Reply #37: The Canadian system; single payer, private practice, publically funded..... [View All]

Here's a good summery of the history and structure
of Canadian 'socialized' medical care.

The plan was created by the great Tommy Douglas;
Baptist Minister, lifetime socialist and grandfather
of Keifer Sutherland. The summery below clears up
a lot of misconceptions regarding the Canadian system.

Thomas C. Douglas:

"The Father of Canadian Health Care"

http://www.mta.ca/faculty/arts/canadian_studies/english/about/study_guide/doctors/delivery.html

Thomas C. Douglas (1904-1986) was not a doctor; he was a politician from Saskatchewan. His contribution to Canadian medicine was not due to a medical skill or great discovery, but as "the father of Canadian health care." He introduced socialized medicine (state-sponsored and salaried-physician medical care) to the province of Saskatchewan during his 44-year political career. Douglas envisioned and worked towards a universal system of health care that moved beyond provincial to national enactment, and today has become the envy of most countries in the world.

Douglas entered politics in the 1930s in Saskatchewan as a member of the Cooperative Commonwealth Federation (CCF), the precursor to the New Democratic Party (NDP). He had been horrified and angered by the destitution that the economic depression and drought had wrought in his province. Douglas was a socialist, and he would lead the first socialist provincial government in Canada. From 1944 to 1964, the CCF formed the government in Saskatchewan, led by premiers Douglas and Woodrow Lloyd.

Among many public projects, the Saskatchewan government pioneered the first public hospital insurance and medicare programs in Canada. Universal health care had been Douglas' concept, which he promoted and fought for throughout his political career. But what was Douglas suggesting? What did he mean by "universal health care"?

Various types of health insurance were available in Canada before the CCF government assumed power. There were many doctor-sponsored plans by non-profit organizations as well as private insuring agencies, to which many Canadians subscribed. In some cases, Canadians were provided with health insurance through the terms of their employment. Thus many Canadians had some form of insurance protection. The sick and needy were admitted to hospitals as charity cases. But there were many inequities in the medical care system, as some plans covered only hospital visits or physician care but not drugs or treatment.

In Saskatchewan, the CCF administration of Douglas became the first provincial government to enact hospital coverage (in 1947) and medical coverage (in 1962). It began with province-wide hospital coverage and a pilot project of full medical services in the town of Swift Current. Doctors were paid salaries by the government (via taxes), which in the end proved to be more money than medical practitioners had earned in the past. It proved successful, and full medical services were extended to the entire province in 1962.

Remembering the financial difficulties of the 1930s, Douglas promoted the plan as both ensuring doctor payment and meeting the health needs and demands of the people. The doctors in the province did not agree. The College of Physicians and Surgeons feared that a full medical services program was a major step towards a socialized, salaried medical profession, answerable only to the government. Doctors in Saskatchewan went on strike for 23 days. Doctors' reactions to government health insurance schemes played an important role in shaping the national health care program.

In 1964, a royal commission recommended a national health care system modeled on the Saskatchewan plan. (In 1958, the Hospital Insurance and Diagnostic Services Act had been passed, providing government-sponsored hospital coverage to all Canadians. The federal government had no plan to extend their commitment to health care with full medical services coverage at that time.) In 1968, the Medical Care Act was passed providing universal health insurance to all Canadians.

It was not socialized medicine; doctors were not paid salaries. Instead doctors work on a fee for service basis, billing not the patient but a third party - the Canadian government. As scholar David Naylor states, it was "private practice and public payment." Canadian physicians have lobbied effectively to secure their position as private practitioners and not salaried employees of the government. In 1984, the Canada Health Act replaced earlier hospital and medical coverage acts.

The Canadian universal health care system, although expensive, remains an important national 'right' or principle of this country. As stated in the Canada Health Act, the federal government is committed to maintaining Canada's world-renowned health insurance system. This system is universally available to permanent residents, comprehensive in the services it covers, accessible without income barriers, portable within the country, and publicly funded. Each province and territory administers its own health care plan with respect for these five basic principles of the Canada Health Act. Studying the Canadian model, our neighbour to the south has been unsuccessful in its attempt to launch a similar public health-insurance system.


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