It's hard to imagine an event more uniquely and stereotypically Canadian: A large group of people, young and old (but tending toward the grey), gathering in a downtown Saskatoon movie theatre to celebrate a piece of legislation.
The celebration at the Broadway Theatre last Sunday night even featured a birthday cake. It was, after all, the 25th anniversary of the Canada Health Act.
Staged by the Canadian Doctors for Medicare, it was an earnest affair.
But it was also a sober reminder that, despite Canadians' jingoistic love for medicare, they know appallingly little about its legal basis and its history, never mind its strengths and weaknesses.
Medicare - the name Canadians give to state-administered health insurance - has evolved slowly over six decades and it remains a work in progress.
The Canada Health Act (CHA for the cognoscenti) is, I would argue, the most important piece of the puzzle because it articulates, as well as anything, the philosophical basis for the country's single-payer system. Canadian Health Magazine went so far as to describe it as a "kind of Canadian Ark of the Covenant."
The political purpose of the 1984 law was to deal with the thorny health-care issues of the day: Physicians, unhappy with contract settlements during an era of high inflation, had taken to extra-billing patients; hospitals, struggling with shortfalls, were imposing user fees on patients.
The practical purpose of the law was to rein in measures that were deeply unpopular with the public and establish the conditions under which Ottawa would transfer health-care dollars to the provinces.
Under the terms of the CHA, if a province wants federal money it has to agree to satisfy five "program criteria" (often described as guiding principles):
Public administration: The provincial health insurance plan must be administered on a non-profit basis, and audited;
Comprehensiveness: The provincial health-insurance plan "must insure all insured health services" provided by hospitals or physicians;
Universality: All insured health services must be provided on "uniform terms and conditions;"
Portability: Insured health services must be paid (at a rate set by the province) even if a patient is treated in another jurisdiction;
Accessibility: The provincial health-insurance plan must provide "reasonable access" to services and provide "reasonable compensation" to medical practitioners.
In addition to these five criteria, the province must provide Ottawa with some basic spending information and "give recognition" for the funding in public documents.
Finally, the CHA states that if extra-billing or user charges for medically necessary services occur in a province, those amounts can be deducted from cash contributions from the federal government.
Those dollar-for-dollar penalties are a heavy stick, but one that is rarely wielded. Between 1984 and 2004, a total of $8.7-million was deducted from transfers to the provinces. During that same period, public spending exceeded $1.1-trillion.
Today, there are more violations of the program criteria of the Canada Health Act than ever, but there is essentially no enforcement. The federal government - under the Conservatives as well as the Liberals - has abdicated its responsibilities under the CHA.
Indeed, the 25th anniversary of the Canada Health Act reminds us that it's been almost that long since Ottawa showed any leadership on health care. Rather, our federal leaders have contented themselves with shovelling federal tax dollars into provincial coffers as medicare slowly unravels. Otherwise, they are hands-off and eerily silent.
When federal health minister Leona Aglukkaq spoke at the Canadian Medical Association conference this week, for example, she did not even utter the word medicare.
This despite the fact the CMA is staging a high-profile meeting in Saskatoon this week where they are cobbling together a blueprint for transforming the health system.
When the Canada Health Act was tabled, there was real passion there, and political leadership. "We thought we were saving medicare," recalled Monique Bégin, the former minister of health and welfare, in a wonderful book called Conversations With Champions of Medicare.
The opposition was also fierce. Everett Coffin, then president of the CMA, described the law as "a rape of the spirit, if not the legal stipulations, of the Canadian Constitution." He also said the CHA would strip Canadians of fundamental freedoms and lead to the collapse of the health system.
Twenty-five years later, the Canada Health Act is still a good foundation, but after a quarter-century it needs modernizing and updating.
Medicare, too, is still alive and kicking, albeit a little creakier. The CMA is still warning of its imminent demise and fighting for what it calls fundamental freedoms (such as paying for private health care).
Whether or not you agree with the approach the doctors' group has taken, you need to appreciate that it is actually trying to reform and renew medicare.
By contrast, politicians and policy-makers are merely sticking their heads in the sand. Why are they not leading the renewal? Is 25 years of inaction not enough?
It is as if our leaders, in lieu of leadership on the all-important health file, are saying: "Let them eat cake."
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Milestones of medicare
1947 Under Premier Tommy Douglas ("the father of Canadian medicare"), Saskatchewan establishes an insurance plan guaranteeing publicly funded hospital care for most residents of the province.
1957 Parliament passes the Hospital Insurance and Diagnostic Services Act, which guarantees federal funding of 50% for provincial hospital-insurance programs.
1961 All provinces have implemented hospital-insurance programs.
1962 Ever the leader, Saskatchewan extends health coverage to include physician services.
1965 The Royal Commission on Health Services, headed by Mr. Justice Emmett Hall, calls for a national health-insurance plan.
1966 Parliament passes the Medical Care Act, which extends federal funding to help cover physician services under provincial plans.
1972 All provinces and territories have health plans covering both hospital care and physician services.
1980 A second commission headed by Judge Hall reports on emerging threats to medicare.
1984 Parliament unanimously passes the Canada Health Act.
Source: Canadian Health Magazine