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Celebrating the struggle for medicare in Saskatchewan,

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Contents Medical Care in the Dust Bowl

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"Medicare's 50th Anniversary" now a blog book

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Medicare's 50th Anniversary Calendar

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Health Care and the 2012 Federal Budget

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Bold Experiment: A pioneer's vision of health care

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Doctor played a key role in historic medicare deal

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Wildrose Party Disguises Health Care Myths as Facts

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UK: 'Healthy competition’ in the NHS is a sick joke

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Delivery Matters: The high costs of for-profit health services in A...

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How Well is Public Health Care Protected from Canada-EU Free Trade?

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Native Women’s Association of Canada Responds to Cuts to Health Pro...

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Medicare 50th Anniversary Coalition Meeting - April 27

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Active federal participation in health care remains essential

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Report from Students for Medicare Conference

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The Medical Reform Group

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More Healthcare or More Health? Rethinking our Priorities

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Is the Charter changing Canada for the worse?

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France: When Health Care Is Downsized by Austerity

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UK: After the health bill, the end of the NHS as we know it

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A Healthy Society: How a Focus on Health Can Revive Canadian Democracy

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Council of Canadians to push provincial governments on public healt...

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Event: Remembering the Future – Can Medicare and Pensions Survive?

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Envisioning the Future of Medicare: A Citizens’ Conference

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Debt Panels By Stephen Colbert

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Making Medicare: New Perspectives on the History of Medicare in Canada

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For-profit Tailor Medical health centre shuts its doors

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Medicare Anniversary Calendar

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Medicare Month Proclamation

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50 years of Medicare!

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Allan Blakeney on the Media During the 1962 Medicare Fight

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The Year We Became Us: Saskatchewan Book Tour

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Privilege and Policy A History of Community Clinics in Saskatchewan

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Premiers meet to discuss pan-Canadian health-care strategy

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50 Years of Medicare

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Labour activists fight against privatization and contracting out of...

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Budget Blackout

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Nine million Italians deprived of healthcare as austerity and priva...

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Health care authors in Moose Jaw

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50 years!

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50 Years of Medicare Conference: Romanow says medicare needs federa...

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Envisioning the Future of Medicare

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Saskatchewan: Birthplace of medicare!

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Celebrating 50 years of medicare in Saskatchewan

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Saskatchewan cities and towns proclaim Medicare Month

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Medicare Birthday Bash - Saskatoon

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Sask. 50th anniversary of medicare

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Medicare’s 50th Anniversary BBQs

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Lessons from medicare’s stormy birth

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Standing on guard for medicare

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Roy Romanow: Medicare is part of us

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Medicare must not be taken for granted

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Saskatoon community clinic marks 50 years

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Grateful for medicare

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Tommy Douglas stamp commemorates universal medicare

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Canadian Dimension: The Limits of Medicine in a Sick Society

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The Dawn of Medicare

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Celebrating the 50th anniversary of medicare in Saskatchewan

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Canadian Health Care Under Neoliberal Assault

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Making Medicare: New Perspectives on the History of Medicare in Canada

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Saskatchewan's Struggle for Medicare: A Timeline

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The Saskatchewan Doctors' Strike

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Beyond Acute Care: Covering Seniors and the Disabled with the Medic...

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Looking back: 50 years after Saskatchewan's medicare crisis

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July 18: National Day of Action for a 2014 health accord

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Medicare’s 50th Anniversary Sets Important Context for N.S. Legisla...

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Video: A History of Medicare in Saskatchewan

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Video: Envisioning the Future of Medicare - Roy Romanow

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Canada's Health Care "Crisis": Accumulation by possession and the n...

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Making Medicare: The History of Health Care in Canada

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Rich-poor gap is making Canadians sick

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Unsung health heroes

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Sick People or Sick Societies?

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Get back to the table!

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Fighting back against health inequity and its origins

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A Healthy Society: Interview with Ryan Mieli

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July is officially Medicare Month in Saskatchewan

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Pharmacare: Campaign for a National Drug Plan

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Harper Hacks Down Our Medicare

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Towards a New Understanding

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Stronger measures needed to crack down on for-profit clinics, say d...

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The Birth of Medicare: From Saskatchewan’s breakthrough to Canada‑w...

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The next 50 years: What does the future hold for Medicare in Saskat...

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50th Anniversary of Medicare Crisis - Documentary

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To address health inequalities, look beyond the role of individual ... 105

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Physicians take healthier approach

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Potential for billions of dollars in increased health cost if Canad...

