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Headshot of Jeffrey Simpson. (Brigitte Bouvier/Brigitte Bouvier/For The Globe and Mail)
Headshot of Jeffrey Simpson. (Brigitte Bouvier/Brigitte Bouvier/For The Globe and Mail)


The anniversary that wasn’t: medicare at 50 Add to ...

The wrong anniversary got celebrated this year, but we could have expected no less from the Harper government.

The vast majority of Canadians were impervious to the stamps, television commercials, banners, toy-soldier battles, medals, decals, speeches, displays and other expensive enticements to create faux interest in the 200th anniversary of the War of 1812.

The remembrance – it could hardly be called a celebration – produced predictably potted history that conformed to the government’s political agenda to promote all things military.

So, predictably, another and far more relevant anniversary passed by unnoticed, and not just by the government: the 50th anniversary of the introduction of medicare in Saskatchewan. It’s beyond everything we know about the current, fiercely partisan government to imagine banners honouring T.C. Douglas, the Saskatchewan premier from the Co-operative Commonwealth Federation who campaigned for so long for public health care.

Say what you like about medicare today, its arrival in Saskatchewan in 1962 and its extension across Canada in 1972 was one of the most consequential developments in 20th-century Canada.

Canadians very quickly fell in love with medicare, and are still in love with it. Most of them don’t know that Canadian health care in international surveys produces middling results at a high cost, a system (or rather a series of systems) encrusted by ideology struggling, with limited success thus far, to reshape itself into something whose outcomes are commensurate with costs.

No matter. Canadians consider medicare their most important national symbol, more important than the flag or the anthem or the Charter of Rights, and way more important than the monarchy and a war fought 200 years ago. In a sense, this identification is weird, for no other people in the world identify themselves through their health-care system. But there medicare is, lodged so deep in the psyche of English-speaking Canadians that, when they participated in a CBC game show, they voted Tommy Douglas the “greatest” Canadian.

Mr. Douglas had left for federal politics when medicare came to Saskatchewan. He handed the file over to Woodrow Lloyd, whose huge contribution has been largely airbrushed from history. Mr. Lloyd had to endure a 23-day d octors’ strike, during which tempers ran white hot and abusive rhetoric rained down on the premier. For the doctors, public health care meant the end of their professional autonomy and the fraying of relationship with patients. They would become nothing more than medical bureaucrats, practising medicine as some ministry desired rather than as they, professionals, believed it should be practised.

In the end, both sides got something: The CCF government got a single-payer system offering medical services to all, regardless of income, paid by the state. And the physicians retained their professional autonomy by billing the state for services rendered.

The CCF, including Mr. Douglas, might have preferred the British payment system, whereby physicians were paid a salary by the National Health Service. But it was not to be. Today, half a century later, about 70 per cent of physicians are still paid on a fee-for-service basis, although that number drops each year.

Saskatchewan then was a rather poor province. It took 18 years from the CCF’s first election in 1944 to public health care’s arrival in 1962, largely because the province didn’t have the money. It spent money on hospitals, but not for doctors’ services until 1962.

And even then, there were concerns about costs. Mr. Douglas ran a tight fiscal ship – only one deficit in all the years he was premier. He thought the flip side of public health care should be its responsible use.

To that end, and to raise a little money, the CCF imposed co-payments, or what we would call user fees: $1.50 to see a doctor, $12.50 for a day in the hospital. The Lloyd government raised the fees three times in the decade after medicare, until a later NDP government eliminated them.

Today’s public health care is deeply rooted in those early battles. They shaped the system(s) we have today and, as such, shaped contemporary Canada far more than 200-year-old battles. It’s a shame so little attention has been paid to how medicare came to be in this, its 50th anniversary year.

Canada Post issued a stamp this year honouring former Saskatchewan premier T.C. Douglas for his campaign for public health care. Incorrect information appeared in the original print version and an earlier online version of this column.

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