By Dian Cohen
If we want a healthcare system that is responsive to our needs, we have to ask “What’s its purpose? What do we want it to do?” The fact that we can document hundreds of thousands of Canadians not getting the care they need screams that the system we have is NOT the system we need. So where did it come from? And what are our priorities today?
Canada got its first Department of Health almost exactly 100 years ago because so many soldiers were returning from WW 1 with tuberculosis and venereal diseases. During the 1930s Great Depression, people were suffering and dying because they couldn’t afford medical treatment. Then came the Second World War, and the stunning discovery that the health of Canadians was so poor that 59 per cent of volunteers failed the initial physical exam.
Once the war ended, Mackenzie King created the Department of National Health and Welfare and made the provinces an eye-popping offer: Ottawa would pay all hospital, medical, pharmaceutical, dental, and home nursing costs if the provinces would consent to a national health insurance plan. The provinces refused – they didn’t like the conditions.
It’s frustrating that our constitution has put delivery of healthcare in the hands of the provinces. Nevertheless, the federal-provincial disagreements energized public opinion in favor of a national health insurance plan. Saskatchewan Premier Tommy Douglas articulated the need — available and affordable acute care. He was concise: deliver basic medical care to those who were sick, injured, or pregnant; and do not ration care based on ability to pay. Prime Minister Louis St. Laurent offered less than Mackenzie King had a decade earlier: to share the costs of only hospital care and diagnostic services 50-50 in exchange for provinces agreeing to some basic standards that would create a semblance of a national program. The Hospital Insurance and Diagnostic Services Act was passed and the purpose of the system was clear. For the young country that we were in the 1950s and 1960s – average age 25 – what we needed was care when we had an accident or got sick or were having a baby. It was specific, episodic care. It was organized around doctors and hospitals where we went to get the care we needed.
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