The Road To Medicare In Canada

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CraigBaird

It is something that Canadians take a great amount of pride in. Our universal health care system ensures that no one ends up losing everything because they can’t afford to pay for their medical care. It may not be a perfect system, but it is better than a lot of people have.

Today on the podcast, I want to look at the road toward Medicare and how we got there.

When Canada became a country in 1867, health care was not organized on a national basis. Communities set up their own health boards, and often these were set up in response to epidemics of cholera, smallpox or typhoid fever. The first formal legislation that gave communities the power to create their boards was passed by Upper Canada in 1834. A half century later in the 1880s, the new Public Health Act would be passed to force local governments to impose proper sanitation and organize health boards. The first provincial board of health would be established in Ontario in 1882. This health board would go into force in 1885 when smallpox hit Quebec, and Ontario put doctors on trains coming into the province and gave them the power to arrest anyone coming in who refused to be vaccinated.

The first bits of health insurance would start to appear in Europe in the 1880s but by the First World War, changes were coming. In Saskatchewan, a plan was created that allowed municipalities to tax their residents to build hospitals, bring in doctors and pay for hospital care.

The Federal Liberal Party would look at a health plan as part of its election campaign, but that was where that ended. During the war, most of the government formed into a united party to deal with the war effort, but to get this support, Borden had to work with Wilfred Laurier, and that meant creating things like a federal health department. That department was also formed, in 1919, as a way to deal with the deadly Spanish Flu. At the same time, with so many injured and disabled veterans, the federal government would help the 160,000 injured and disabled servicemen by creating the Department of Soldiers’ Civil Reestablishment in 1917. This had training facilities for amputees and also treated cases of tuberculosis. This was the first time the federal government was funding health services for Canadians who could traditionally have been able to pay for their own care.

Throughout the 1920s, various things would come into play that would form the initial steps towards universal health care. Union hospitals began to appear in Alberta and Saskatchewan. Alberta would have 11 union hospitals in place by 1922. These hospitals typically charged one cent per acre to homesteaders, or $1.60 in total a year, to provide medical care. Saskatchewan would have 30 established by 1930, providing the same type of service and for the same cost. While the 1920s were a heyday for many, there were still many poor people and charitable organizations encouraged doctors to work for free to the poor. In order to compensate for the lost income, the doctors charged different rates depending on how much a person made. This allowed the middle-class and wealthy to support the medical needs of the poor. This was shown in a notice in the Calgary Herald that stated by a vote of six to five, the city council of Calgary would implement different pay for different patients. City patients would pay $2 per day, maternity was free, country patients paid $3. Semi-private rooms were $3 per day for city patients, country patients paid $4. For the private ward, it was $5.50 for city patients and $6 for country patients.

The problem was that as the population grew and new diagnostic methods came in like x-rays, many did not go to the hospital for fear of the medical debt. In a speech to the 1929 Medical Services Conference, Dr. Kenneth MacKenzie would outline what would one day be a universal health care system, in his speech. He would say:

“Now the poor man gets this service for nothing. On the other hand the rich man is well able to pay for it at market price, but about 60 per cent of our population, I should say, belongs to a class whose earning powers are small and in order to balance their budget they cannot afford these expensive forms of diagnosis and treatment. They are too proud to accept them for nothing and they are intelligent enough to want to get the best that medical science can offer. Now ,if there is an evil there must be a remedy and that remedy, as I see it, must be a form of distribution of cost among all the people at large.”

The Great Depression would have a major impact Canada and the experience of so many Canadians being in challenging financial situations would shape leaders in the coming decades. During The Depression, provinces and local governments would provide relief payments for food, shelter, clothing and provinces would incorporate medical costs into the provincial budget.

With the cost of living falling by 25 per cent and incomes falling by 36 per cent between 1928 and 1933, how people paid for things changed heavily. One doctor in rural Ontario said he was paid 20 chickens, several ducks, potatoes, wood, a turkey and geese for his services.

In 1933, a lack of money in Winnipeg resulted in the municipal government from being able to pay for medical services for the poor. Doctors saw their incomes decline and they resented the city government for being unable to pay the amount for service they had promised. In March, the first doctors’ strike in Canadian history would result. The strike would last for seven months and when it ended, the Greater Winnipeg Relief Plan had been created and until 1965, it would provide payments for doctors who treated the poor.

The same year as that strike, the Ontario government offered to subsidize medical costs to 50 per cent, to a maximum of $100 per month per doctor. While doctors were unhappy with the state intervention in the doctor-patient relationship, and this will come up again, they were desperate enough to supported it. As a result, the Ontario Medical Association began to support the idea of province-wide health insurance but a change in government but any progress towards that ended in 1934 with the election of the new ruling party of the province, the Liberals.

