July 1 of this year marks the 50th anniversary of Medicare in Canada. On June 29, Nova Scotia’s Minister of Health and Wellness released for public input proposed new legislation to replace the outdated Health Services and Insurance Act. Are these two events related? Probably not, but I think they should be.
For it was on July 1, 1962 that insured medical services started in Saskatchewan. This did not happen overnight. A number of important preparatory steps took place over almost 20 years. This included creating the first health region in the province, and setting up insured hospital services in 1947.
Nor did it happen without major struggle. There was a bitter provincial election campaign in 1960, and there was a lengthy and controversial debate on the Saskatchewan Medical Care Insurance Act before it was passed in 1961. And when Medicare began, so also did a three-week doctors' strike. And throughout that period, there was strong opposition by the established medical profession, the insurance industry, the mainstream media, and the provincial Liberal Party of that time. There was intense pressure applied to the government to back away and withdraw the Act.
But once the strike was settled through a negotiated settlement between the government and the Saskatchewan Medical Association called “The Saskatoon Agreement”, it quickly became the focus for a possible move to the rest of the country. This was due especially to the Hall Commission Report of 1964, continued public pressure, and the efforts of all parties to approve federal legislation in 1966. By 1972, insured hospital and medical services were in place across Canada. In Nova Scotia, insured hospital services were in place by 1958 and insured medical services by 1969. Here also, there was vigorous debate and rallies organized in part by Medicare Now Committees.
So we should remember and thank the tireless efforts of the CCF/NDP government of 50 years ago led by Tommy Douglas and Woodrow Lloyd and of the people of Saskatchewan to help put in place our most prized social program. But that remembrance should not be observed with simply quiet reflection, but with an active and ongoing campaign to ensure that Medicare nationally and provincially is protected, strengthened and extended.
The recent release of proposed new legislation for Medicare in Nova Scotia provides an important opportunity to put our collective remembrance into effect. Building on the efforts of our predecessors in Saskatchewan and in Nova Scotia, we must ensure that the new legislation enshrines the principles of earlier Medicare legislation including most notably, the Canada Health Act, that it stops privatization in all its forms, and that it moves us forward to a stronger, more comprehensive public health care system as was originally envisioned for Medicare. What we have achieved mostly thus far is what has been called Phase One, that is, to remove financial barriers to receiving hospital and medical care through universal public insurance.
As was made clear at the recent conference on Medicare in Saskatchewan, where we need to make progress now is Phase Two, that is, to extend Medicare to cover many other important services such as home care, long-term care, dental care, pharmacare and other initiatives to address the social determinants of health, while, at the same time, managing health care better by waitlist management, teamwork, evidence-based initiatives, and community-based care including community health centres. The new legislation should help us achieve this next major step.
The key lessons of our experience with Medicare going back at least 50 years should be that we have advanced with several key steps (not everything at once), that struggle and debate have been with us from the beginning, and that we can’t stand still, we must always move forward. As has often been said, “eternal vigilance is the price of progress” which is certainly true for the history and development of Medicare in Canada.
Ian Johnson is a Servicing Coordinator/Policy Analyst with the Nova Scotia Government and General Employees Union. He has been a Research Associate with the Nova Scotia office of CCPA since it was established in 1999. He is also the Vice-Chair of the Nova Scotia Citizens’ Health Care Network and a past Chair of the Community Health Services (Saskatoon) Association, better known as the Saskatoon Community Clinic.