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As medicare turns 50, let’s see the full vision implemented

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Opinion: Time to fight for universal Pharmacare

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272 billion reasons to fear privatization

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Medicare's 50th Anniversary Signing Off

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Medical Care in the Dust Bowl Monday, March 19, 2012 Civilization.ca Between 1929 and 1932, as the national and international economies collapsed, Canadians of all social classes were experiencing the most calamitous decline in their incomes ever. The average per capita income fell 48 per cent during the worst years of the Great Depression, with professional incomes declining by 36 per cent between 1928 and 1933. The cost of living fell by 25 per cent. In rural Ontario, one doctor received “twenty chickens, several ducks, geese, a turkey, potatoes and wood� as payment in 1933. In Saskatchewan the situation was even worse. The sustained failure of the wheat crop meant that many communities could not afford to pay the salaries of their municipal doctors, who were then on relief like the majority of their patients. As well, 130 other practitioners in hard-hit areas were trying to subsist on an average of $27 per month. To keep them in the province, the provincial government paid them $75 per month for the next five years. By 1937, two-thirds of the province’s population was trying to survive on monthly relief payments of $20.20 for a family of five. Not surprisingly, many doctors left, and the doctor-to-patient ratio decreased from 1:1,579 in 1931 to 1:1,700 in 1941. But concerned local politicians like Matt Anderson, a Norwegian immigrant, argued in favour of a municipal health insurance plan funded through annual individual or family premiums. In 1938, having gained the support of doctors in Regina, Anderson presented the measure to his colleagues on various regional councils, where straw votes found 80 per cent of the residents in favour of the project. By 1939, Anderson had persuaded the provincial government to introduce the Municipal Medical and Hospital Services Act, which was passed unanimously. Such local initiatives indicated the extent to which rural Canadians were seeking to control the costs of hospital and medical care.

"Medicare's 50th Anniversary" now a blog book Wednesday, March 21, 2012 NYC March 22, 2012 Don't want to spend time scrolling down this blog or searching for something? Check out the blog book below to see if assists you. The links and videos don't work of course. 8

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You can also download the book or embed it.

Open publication - Free publishing - More ccf

Medicare's 50th Anniversary Calendar Sunday, April 01, 2012 This post is connected to Medicare's 50th Anniversary Google Calendar and will display events as they are entered. You can bookmark this page or simply click on the left sidebar calendar to visit this events post. If you have a relevant event you would like too see added, email me at redougie@gmail.com.

Health Care and the 2012 Federal Budget Sunday, April 01, 2012 By Adrienne Silnicki Council of Canadians March 28th, 2012 It’s federal budget time again and everyone from the Council of Canadians to allies, politicians, news outlets and the Twitterverse seems to be abuzz with concerns over what this Harper budget will contain. The world of health care is equally concerned, although much of its fate was laid out by Flaherty at the Finance Minister’s meeting in mid-December. Much like with the health care accord, the federal government is able to tie federal dollars to new programmes, services, national standards and benchmarks at any time. The budget gives the Harper government an opportunity to strengthen and expand health care in Canada- but I’m feeling rather pessimistic that they’ll take this opportunity. There are lots of things I’d like to see in the federal budget, like a commitment to enforce the Canada Health Act, the setting of new national standards on care, the implementation Medicare's 50th Anniversary Volume 2

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of new universal programmes like pharmacare, dental care, mental health services. I’d like for there to be a continuing care plan in Canada that ensures every province and territory is able to help Canadians age with dignity and give Canadians options on how they want to age (i.e. to stay in their own home, get a bed at a long term care facility, access care at a community centre). I’d also like to see the federal government acknowledge that it plays a very important role in Canadian health care and I’d like to see them go even further by recognizing that social determinants of health-such as poverty, education, affordable housing, unemployment, and environment- play a fundamental role in people’s health and wellbeing as well. But I doubt in yet another austerity budget we’re about to see Harper offer any assistance to those who are in most need. But here’s what we do know: Canada has been increasing its use of health care services. This is partially a result of decreased wait times and partly because of an expanding range of services (see the Canadian Centre for Policy Alternatives’ Alternative Federal budget for a good breakdown of this). Canadians are living longer (yay!) which means a broader range of services are accessed for a longer period of time. So, with more demand and more supply, the costs increase (see Professor Rowe- I’m figuring out this whole economics thing!). The problem is then, how do we pay for the services? Well if you listen to the right- and I’m sure when we all tune into the budget tomorrow- we’ll hear that we can’t pay for it, it’s too expense and it’s- here comes my least favourite word …- unsustainable. But that’s just incorrect. It’s nice that the budget comes just after the release of the Senate Committees review on the 2004 health care accord. Now, I’m not a fan that the Senate reviewed the 2004 health accord. I firmly believe that it should have been done by the Parliamentary health care committee- but the Harper government didn’t have a majority in Parliament at the time but they did have control of the Senate and so in typical Conservative anti-democratic fashion, the review was struck in Senate. Several of our pro-medicare allies- including the Canadian Health Coalition and unions and groups representing health care professionals- asked to present to Senate and were turned down. But in a surprising move to many of us, some of the Senates recommendations weren’t terrible! In fact, the Senate and I even agree that: Harper and his government need to be responsible and accountable for health care in Canada, pharmacare is necessary and the federal government should take the lead, and we need a continuing care strategy for the country. Whoa! So if Harper was to listen to the Senate (they have not endorsed all of these recommendations), or to the Alternative Federal Budget, or to the Council of Canadians and our pro-medicare allies they might hear that in this next federal budget we want: 1. Canada needs to implement pharmacare- a universal drug care coverage plan. Pharmacare would save Canadians $10.7 billion a year or 43 per cent of current expenditure on drugs. Savings would come from bulk-purchasing, using new cost comparator countries for pricing drugs, a single universal public insurer, and a national formulary of essential drugs. 2. A continuum of care strategy is needed to help ageing Canadians access appropriate care. An expansion of community-based care, home care and long term care is needed 10

