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In the past 18 months I have required two major, but unrelated surgeries, experiencing first hand Ontario's version of Medicare. The two interventions required down time and an enforced idleness for reflection on life and what it means to be Canadian. I feel blessed.

It is not just the absence of any indebtedness related to care, though that certainly helps, but the core elements of what Medicare represents: efficiency, equity and effectiveness or doing it well, availing the care to all and delivering improved health – social justice in a time when it is an endangered species.

This is no small feat and should never be taken for granted.

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What is the history of single-payer health insurance and why is Medicare Canada's most treasured social program? The first mandatory health insurance was introduced in Germany (1883). Thereafter many western European countries followed suit. In Canada, Saskatchewan's rural municipality of Sarnia created an early form of Medicare (1915) followed a year later by a municipal hospital act. In 1947, The Hospital Insurance Act (1947) came into being, again in Saskatchewan, which all provinces followed by 1961. In 1962, Saskatchewan introduced universal Medicare. In short, an idea spawned in Europe and taken up by Tommy Douglas set the stage for the passage of the Medical Care Act by the Canadian parliament in 1966.

My own life intertwined with this history from the 1950s to the present in many ways. The first exposure was to life without Medicare when my father suffered a stroke leaving him at age 54 with a permanent severe neurological deficit. Occurring at the peak of his career, he was never able to return to more than a small fraction of his original activity, eventually succumbing to complications of the stroke. I well remember my mother struggling with our much-reduced economic status to find the money to pay the health care bills. Had he taken ill a few years later she would have been relieved of that burden.

I remember, too, being a medical student of the wards of the old Toronto General Hospital and the many differences between "private" and "public" status. To emphasize that reality there was a Private Patients Pavilion – a whole wing of beds for the exclusive use of those who were "paying customers."

The impact of Medicare was dramatic.

In my subsequent practice as an orthopedic surgeon spanning more than 40 years, there has never been an instance in which a patient's course of treatment or surgery was ever thwarted by cost considerations. Sometimes criticized for failure to change, Canada's health care system has seen advances in cancer, cardiac and trauma care, among others. Many advances seen in recent decades were facilitated by the single payer model of insurance that Medicare represents.

Similarly, the complex "state of the art" medical and surgical treatment I received in 2012 and 2014 was unconstrained by cost considerations. There is so much for which to be grateful in the legacy of Tommy Douglas.

This gratitude is clearly shared by Canadians, as I learned while being a medical advisor to Roy Romanow during the Royal Commission of 2001-2. The five conditions of insurance under the Canada Health Act (1986) have become iconic: universality, portability, public administration, comprehensiveness and accessibility.

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Public support however is not unconditional. Medicare needs to respond to evolving needs, should have much greater uptake on best practices, needs to focus on a host of proven upstream practices thereby promoting health and preventing disease. Indeed the future of Medicare depends on an ability to change.

To preserve Medicare is the responsibility of all. This includes ensuring our own health literacy and physical fitness. We must be clear about the implications of those who seek to commodify health care; it is a matter of social justice that care should always be based on need and not ability to pay.

I am a very grateful Canadian and can only hope that collectively we have the wisdom to ensure the future of a program which above all supports Canadian values.

Robert McMurtry is an expert advisor with EvidenceNetwork.ca and an orthopedic surgeon, a former dean of medicine, founding assistant deputy minister of health federally and a medical advisor to the Romanow Commission. He is also a Member of the Order of Canada.

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