Canada's mostly functional and universal health care system is something that most Canadians are inordinately proud of. Its origins can be traced back to Tommy Douglas and the emergence of the CCF and socialism in the west; but in practise, nothing was instituted on a federal level until 1984, when the Canada Health Act (CHA) came into being to define the terms of a health care system for Canadian citizens.
Tommy Douglas is widely regarded as the "Father of Medicare" in Canada, though his actions predated the CHA by nearly fifty years. In 1947, as premier of Saskatchewan, he and his provincial Cabinet ministers introduced a public system of health care, which effectively ensured hospital treatment for any Saskatchewan resident who might require it. Douglas' party, the Co-operative Commonwealth Federation, made up the first socialist government in North America; their successes on the provincial level made them solid proponents of a Canada-wide Medicare programme.
By 1958 the federal government was firmly on board, though still somewhat aloof from the proceedings: newly-elected Prime Minister John Diefenbaker (co-incidentally from Saskatchewan) declared his support for provincial health care programmes in the form of financial grants. He promised that any province that created a hospital plan would receive fifty cents from the federal government for every dollar they contributed to the plan.
This was incentive enough. Three years later, every province in Canada had created its own health programme, effectively guaranteeing hospital care for all Canadians.
A good idea in principle, and effective in its execution, but these provincial health plans were still incomplete: there was no coverage available outside of hospital stays. The movement to include doctors' services again began in Saskatchewan, which instituted it in 1962 to wide public approval.
Prime Minister Lester B. Pearson introduced a wide-ranging federal health legislation in 1966. It encompassed not only the hospital care guaranteed by the provinces but also doctors' services outside hospitals, as in Saskatchewan. This was Medicare, and it was generally successful; by 1972, every Canadian in every province and territory was covered under this expanded range of health services.
It still sounded good and looked better on paper, but the programme wasn't running quite as it should have been. In 1979, a report issued by Supreme Court Justice Emmett Hall made note of the fact that "extra billing by doctors and user fees levied by hospitals were creating a two-tiered system that threatened the accessibility of care." It was a very valid point.
What it boiled down to was that people who could afford to pay exorbitant hospital and doctors' fees could jump the public queues and receive the care they needed promptly, while the rest had to wait in line. With the advent of private clinics, this remains a serious problem in Canada today, though now the solution isn't nearly so clear-cut as it was then.
To save universal health care, Prime Minister Pierre Elliott Trudeau and his Liberal government created and passed the Canada Health Act in 1984. Its main purpose was to define in unequivocally clear terms what the health care system should accomplish and how it should go about doing it. A lesser though still important aim was discouraging user charges in hospitals and extra billing by doctors: a clause in the Act instituted a financial penalty to be levied if any province permitted the extra charges.
In writing, the Canada Health Act has five key aims.
- Public Administration: the administration of a government health insurance plan must be carried out by a public authority, and must not be for profit.
- Comprehensiveness: all necessary medical services are covered.
- Universality: every insured resident of a given province or territory is entitled to the same level and extent of coverage as is everyone else.
- Portability: when an insured person travels or moves within or outside Canada, their coverage is maintained.
- Accessibility: all insured persons must have access to the hospital and physicians' services that they need, without being obstructed by financial or other barriers.
Cash contributions to the programme are provided to the provinces and territories from the federal government via the Canada Health and Social Transfer (CHST).
The Act also makes it very clear that no user charges or surcharges on insured services are permitted. A penalty provision sees to it that mandatory dollar-for-dollar deductions were taken from the CHST if a province was found to have permitted extra-billing; that is, if a commission discovered that a province had permitted $400 000 in hospital user fees, that same amount would be deducted from the CHST.
Though perfectly reasonable, it was an awfully stiff penalty, and for a long while was an effective deterrent against privatisation of health services. In the late 1990s, however, private diagnostic clinics and queue-jumping for better and faster services (such as MRIs and CAT scans) at high cost became common enough to be a problem, particularly in conservative Alberta.
In spring of 2001, former Saskatchewan premier Roy Romanow was hired by the federal government to investigate and report on the state of health care in Canada, and to make suggestions for its improvement. His report suggested sweeping changes to the health care system; specific to the Canada Health Act, Romanow recommended that government accountability to taxpayers be added to the list of five aims; he felt that the Canadian people have a right to know where their money is going, and whether or not it is being used wisely and fairly.
Thus far, no actions have been taken in accordance with the report, and the Act has not changed since its creation.
Sources:
Canada Health Act. British Columbia Ministry of Health Services. http://www.healthservices.gov.bc.ca/cpa/canhealthact.html
Canada Health Act: Overview. Health Canada.
http://www.hc-sc.gc.ca/medicare/chaover.htm
Commission on the Future of Health Care in Canada. Health Canada.
http://www.hc-sc.gc.ca/english/care/romanow/index1.html
Dispute Avoidance and Resolution Process Under the Canada Health Act. Health Canada.
http://www.hc-sc.gc.ca/medicare/DAR.htm
Policy Interpretation Letters. Health Canada.
http://www.hc-sc.gc.ca/medicare/Marleau.htm
"Romanow says Medicare 'moral enterprise, not business venture'". CBC News, 9 December 2002.
http://www.cbc.ca/stories/2002/11/28/romanow_rls021128
The Canada Health Act.
http://www.mapleleafweb.com/features/medicare/romanow/part_2/health_act.html
The full text of the Canada Health Act can be viewed courtesy of the Canadian Department of Justice at http://laws.justice.gc.ca/en/C-6/text.html.
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