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to reduce wait times across the country. 3. The federal government needs to recommit to the principles of the Canada Health Act: universality, accessibility, public administration, comprehensiveness, and portability. 4. Some provinces are allowing clinics to operate illegally by charging user fees and extra-billing for medically necessary services. The federal government needs to stop this from happening by penalizing those provinces through dollar-for-dollar deductions in cash transfers. 5. The creation of stand-alone legislation for pharmacare, continuing care, dental care and mental health services is essential for truly comprehensive and universal health care across Canada. 6. The federal government needs to negotiate a 2014 health care accord with the provinces and territories that includes: national standards and benchmarks tied to the Canada Health Transfers, pharmacare, continuing care, expanded mental health services, and dental care. The new accord should include a 6 per cent escalating transfer for the duration of a new ten-year accord. I wish I could tell you that I’m hopeful that all of this will occur. But to be honest, I’m not. I do, however, have the date October 19, 2015 (the next federal election) dance in and out of my thoughts most days. Until then, we’ll just keep hammering away with our demands for truly universal and comprehensive health care in Canada. Maybe we can even bug them so much that they give in to our demands and realize that the one per cent isn’t worth the suffering of the 99. Too optimistic? I think not.

Bold Experiment: A pioneer's vision of health care Friday, April 06, 2012 Bold Experiment By Matthew S. Anderson Your Nickel's Worth Publishing Bold Experiment , an autobiography written by Matthew S. Anderson (1882 - 1974) - a man recognized by Tommy Douglas as 'a pioneer of social medicine'. The 80-page book, including photographs, documents and memorabilia, uncovers the littleknown history behind an important piece of our Canadian culture, heritage and identity: the story behind how Medicare first came to Saskatchewan. Since its inception as a province, Saskatchewan has been home to grassroots idealism, to people willing to work hard to make a difference and to those willing to persevere despite the odds. Matthew Anderson believed strongly that Canadians should have protection against the cost of illness. After almost 20 years of dedication and

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determination to transform the idea into reality, this man, a plain "dirt farmer" from Bulyea, Saskatchewan, forged and made work North America's first comprehensive, prepaid medical care plan. "Matthew Anderson was a Canadian original - a genuine hero, who pioneered in the creation of public medicare. His concern for others, and his good Prairie common sense, produced the basic ideas for a world-class system of collective care. It's important that his story be told, and that we honour the memory of this remarkable man." - Allan Rock, Ambassador and Permanent Representative of Canada to the United Nations (former Canadian federal health minister) "What a fascinating glimpse into our province's history that helped break trail for a national health care system." - Pamela Wallin Given the interest in the Tommy Douglas story and the history of Medicare, this book provides a timely perspective from one of the early pioneers of health care in North America. Click HERE to buy online.

Doctor played a key role in historic medicare deal Saturday, April 07, 2012 Dr. Graham Clarkson, one of the architects of Canada’s medicare program, died March 13 at 87. BY ED STRUZIK EDMONTONJOURNAL.COM APRIL 7, 2012

Dr. Graham Clarkson When longtime Edmonton resident Dr. Graham Clarkson died March 13, he took with him one of the last living chapters in a remarkable event in Canadian history. The story of medicare included the likes of former Saskatchewan premiers Tommy Douglas and Allan Blakeney and Lord Stephen Taylor, the British physician who had helped implement the National Health Service in the United Kingdom. But Clarkson, who died at 87, also played a key role. “He never stopped advocating for better health care,” says Don Junk, a lifelong friend. “Once medicare was accepted by doctors, he pushed hard for better geriatric care in Alberta and for shorter hospital stays and more outpatient services. It didn’t always make him popular with his colleagues. ... But he wouldn’t back down if he thought it would do some public good.” Born in Glasgow, Scotland, Clarkson went to war at the age of 17 and was nearly killed 12

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by a grenade. During his recuperation in London, he studied Mandarin in hopes of serving with British intelligence in Southeast Asia. He ended up going to medical school in Glasgow instead. June Clarkson was an occupational therapist when they met in that city. Shortly after they married, the couple moved to the Whiskey Trail in the Scottish Highlands. As “rewarding” as that experience was, says June, Clarkson applied for a job as a medical officer serving the Royal Canadian Air Force in Moose Jaw in 1956. The timing couldn’t have been better. A few years later, Saskatchewan premier Douglas would introduce his universal health-care plan and he needed someone like Clarkson who had worked in a universal health-care system. In short order, Clarkson became the first executive director of the Saskatchewan Medical Care Insurance Commission. In that role, he advised premiers Douglas and Woodrow Lloyd and then-health minister Blakeney on how to implement what they had hoped to do. By all accounts, it took a lot of doing. The province’s doctors wanted no part of the mandatory government-run plan. In a bid to defeat the CCF in 1960, the association they formed lost the war to oust the government but was slowly beginning to win the oftennasty battle for public opinion. Leading the “Keep Our Doctors” campaign, Father Athol Murray declared at one point: “If the government doesn’t withdraw this act — the Medical Care Insurance Act — there will be blood running in the streets — and God help us if it doesn’t.” When the doctors subsequently threatened to continue billing patients or leave the province altogether, Clarkson travelled to Great Britain to see if he could line up doctors who were willing to replace them. As the dispute dragged on, Taylor came in on his own accord to broker a deal to the dispute, which was making headlines in Washington, New York City and London. In an article written for the Journal of the Canadian Medical Association many years later, Taylor described what transpired on the day a delicate deal with the doctors was finally brokered by Clarkson and others. “I got up that Monday morning and when I was having my bath, there was a knock at the door. In came Dr. Clarkson. ‘It’s all right,’ he said. ‘It’s on. They are going to sign this morning.’ “I have seldom seen anyone grinning more widely,” wrote Taylor, “and I have seldom enjoyed a bath more.” The appeal of Saskatchewan’s medicare program was not lost on prime minister John Diefenbaker. He had offered provinces 50 cents for every dollar spent on universal heath care. Then in 1962, he appointed justice Emmett Hall to chair a royal commission on the future of health care in Canada. The rest, of course, is history. But June Clarkson worries that Canadians are forgetting Medicare's 50th Anniversary Volume 2

