Part 1: Back to the Future

Canada, as a country, has always been somewhat star-struck. Maybe it’s because Canadians are, as a whole, so gosh-darned polite and humble. Or maybe it’s because we have such a massive inferiority complex we only feel validated if someone bigger and more important than us, say, someone with a huge international profile like U.S. senator and former presidential candidate Bernie Sanders, decides they need to start paying attention to what we’re doing.

In the case of Senator Sanders, he made a much-ballyhooed trip to Canada in late October of 2017 at the invitation of Dr. Danielle Martin, vice-president of medical affairs and health system solutions at Women’s College Hospital in Toronto, and Kathleen Wynne, premier of Ontario. Dr. Martin, who became a YouTube sensation in 2014 by taking on a Republican senator during a widely publicized appearance before a partisan U.S. Senate committee looking into the Patient Protection and Affordable Care Act (a.k.a. Obamacare), had recently published a book, entitled Better Now: Six Big Ideas to Improve Health Care for All Canadians, in which she suggested there was nothing seriously wrong with Canada’s health care system that a Liberal dose of socialism (i.e., boatloads of money taken from the pockets of unsuspecting taxpayers) couldn’t fix. Not surprisingly, the good senator, himself a dyed-in-the-wool socialist, was quick to latch onto Dr. Martin’s nonsense.

Like something out of Mr. Smith Goes to Washington, or perhaps a strange and baffling episode of The Twilight Zone, we were treated to scene after scene of Senator Sanders being taken from one health care centre to the next — events all carefully orchestrated so that the beaming senator could witness one miracle after another. I couldn’t help thinking how terribly appropriate it was that this truly naive and easily led visitor from the south had chosen to make his pilgrimage to Canada so close to Halloween. It was as if Dr. Martin and Premier Wynne were taking young Bernie door to door, smiling like Cheshire cats as he received treat after treat, which the little boy squirrelled away in his satchel so he could take each piece of candy out and savour it once he got back home.

Watching all this unfold, hour after hour, day after day, thanks in part to our ever-accommodating media, who apparently are incapable of asking probing, tough questions, I began to feel sorry for Sanders. Here was a man who’d built a reputation as something of a straight shooter, that rare breed of politician who actually cared about the truth, one who said what he meant and meant what he said. Sadly for Senator Sanders, he was being showered with “treats” by two used-car salespersons, who appeared to have no qualms about “tricking” the senator into believing that Canada has one of the best, if not the best, health care systems in the world. Never mind the shortages of doctors, nurses, and pharmacists. Never mind that many of our emergency departments are now operating well above 100 percent of their capacity, which has resulted in patients being stacked up on gurneys like so many planes on a runway, waiting for takeoff. And for God’s sake, whatever you do, don’t you dare mention wait times. After all, being a child of the 1960s, Bernie is not a young man anymore. We don’t want to give him a heart attack.

If I’d been asked to meet with Senator Sanders, here’s what I would have told him: “In order to know where you’re going, you have to know where you’ve been.”

Now, lots of people think they know how Canada’s health care system came into being. “Tommy Douglas, the former premier of Saskatchewan and one-time leader of the New Democratic Party,” they’ll tell you, “was the father of Canadian medicare.” They’re wrong, but that’s what pretty much everyone in this country has grown up believing. So much so that in a poll conducted by the Canadian Broadcasting Corporation in 2004, Douglas was named the “Greatest Canadian.” Even more believe that they, and they alone, know what’s in the Canada Health Act. They’ll swear up and down, for instance, that one of the five principles of the act says medicare must be publicly funded. In fact, it says that medicare must be publicly administered. There’s a big difference. This has resulted in Canada’s health care landscape being littered with so much unhelpful rhetoric it’s a wonder anyone can see the forest for the trees.

To help cut through some of this clutter, I thought it might be a good idea to look back at how we came to find ourselves in the mess we’re in when it comes to health care. To this end, I’m going to focus on five things I believe were seminal in the building of our health care house of cards here in Canada, where it’s become only too easy to fool ourselves into believing we do indeed have the best system in the world, even though the truth is far from that: Tommy Douglas and the Saskatchewan experiment; the Hall Commission and the introduction of medicare; the Canada Health Act; the Savings and Restructuring Act; and the Commitment to the Future of Medicare Act.

Starting with Tommy Douglas and the Saskatchewan experiment is something of a “no-brainer,” of course, even if Douglas really wasn’t medicare’s father. After all, without this bold early attempt, it’s entirely possible the rest of Canada’s provinces might never have been convinced to dip their collective toes into the healing waters of medicare. Likewise, a closer examination of the mid-1960s commission overseen by Justice Emmett Hall is in order, if for no other reason than to show there were just as many Canadians against the creation of a national health care system as there were in favour. Which brings us to the Canada Health Act. While many feel the Canada Health Act has been something of an albatross around our necks, the very thing that’s been stifling innovation and creativity and ultimately pulling us down these past thirty-plus years, the fact remains that its introduction was, without a doubt, one of the most important moments in our country’s history. Finally, I’ll take a look at two pieces of legislation that had big impacts here in Ontario when they were introduced and are still affecting our health care system today, as other provinces (Alberta, Quebec, and British Columbia, in particular) have gone on to bring forward their own versions of the bills. The Savings and Restructuring Act was brought in by the Mike Harris Conservatives in 1996, as part of their Common Sense Revolution. The Commitment to the Future of Medicare Act was the work of George Smitherman, Premier Dalton McGuinty’s first health minister, after the Liberals defeated the Progressive Conservatives in 2003. In some ways, both of these pieces of legislation have had an even bigger impact on the health care environment in Ontario, and, indeed, in the rest of Canada, than even the Canada Health Act.