Oh Canada!

Underdog U.S.A. beat the vaunted Canadian hockey superstars in the qualifying rounds at the Winter Olympics. It was a crushing defeat, unexpected and glorious at the same time. I had just returned from a trip to Ottawa, Canada’s capital, where the Olympics were on everyone’s mind. The U.S. is that 10,000 lb. gorilla next door; when we sneezed, Canada got pneumonia. Canada – a nation with a population smaller than the state of California – wanted a victory against its domineering neighbor. But Canada isn’t always the follower, the victim of American whims; sometimes Canada is actually ahead of us on major issues. And as I had just blogged about Anthem Blue Cross (California) and its massive increase in individual premium rates (as much as 39%), a smile of recognition crossed my face. I had briefly visited the Museum of Civilization, a s hort diversion from a heavy schedule, across the river in Quebec, and noted with particular interest the history of one of Canada’s most controversial differences from the United States: universal healthcare.

The move to have universal healthcare was born, not in the teeming urban centers of Canada, but in the agricultural heartland, Saskatchewan, and not in the most recent past but in 1947. It seems the Provincial Premiere (“governor”), Tommy Douglas, thought it would be a great concept if most of Saskatchewan’s citizens got hospitalization (Saskatchewan Hospitalization Act), whether they could pay for it or not. The local legislature agreed, and the experiment began. But attempts to expand the coverage or take the notion of universal healthcare insurance to the national level hit the same storms of protest we are seeing in the United States. Government making life and death decisions, extreme socialization, destruction of the economic basis for Canadian health insurance companies, loss of choice in medical care.

Flawed, plagued with long waits (particularly near the end of a fiscal year), and constantly subject to reform, the modern Canadian healthcare system is still viewed with affection by most Canadians who simply look on in horror as American families are forced into bankruptcy over medical costs. The Canadian plan was pretty basic in 1947, and it was not until a decade and a half later that the provincial plan began to look more like that national healthcare that exists in Canada today. “In 1962, the NDP (New Democratic Party) government of Saskatchewan introduces the first public Medicare program. Doctors react by going on strike over a fee-for billing principle. The strike only lasts 3 weeks, and ends with the doctors keeping the principle meaning they can now influence healthcare spending. Four years later, the federal government follows suit creating a national Medicare program. They also agree to pay for half the costs. A few years later, the [Pierre Elliott]Trudeau government gave the provinces more control over health spending, by shifting to block funding. This meant the federal government would set a fixed amount per year… Between 1980 and 84, the Canadian Health Coalition (CHC) issued demands for the healthcare system to reflect five principles. The group wanted it to: be public, and Not-for-profit, comprehensive, universal, portable and accessible… The result was, the Canada Health Act, passed unanimously by Parliament in 1984.” canadianaffairs.suite101.com/article.cfm/structure_and_history_of_canadian _healthcare

The politicians who pushed healthcare into being were politically extinguished in the process. The battles raged, and healthcare insurers, doctors, pharmas poured tons of lobbying dollars (Canadian, of course) into pushing out the political champions of healthcare reform. While their efforts succeeded in terminating the careers of many prominent Canadian politicians, in the end the policy they opposed crept into law. I thought back of the devastation during the Clinton administration as the first significant nascent efforts to bring universal healthcare to the United States were crushed under the feet of well-compensated politicians. I am not sure that President Obama is likely to get what he wants out of Congress either, but the lesson of Canada is a simple one. A government-sponsored healthcare system is inevitable in a moder n democracy, particularly one where healthcare costs are both out of alignment with the rest of the Western world and where the upward pressures on costs make the prospect of affordability a national crisis in the immediate future… but the politicians who champion that program may be forced to do so at the cost of their political life.

I’m Peter Dekom, and it helps to see how others have walked down the same road.