|/* Written 12:21 PM May 14, 1998 by firstname.lastname@example.org 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
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
* 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
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
* (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.
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
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.
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.
This piece was written by my friend Craig Urquhart:
I hope this helps in the debate about the US health system.
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