In Alberta, the United Farmers of Alberta government passed the Alberta Health Insurance Act in 1935, but before it could be implemented the government was defeated and the Social Credit Party of Alberta came in.

In Saskatchewan, despite the practice of communities coming together to pay for doctor services throughout the 1920s, this was not happening in the 1930s. It was estimated that 130 doctors in the hard-hit areas of Saskatchewan were making an average of $27 per month. This would be about $515 today. In order to keep doctors in the province, the government paid them $75 per month for the next five years. By 1937, 66 per cent of the population of Saskatchewan was living on relief payments of only $20 for a family of five. Even with the province paying doctors, the doctor-to-patient ratio fell from 1 doctor for every 1,579 people in 1931, to one doctor for every 1,700 people in 1940.

Matt Anderson, a Norwegian immigrant in Regina went around to gain support for doctors for a municipal health insurance plan funded through individual and family premiums. In 1938, he was able to present his measure to colleagues at various councils, and votes saw 80 per cent of residents in those communities were in favour of this system. In 1939, Anderson convinced the provincial government to introduce the Municipal Medical and Hospital Services Act, which passed.

After a decade of lean financial years, and then six years of war, and despite not having funding for it from the federal government, Saskatchewan proceeded with provincial health insurance. Even with some programs in place, there was still no universal health care. One woman would relate the following story that showed how much needed to change with medical services. Her daughter was badly burned in October of 1943 after a shopkeeper started burning trash. She says, “She was rushed to hospital by a car we stopped in the street. They wouldn’t admit her until we paid $35. We didn’t have the money. Had to go to the old civic office and get a pay per saying we would pay later. She was in the hospital for 14 months. We had a wonderful doctor who saved her, Dr. Charlie Burns. He lowered his fees to half. It took us years to pay off the hospital and doctor bills.”

Thankfully, change was coming.

As with anything to do with Universal Health Care, it begins in Saskatchewan and with a man by the name of Tommy Douglas.

It was under Tommy Douglas, premier of Saskatchewan and leader of the Co-operative Commonwealth Federation, that public hospital care was implemented in 1947. Tommy Douglas had become premier of Saskatchewan on July 10, 1944, bringing into power the first democratic socialist government in North America. As a young man in Winnipeg, he had been witness to the Winnipeg General Strike, something I did an episode on earlier. From a rooftop on Main Street, he saw police charge towards strikers with clubs and guns, and saw a streetcar turned over and lit on fire. Seeing this unrest would have a huge impact on Douglas, who would see it as a reason to provide fundamental freedoms to people. He would take that philosophy to the highest office in the Province of Saskatchewan.

All levels within Saskatchewan worked together to help make this happen. Local governments worked to create a union hospital system and municipal hospital care plans and the provincial government followed suit with A Bill Respecting Health Insurance. In an unusual move, Premier Tommy Douglas also made himself the Health Minister to help get this health care legislation put through.

With Saskatchewan implementing what it was calling the Saskatchewan Hospital Services Plan, other provinces were quick to follow in the footsteps of the prairie province. British Columbia would implement its own service in 1948.

Under the Saskatchewan plan, 900 municipalities enrolled all their citizens in the plan. Each year at tax time, an annual premium was collected and the hospital services card for an individual or family would be updated. By 1954, 810,000 people in Saskatchewan were under the plan.

Alberta would follow Saskatchewan and British Columbia, under its Social Credit Party and Premier Ernest Manning, to create universal health care in its provincial borders. In Alberta by 1954, 650,000 were covered by the hospital plan.

With these three provinces, it was shown that the service could be successful, and with disparities over provincial health coverage, discussions began with the goal of looking at a federal program. At the time, 50 per cent of Canadians were covered by voluntary private or nonprofit prepayment plans, but public pressure was growing that the country needed to move towards universal healthcare. Over several years, which would include debate among stakeholders, doctors, provincial governments and the federal government, a plan would come forward. The federal government would make an offer to fund about 50 per cent of the national cost of diagnostic services and in-patient hospital care for provinces. British Columbia, Alberta, Saskatchewan, Ontario and Newfoundland would accept this proposal.

In 1949, a Gallup poll found that 80 per cent said yes they would support a government-funded health plan, while only 16 per cent said no.

One problem was the rise of the Cold War and the fact that many saw any sort of public health as socialism or communism. Paul Martin, Minister of National Health and Welfare from 1946 to 1957, would say after being criticized for his support for hospital insurance, the following.