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what it took to get the universal health care they enjoy now. “When Graham died, Allan Blakeney’s wife wrote to offer her condolences. She said that now with Graham gone and Allan recently passing, there is really no one left to remind us what happened back then.” Graham Clarkson is survived by sons Ron and Bruce and daughters Hazel and Wendy.

Wildrose Party Disguises Health Care Myths as Facts Sunday, April 08, 2012 By Adrienne Silnicki Council of Canadians April 8th, 2012 Danielle Smith of the Wildrose party has been quoted extensively talking about health care in the Edmonton Journal and Globe and Mail, among others. The Wildrose is running on a platform of creating a two-tiered system of health care in Canada. They claim that offering private health care creates: more options, reduces wait times, and protects and strengthens public health care. Each one of these points is false and not backed by evidence from the science and health research community. I’m going to attempt to separate myth from fact in the paragraphs below. I hope you’ll read more. Myth: Private Care Reduces Wait Times Fact: Health professionals are in short supply in Canada. We need more nurses, doctors, technicians (MRI, CT, X-ray), anesthesiologists, and others. When we create a parallel public-private health care system we split these much needed health professionals into two different systems, creating more demand while the supply remains static. This creates a backlog in health care and lengthens wait times for everyone. Studies completed on parallel private systems have not shown a reduction in wait times for public health care. In the UK, a parallel private health system has only extended wait times. “This backs up Canadian evidence from the province of Manitoba where, until 1999, patients paid an additional facility fee or “tray fee” if they chose to have cataract surgery in a private facility (the surgery itself was still paid for by the provincial health plan). At the time the fee was in place, the Manitoba researchers found that patients whose surgeons worked only in public facilities could expect a median wait of 10 weeks in 1998/99; however, patients whose surgeons worked in both public and private facilities could expect a median wait of 26 weeks.” (Canadian Health Services Research Foundation, 2005). Myth: Two-tiered health care creates options

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Fact: Two-tiered health care only creates options for the richest and healthiest among us. The private system is notorious for cherry-picking patients. The private system can make money off of healthy Canadians, but they cannot make money off patients who have chronic care needs. The private system will often refuse those patients services- like you often hear of with private insurance companies who have qualifying tests that people must past or they’re denied coverage- and then the public system is left with the most expensive and complicate patients which bankrupts the system- which we’re seeing happen in England to the National Health Service. For healthy and wealthy Canadians, a two-tiered system does mean more options. However, many private facilities have been shown to offer lower quality and more dangerous care- adding the profit motive to care means finding cuts somewhere. And yes, efficiencies can and need to be found in both the public and private systems, but, investors will always want bigger returns on their investments and in some cases the drive to make money has come at a cost to safety (see this Marketplace episode on p r i v a t e c l e a n i n g c o m p a n i e s i n h o s p i t a l s : http://www.cbc.ca/marketplace/2012/dirtyhospitals/). Private care may offer you services faster, but it does so at a very high cost. Even in Alberta. Redford is offering to pay for private services with public money but only to a certain point- the cost of the service in the public sector- and then patients will need to pay out of their pocket. A parallel private health system offers choice to the healthy and wealthy at a cost to public health care. The public system is the only one that offers the choice to receive care to all Canadians. But if you bankrupt the public system by allowing the private one to cherry-pick patients, then there is no choice for anyone (for more information on how this happens see the references to the NHS at the bottom of the blog). Myth: Two-tiered health care protects and strengthens medicare Fact: Medicare is protected and strengthened when governments invest in publicly delivered health care. The privatisation of health care delivery in Canada has shown to weaken health care. Parallel delivery systems (meaning for-profit and public) have drained health care resources by splitting human resources and directing investments outside of public health care. To protect and strengthen universal health care in Canada we need provincial, territorial and federal governments to enforce and commit to the principles of the Canada Health Act: comprehensive, publicly administered, portable, accessible, and universal, and to the criteria of the Act: no user fees or extra-billing for medically necessary services. The federal government needs to work with the provinces and territories to implement evidence-based and innovative best practices- that are happening in pockets and silos across the country in the public sector- and extend those practices into every province and territory. We need to share best practices with one another and work together to strengthen the system. Resources need to be spent on extending health care to cover areas that are much needed such as: pharmacare, continuing care, dental care, and mental health services. These areas would ensure that Canadians have a full continuum of care from cradle to grave- which was the initial intention of medicare’s founders.

