen. Dr. Norman Bethune, who practised in Montreal, was prominent in this movement for universal access to medical treatment. During the Spanish Civil War, he lobbied the resolutely anti-"communist" Liberal government for aid. On the front lines, he invented techniques that revolutionized battlefield medicine. Mackenzie King's Liberals (liberals of a different age) refused; Mackenzie himself was an admirer of Adolf Hitler and refused any support for the Spanish anarchists or "socialists". The dictator Franco quickly assumed power. Bethune discovered this same elitist attitude throughout the Canadian medical establishment when he returned. In a city of desperate poverty and contagion, he was forced to admit patients free of charge to the hospital where he worked. For this and other radical procedures, he was eventually asked to resign. He found a place for himself in the fight against the Japanese occupying forces in China; he was well-loved by Mao Tse-Tung and died while reforming Chinese relief and battlefield medicine. Ironically, this early champion of Medicare in Canada was largely ignored in his home country. Instead, he became a revered hero of the "Communist" revolution in China. In an added irony, that revolution would proceed to betrey each and every one of his ideals. In a more liberal age, his memory has been revived by the powers-that-be.
*** Specific Issues:
* Inefficiency of the American Health Bureaucracy: Many studies have shown that the American system, which requires extensive and endless paperwork and is needessly complex, is much less efficient than the one claims-process expedited by doctors, wherein the patient never even sees or is aware of the claim. All such claims are handled out of a central bureau. The savings in time and energy are extensive, especially for hospitals and medical-administrative overhead.
* Fraud: The mass of the population has no need whatsoever to defraud the system, as there are no special categories of serivce. You can win nothing by faking your identity. Studies have shown that fraud is minimal, though common protective measures can guard against such abuse. Photo-ID cards, always having to show your card at a hospital or doctor's office, etc. are measures used today. Other measures are also being contemplated. Occasional fraud stings can deter a lot of people from abusing the service. Residency requirements are relatively severe, so "Border-Jumping" defrauders are relatively few. Services are also portable across provincial boundaries, though they don't cover services required overseas, unless they can't be delivered here. Such paid trips to hospitals and clinics outside Canada are notable for their rarity.
* Research: Contrary to most American insurance-company propaganda, Canada remains, for its population size, one of the world centres for medical research, similar to any European state with a well-endowed medical system. It compares favourably even to the U.S., where ultra-rich benefactors promote their own research agendas. Canadian universities and hospitals are at the forefront of many areas of medical research; some of them, such as the University of Toronto, do world-renowned research into many different fields.
* Abuse of Services and High Costs: Some Americans worry about hypochondriac patients and those who rush off to the hospital frequently for minor ailments: this has been wildly over-stated. Canadian provinces have debated having a minor fee, say, $5, for doctor's appointments; this has been rejected, as studies have shown that there's realtively little abuse. The bureaucratic culture of mega-hospitals has been recently called into question. A new focus on clinic-care and small-scale medical service delivery, as well as a new focus on preventative medicine, has been going on. This is to be expected in a democratic society; constant debates over services are indicative of neither instability or an unhealthy system, but of democratic input and raucus public interest in a service they deeply love.
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This piece was written by my friend Craig Urquhart: craig.urquhart@utoronto.ca I hope this helps in the debate about the US health system. Yours, Luke.
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E-mail address for Jim Ramsell: ramselj@peak.org Owner single-payer list: single-payer@peak.org My webpage is: http://www.peak.org/~ramselj |