“Hospital insurance is not socialism, nor is it a socialistic device or concept, nor does it have any essential relationship with the socialist philosophy.”

Moving towards a national health care program, that would come with the Hospital Insurance and Diagnostic Services Act, which was passed by the Liberal government of Louis St. Laurent on May 1, 1957, was the first formal legislation nationwide to the increasing pressure of having a national agreement.

Under the plan, each province had to establish a hospital planning division, licence, inspect and supervise hospitals, approve hospital budgets and collect the statistics and required reports.

The Conservatives would come into power in June of 1957 and under John Diefenbaker, they had to implement the Act and negotiate with the provinces. On July 1, 1958, Newfoundland, Manitoba, Saskatchewan, Alberta and British Columbia all received federal payments since they had insurance programs that met federal requirements. On Jan. 1, 1959, Ontario joined the program with Nova Scotia and New Brunswick. Prince Edward Island would join on Oct. 1959, followed by Quebec on Jan. 1, 1961.

In 1960, Prime Minister John Diefenbaker appointed Justice Emmett Hall to be the chair of the Royal Commission On Health Services. In a two-volume report published in the mid-1960s, he would recommend Medicare for all.

Emmett Hall would have this to say about Medicare

Within four years, nearly all Canadians, an estimated 99 per cent, would be entitled to hospital care benefits, which provided protection from large hospital bills. The Act was not perfect though. For one, it did not cover medical services, which made up 40 per cent of national healthcare costs.

There was also resistance to universal healthcare. In 1962 in Saskatchewan, doctors opposed the decision of the Douglas government to require doctors to collect their fees solely from the government medical plan. In protest, 90 per cent of the doctors closed their offices in protest on July 1. The Saskatchewan Doctors Strike came about because of the Saskatchewan Medical Care Insurance Bill, which was introduced on Oct. 13, 1961. Douglas had announced his intention in 1959 to provide medical care insurance, based on pre-payment, universal coverage and quality service. The 1960 election was based entirely on this issue. The day that the Act came into force was the same day the doctors went on strike.

This clip is from the start of the strike, showing the wide divide between the province and doctors.

The doctors felt that it would interfere with the doctor-patient relationship. There was some support for the doctors in the province as well. In Regina, a group of mothers formed a committee to support the doctors, and several other committees formed throughout the province. Called the Keep Our Doctors committees, they organized a campaign against the government. With so many doctors either closing their offices or leaving the province, the Medical Care Insurance Commission brought doctors from other parts of Canada, Britain and the United States to fill in the gaps left. In many communities, citizen groups would organize medical clinics and hire doctors to attend to them. Within two weeks of going on strike, the support for the Keep Our Doctors committees were beginning to lag. Lord Taylor, the man who had been active in getting Britain its health care system, came to Saskatchewan to serve as a mediator between the doctors and the government. An agreement would be signed on July 23, 1962. A few weeks later, on Aug. 2, the Act was amended to allow doctors to practice outside the plan and payments by the government would be 85 per cent of the college fee schedule. As well, the number of doctors on the Medical Care Insurance Commission was increased by three. Doctors soon returned to work, but the bad feelings between patients and doctors and doctors and the government would remain for years.

At the end of the strike, citizens were divided on whether or not universal health care was a good idea.

Tommy Douglas, who would enter federal politics, would talk about the need for universal health care.

In 1965, at the Federal-Provincial Conference, the decision to move towards Medicare was made. On July 1, 1967, the 100th anniversary of Confederation, the Liberals under Prime Minister Lester B. Pearson introduced the Medical Care Act, which covered 50 per cent of the cost of a physician outside the hospital.

When Medicare became law, and while it would be five years before all provinces signed on, it was big news for Canada.

The Hospital Insurance and Diagnostic Services Act and the Medical Care Act would provide hospital and physician services to all Canadians no matter their ability to pay, rich or poor.

Changes would come to Canada’s Universal Health Care over the years. Some would support the program, some would not, but its importance cannot be understated.

In 1980, Emmett Hall would do another review of Canada’s health care system and say that despite its problems, by world standards, it was one of the very best health services today.

As for Tommy Douglas, the man who helped start it all. Canadian’s love of universal health care can be shown in the fact that when it came time to pick the greatest Canadian in history, Douglas won, beating out luminaries such as Terry Fox, Pierre Trudeau and Sir Frederick Banting.

Information comes from Canadian Encyclopedia, Canadian Museum of History, Wikipedia and CBC.

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