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The Quebec Example The notion of parallel public and private delivery systems is not new to Canada and several provinces have been expanding the scope of private services in health care. Canada’s most extreme example of a private parallel system is found in Quebec. After the Quebec V. Chaoulli case in 2005 Quebec began privatising some medically necessary services and offering what the Wildrose party is now proposing a two-tiered simultaneous public and private health care system. Quebec now has over 55 delisted services- these are medically necessary services which are given a benchmark time in which they must be performed and completed. If these services cannot be completed within that benchmarked time then patients are eligible to seek private care, which is paid for with public dollars. Some Quebec doctors are abusing the system by artificially inflating wait times and moving patients to their own private practice. When doctors are able to practise in both the public and private sector (as some Quebec doctors are) and receive higher remuneration through duplicate private health insurance, this has been show to encourage a higher service volume in private delivery to the detriment of public delivery. It has also shown to delay surgery in the public sector (to maintain long waitlists), and raises numerous ethical questions when doctors refer public patients to their private practice (see: Duplicate Private Health Care Insurance: Potential Implications for Quebec and Canada. Odette Madore. Economics Division, Parliament of Canada. 20 March 2006. http://www.parl.gc.ca/Content/LOP/ResearchPublications/prb0571-e.htm) It seems like Alberta is proposing something similar, except that doctors won’t be paid by the public purse for the additional expense of private care. Instead, the additional money will come from the pockets of the patients. This means that only those that can afford the additional expense will be able to jump the queue. Those in need- who may live paycheque-to-paycheque- will be forced to wait longer, and if they’re unable to work, they’ll have to make do with even less income. The Solution Instead of splitting resources between the public and private sector which creates a twotiered system and unjustly lengthens wait times, the Albertan government could be strengthening the public sector by investing resources there. Danielle Smith of the Wildrose Party has estimated that paying for a two-tiered system will cost $180 million a year for the province- this figure doesn’t include what it will cost Albertans out-of-pocket when they use the private system. Why not invest the $180 million a year in innovation in the public sector? Use that money to implement some of the evidence-based solutions that are already available and being implemented in provinces and territories across the country. $180 million will go further in the public system than the private and it will ensure that all Albertans have access to the medically necessary services they need. Since the 2004 health care accord Canadians have witnessed some drastic reductions in wait times in benchmarked surgeries. This could go even further, if the Albertan government was willing to invest the resources needed instead of starving the public sector by withholding funds and splitting human resources. By investing in the public sector and using evidence-based innovations- wait times will be reduced for all Albertans. It’s a straightforward, sensible, and kind solution. More Information 16

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Watch the 2014 Health Care Accord Townhall with Maude Barlow here (3 parts): http://www.youtube.com/watch?v=ORdwqC9RewE&list=UUEm2QhhWO5sND7D15iHCIP A&index=3&feature=plpp_video http://www.youtube.com/user/CouncilofCanadians?ob=0&feature=results_main http://www.youtube.com/watch?v=J7LQ3ZIA0UM&list=UUEm2QhhWO5sND7D15iHCIPA &index=2&feature=plpp_video Why a Private-Parallel System Lengthens Wait Times: Canadian Health Services Research Foundation (CHSRF). Myth Busters: My Busted, March 2001; Busted Again! March 2005. Available at: http://www.chsrf.ca/Migrated/PDF/myth17_e.pdf Read more about the problems of two-tiered health care from real life examples: Children’s health services opening to for-profit interests. http://www.guardian.co.uk/commentisfree/2012/mar/16/privatising-nhs-children-servicesdisaster

UK: 'Healthy competition’ in the NHS is a sick joke Wednesday, April 11, 2012 Real health choice under the NHS reform Bill doesn't exist, and the so-called market is a mockery. By Max Pemberton The Telegraph April 9, 2012

Richard Branson and his daughter Holly Photo: REX On March 27 the NHS reform Bill – or to give it its official name, the Health and Social Care Bill – received Royal Assent and became law. With the ink barely dry on Her Majesty’s signature, the carving up of the NHS has begun. Virgin Care has won a £500  million contract to provide community services across Surrey and began running these services, as well as the county’s prison healthcare, on April 1. This was no April Fool’s joke, though I had to smile at the thought of Virgin managing sexual health clinics. In reality, the joke may be on all of us, as Richard Branson’s company becomes one of the first of many vultures to start picking over the rich, tender flesh of the NHS now that it has been splayed open by the Bill. His daughter, Holly Branson, was a few years below me at medical school. I remember thinking how good it was that someone steeped in privilege had seemingly decided to dedicate her life to serving other people. I had a vision – somewhat idealised, I know – of

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her working in the East End, providing care to the deprived and poverty-stricken. But no. After a brief stint as a junior doctor at a London hospital, she quit the NHS to work for her father. It saddens me to see someone who underwent the same training I did stand by as their family business profits from the sick and undermines the very institution that provided them with their education. Richard Branson likes to be thought of as an affable, benign maverick, on his way to becoming a national treasure. He’s the cuddly face of corporate Britain. But just because he has a beard and looks like Noel Edmonds does not mean his multinational business is any less aggressive and expansionist than the next. What the Virgin Care takeover in Surrey really exposes are the two fundamental lies that have been peddled by the Government over the past year in attempts to manage the PR disaster that was the NHS Reform Bill. The first is the flat denial that the Bill represented any sort of privatisation of the NHS, despite it being obvious to anyone who read it that this is precisely what it was.

