Doctors celebrate Canada Health Act's 25th anniversary

Decades-old federal legislation is not typically feted with impassioned speeches, popcorn, cake and sangría. The Canada Health Act, however, is not a typical piece of federal legislation.

On Sunday night in a movie theatre in Saskatoon – smack dab in the middle of the place where the first Canadian medicare system took shape under the leadership of Greatest Canadian Tommy Douglas – well over a hundred physicians, nurses, politicians and citizens gathered to celebrate the 1984 law culminating the years and years of incremental progress that led to the single-payer, universal Canadian health-insurance systems now in place in every province and territory.

The 25-year-old legislation's birthday party was thrown by an activist group of physicians known as Canadian Doctors for Medicare, which has set up shop here in Saskatoon in large part to act as a counterweight to the Canadian Medical Association's reformist lobbying.

A large audience turned out to hear keynote speeches given by Canadian Doctors for Medicare chair Dr Danielle Martin (left) and by former Saskatchewan premier and federal health commission leader Roy Romanow (right). Local and national politicians and medical leaders, including new CMA president Anne Doig, NDP MP Judy Wasylycia-Leis, Canadian Federation of Nurses Unions president Linda Silas and others were in attendance.

Mr Romanow's speech began with a recitation of the history of the creation of the Canadian medicare system. He took a few shots at the Conservative federal government, including some pointed comments about Prime Minister Lester B Pearson's accomplishment of negotiating a bill creating universal medicare through Parliament when he was in command of a minority government.

Mr Romanow appealed for government to introduce a universal pharmacare plan, to insure Canadian patients against catastrophic drug costs. He also urged the addition to medicare coverage of home care and palliative care.

Continued vigilance and lobbying will be required to protect and improve Canada's medicare system, Mr Romanow said. “A great responsbility rests on all of us who believe in medicare.”

The ongoing medicare fight represents something more than a battle for the nation's healthcare system, he said. It is a “canary in the coal mine” -- the first point at which the federal government's willingness to stand up for the protection of Canada's social support system is being tested, Mr Romanow said. “We need today an active federal government, to create a functioning, not a warring, federation,” he said, warning against decentralization. “We do not feed a federal government that cedes issues to the provinces and special interests.”

Dr Danielle Martin followed Mr Romanow's speech by arguing that evidence has shown publicly delivered, not-for-profit healthcare to be cheaper and of a higher quality than private, for-profit care. Another advantage, she said, can be seen in the difference between administrative costs in the healthcare systems of the United States and Canada. In the US, administrative costs represent 31% of health spending; in Canada that figure is just 1.3%.

Dr Martin also argued that medicare has not only served patients well but has also been beneficial financially to physicians. In the 1970s and 80s, she said, budget cuts pushed doctors to charge patients directly for care. The Canada Health Act relieved doctors of that burden and instituted a national system that established how physicians would be paid, which in turn, Dr Martin said, led to improved collegiality among doctors because there was less inequality in pay for similar work.

But Dr Martin's goal is not simply to prevent change. She believes, like Dr Doig and Mr Romanow and many others, that medicare must adapt with the times. Dr Martin's goal is to make sure that those adaptations don't threaten the principles that made medicare so valuable to Canadians in the first place. “A better medicare is possible,” she said.

Before the giant birthday cake was cut and the party began, Dr Martin encouraged physicians to think fondly of the 25-year-old legislation. “This,” she said, “is an opportunity for the medical profsesion to realize the Canada Health Act has served us well.”

As attendees got ready to leave, one young med school graduate stood up at a microphone to invite people to her friend's parents' house to drink sangría and continue the conversation about health policy, proving once again that the Canada Health Act truly is an unusual piece of legislation. As Dr Nuala Kenny, the well-known retired Nova Scotia pediatrician and bioethicist, said: just compare the civil tone of Sunday's Canada Health Act discussion to the wildly acrimonious attitudes we've seen on television at the health-insurance reform town-hall meetings taking place now in the United States.

Photo (Danielle Martin): Canadian Doctors for Medicare
Photo (Roy Romanow): Canadian Institute of Wellbeing

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