Delivery Matters: The high costs of for-profit health services in A... Wednesday, April 11, 2012 ByDiana Gibson, Jill Clements Parkland Institute April 11, 2012

Executive summary In Alberta and across Canada, the private for-profit healthcare sector is being positioned as a solution to wait times and the financial challenges facing the health care system. Consequently, for-profit delivery of healthcare is increasing. The provincial and federal governments are also increasingly referring to public healthcare as a publicly funded health system, under the premise that it does not matter who delivers the services. This report explores the implications of this trend with regards to costs, wait-times and other issues associated with healthcare delivery. The Alberta government promised to provide a costbenefit analysis to demonstrate to Albertans the value of utilizing for-profit service providers in the delivery of publicly funded health care.1 To date this has not been completed or published. This report provides some of the information necessary to do that cost-benefit analysis on the basis of information and data garnered through the Freedom of Information and Privacy (FOIP) request process. This report is the second in a new series by the Parkland Institute: Delivery Matters. The first report examined delivery of long-term and continuing care services and provided a solid body of evidence that quality is significantly poorer in investor-owned facilities. 18

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Similarly, this report explores the delivery of clinical services, specifically arthroplasty or total hip and knee replacements, through private, for-profit clinics. It includes a case study of Calgary’s Health Resources Centre (HRC) that specifically examines the cost, quality, access and other implications of expanding this form of provision and places it in the context of national and international research. It also examines a wait-list reduction pilot project, the Alberta Hip and Knee Replacement Project, which includes for-profit and not-for-profit providers, allowing for a comparison of the two models. The clear conclusion is that it matters who delivers clinical services. The spectacular fall from grace of HRC is a fascinating study in the ills of health care privatization, the risks to patient care, and the need to reiterate the importance of our publicly financed and delivered health care system. The case study of HRC is very consistent with international studies, validating the conclusion that for-profit incursions into the health care system are risky, costly and lack the accountability Canadians expect, demand and deserve. The findings of this report are that HRC clearly cost more on a per surgery basis than public alternatives. The report also finds that the wait time gains were despite not because of the for-profit nature of HRC. The success of the public partners in the pilot project on wait-time reductions in Alberta clearly shows that public solutions can achieve the same wait-list targets at less cost and much less risk to the public. download the full report read the media release

How Well is Public Health Care Protected from Canada-EU Free Trade? Wednesday, April 11, 2012 Canadian Labour Congress Tuesday, 10 April 2012 Background Canada and the European Union (EU) are close to concluding a Comprehensive Economic and Trade Agreement (CETA). Recently, Canada’s first offers to the European Union on Services and Investment were leaked to the public by the Quebec Network on Continental Integration (RQIC).1 Canada’s financial services offers were released on February 9, 2012. That same day, la Fédération Interprofessionelle de la santé du Québec (FIQ) released their analysis of Canada’s offers and raised worrisome implications for health and social services.2 When the government was pressed in Question Period the next day by NDP Members of Parliament Libby Davis and Anne Minh-Thu Quach, Conservative MP Gerard Keddy replied that:

... a free trade agreement with the European Union would exclude public services such as public health, public education and social services. Canada’s trade obligations do not

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require us to privatize any part of our health care system. End of story. The government argues that health care services are protected in Canada’s trade agreements primarily because of its Annex II Social Services Reservation. When the federal government says that Canada’s public health care system is not on the table, this is what it is referring to. This Annex II Social Services Reservation appears in Canada’s CETA initial offer, and it states the following:

Canada reserves the right to adopt or maintain any measure with respect to the provision of public law enforcement and correctional services, and the following services to the extent that they are social services established or maintained for a public purpose: income security or insurance, social security or insurance, social welfare, public education, public training, health, and child care.3 This reservation allows governments to adopt future measures that would otherwise contravene Canada’s trade and investment agreements. Download the full backgrounder

Native Women’s Association of Canada Responds to Cuts to Health Pro... Friday, April 13, 2012 Native Women’s Association of Canada Ottawa, ON (April 13, 2012)--The Health Department of the Native Women’s Association of Canada (NWAC) is extremely distressed and concerned over Health Canada’s decision to cut all funding for projects aimed at improving the health of Aboriginal women in Canada. Few people in the world are in greater need of human rights protection than Indigenous peoples. Although governments have a duty and responsibility to ensure the welfare and safety of all their citizens, Indigenous peoples are often the target of policies designed to erode or suppress their rights and distinct cultural identities. Canada is no exception! NWAC has worked tirelessly for more than 30 years to address shameful inequities that continue to plague Aboriginal women’s health in Canada. Aboriginal women are the least healthy and suffer the greatest chronic health conditions than any other segment of Canadian society. The burden of ill health affects them as individuals, their families, communities and the health system as a whole. However, Aboriginal women lag far behind the rest of the Canadian population in both of these areas. Health Canada has advised NWAC today that it will not support its national innovative health programs or policy work, some of which have been held up as “best practices” in health, in order to preserve direct services to First Nations living on reserve only. Currently the vast majority of Aboriginal women (more than 70%) do not live on reserves, rather in rural and urban centers. This budget shows that for the most part, Aboriginal

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women’s health is not a priority for this Government. Aboriginal women raise their families most often single handedly and in poverty situations (over 40% of Aboriginal women live in poverty). Further, it is well known that Aboriginal women carry the burden of ill health and have the highest rates of chronic disease. They experience unacceptably high levels of violence and abuse, Aboriginal women are newly diagnosed with HIV at over three times the rate of their non-Aboriginal counterparts, have atrocious disparities in suicide rates, and live on average almost six years less that non Aboriginal women. Yes, more is needed to help local communities struggling with health disparities, but cutting the head off the national voice for Aboriginal women’s health shows a lack of commitment to address the issues that affect the most marginalized population in this country -- a country that is envied by many other nations across the globe for its ‘great’ health care system and quality of life. “NWAC is calling on the public to demand that the Federal Government of Canada rethink its choices and give Canadians the information they need to understand the impacts of this budget and re-think this devastating decision. Today’s cuts to Aboriginal health and well-being will be tomorrow’s burden.” says Native Women’s Association of Canada’s President, Jeannette Corbiere Lavell.

Medicare 50th Anniversary Coalition Meeting April 27 Saturday, April 14, 2012 CUPE Saskatchewan The Medicare 50th Anniversary Coalition is holding a second meeting on Friday, April 27, 2012 in Davidson at the Town Hall beginning at 10:30 am. Lunch will be provided. Progressive community groups and organizations, employee associations, unions and interested individuals are invited to join in a coalition to celebrate the 50th birthday of Medicare in Saskatchewan. RSVPs can be made to cupesask@sasktel.net or by calling Nathan at 757-1009.

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Active federal participation in health care remains essential Saturday, April 14, 2012 Canadians take pride in their health system but are aware of its shortcomings. By Danielle Martin TheStar.com April 14, 2012 I don’t know about you, but in my house we don’t each buy our own toothpaste. It’s not a good use of money to have multiple small tubes scattered around the sink — not to mention the wasted time if each family member makes a separate trip to the drugstore. We agree on a brand, buy one big tube, and save our money and time. Ditto with planning meals: one person buys the groceries. We may each be responsible for feeding ourselves, but we all have access to whatever is in the fridge. I share this just in case the prime minister and premiers do things differently at their houses and might find the approach instructive. Because it’s clear that when it comes to health-care policy, they’re wasting the family budget buying multiples of everything, and everyone is cooking a different dinner. To make matters worse, the person who’s supposed to be the head of the family has left an allowance on the table and gone on vacation. Indefinitely. Whose job is it to co-ordinate health-care reform in Canada? Canadians expect our federal government to play that role. We want to know that wherever we live, we will have access to an equivalent basket of services. We want to know that our governments are buying in bulk whenever possible, maximizing savings. And we want assurances that some basic standards are being met from coast to coast to coast. Health care may be a provincial responsibility, but we know there’s a need for a family to co-ordinate its efforts. So when the Harper government plunked a 6-per-cent escalator on the table and walked away from its role in health care, I was disappointed. And it seems I wasn’t the only one. A recent Environics poll on health care showed a sea change from 10 years ago — 62 per cent of Canadians think that health care is about more than just money, it’s about what our leaders do with it. That’s up more than 20 per cent from 2002. And the Senate report released last month, “Time for Transformative Change”, urged the federal government to take an active role in transforming the health-care system, and ensure that funding is used as an incentive for change. The report assessed the impact of the 2004 health accord, and showed clearly that a 2014 accord is needed to further improve our system. Senator Art Eggleton echoed this point, saying that the federal government can’t just put the money on the table and walk away — it needs to be a key partner in leadership on health care.

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Meanwhile, the 2012 federal budget cut Health Canada, and said nothing about meaningful change. The only nod to improving the system was a three-year, $6.5-million study on cost-effectiveness in health care. But that ignores the mountains of evidence we already have about how to improve our health-care system while making it more efficient. It’s becoming baffling to Canadians as to why our federal government wouldn’t co-ordinate a national pharmacare system that could save billions. Everyone knows you get a better deal if you buy in bulk. Cost-effectiveness can also be found by making the right choices around a more caring and appropriate system for our elderly. We need a spectrum of continuing care, from long-term care, assisted living, home care and palliative care that alleviates pressures on hospitals and puts the patient first. We should be shifting as a nation toward a system that puts less pressure on acute resources, and respects the choices of our seniors. The Environics poll also shows that those Canadians who have the most frequent interactions with the health-care system are most pessimistic about it. We’re not doing as well as we could be for people with chronic conditions, and improving community care and self-management is another win-win — it’s cost-effective, and better for patients. But the poll also showed that Canadians are still optimistic about our health-care system. Most of us believe it’s the best in the world. We’re happy with a publicly funded system. A lot of us think that it takes care of our most vulnerable, and that it will be there for us if we’re ill or injured. It makes you wonder why the federal government wouldn’t want to fight for that system, and lead the transformation needed to keep Canada ahead of the pack on health care. Canadians take pride in their health-care system — so should their government.

Danielle Martin is a family physician in Toronto and Chair of Canadian Doctors for Medicare.

Report from Students for Medicare Conference Sunday, April 15, 2012 Older Women's Network April 12, 2012 OWN members Pam Churchill, Marilyn Schafer, Carolyn Bennet, Mary Hynes, Sally Ferguson and Erin Harris attended Students for Medicare’s 4th Annual Conference, “Medicare in the Age of Austerity” on March 31, 2012. Other OWN members might like to know what happened. Schedule and program Conference Videos — Both keynote speeches are online, at the links below: Gordon Guyatt, Canadian Healthcare 101, 1 of Medicare's 50th Anniversary Volume 2

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7 Dr. Gordon Guyatt, Internist, Evidence-Based Medicine expert, Office of Order of Canada, Founder of Medical Reform Group gives an introduction to the healthcare debate in Canada and presents evidence for the equity and efficiency of a publicly funded healthcare system. Armine Yalnizyan on Austerity, 1 of 3 Armine Yalnizyan, Senior Economist with the Canadian Center for Policy Alternatives discusses austerity and five key ways health professionals and students can join forces to fight for progressive change in Canada. Top 10 Tweetable Moments Information collated from the keynote sessions and facilitated discussions that you can promote through your networks: 1. Universal health care; anyone can go into the ER, get seen, without someone asking if they can afford it (seems simple). 2. Ways to get more knowledgeable about Canada’s health care system, see: @CdnDrs4Medicare & CHSRF.ca 3. Can Canada do better with less growth? Yes, but innovation is needed. 4. Need more young people in the healthcare debate. Share your voice! You can evict a bunch of people from a park, but you can’t evict an idea. 5. The healthcare public vs. private pay question is one of values: equity for all or autonomy for some. Where do you stand? 6. Public discourse is too often fueled by fear and assumptions. Let’s start sharing stories that reflect the positives in our system. 7. In conveying messages, stick to simple information, with a clear message, and as always, think about what is tweetable! 8. Need to inform the public before policy makers (i.e. prevention may be more valuable). Once the public is convinced, bigwigs follow suit! 9. Conservatives use Europe as an example of private healthcare systems. Europe has more public funding, higher taxes and better safety nets! 10. Do we live in a one-tier or two-tier system? Drugs, dental, rehab, home care are not covered! Can we move towards a more universal system? Get involved! If you support Students for Medicare and are interested in hearing about their work, or just getting occasional notifications of other interesting events and news stories, get on their monthly mailing list: just email studentsformedicare@gmail.com. Website: http://www.studentsformedicare.com Facebook: Students for Medicare / Twitter: @stdnts4medicare

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The Medical Reform Group Sunday, April 15, 2012 Medical Reform Group An organization of physicians, medical students and others committed to ensuring access to high quality health care to all Canadians. Visit their website HERE.

More Healthcare or More Health? Rethinking our Priorities Monday, April 16, 2012 OPEN MINDS The University of Regina Faculty of Arts is pleased to present Open Minds, a public discussion series wherein university professors and members of the community debate current HOT topics. Monday 23 April at 7:00pm MacKenzie Art Gallery Agra Torchinsky Salon (2nd floor) 3475 Albert Street, Regina, SK More Healthcare or More Health? Rethinking our Priorities A discussion featuring:

Dr. Tom McIntosh Saskatchewan Population Health and Evaluation Research Unit, and Department of Political Science, University of Regina Dr. Carrie Bourassa Indigenous Peoples' Health Research Centre, and Indigenous Health Studies Program, First Nations University of Canada Dr. Bonnie Jeffery Saskatchewan Population Health and Evaluation Research Unit and Faculty of Social Medicare's 50th Anniversary Volume 2

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Work, University of Regina Each guest speaker will have a chance to talk briefly before the floor is opened to debate and to questions from the audience. We want to hear YOUR views - all are welcome to come and share their thoughts! For more information call: 306-585-4226.

Is the Charter changing Canada for the worse? Tuesday, April 17, 2012 By Haroon Siddiqui TheStar.com April 17, 2012 The Charter of Rights and Freedoms, the 30th anniversary of which falls today, is changing Canada for the worse — its emphasis on individual rights may trump the broader public good and even open the door to Americanization of medicare, says one of its architects, Roy Romanow, the former NDP premier of Saskatchewan. A new generation of “Charter kids” and “Charter judges” is advancing individual rights and diluting the “communitarian impulses” of Canadians, he said in a telephone interview from Saskatoon, where he teaches at the University of Saskatchewan. Romanow played a pivotal role at the historic 1981 First Ministers’ Conference in Ottawa that paved the way to the signing of the Charter by the Queen on April 17, 1982. As Saskatchewan’s attorney general at the time, he worked across party lines to help break a deadlock between then Prime Minister Pierre Elliot Trudeau and the premiers. Joining him in brokering the Charter were Liberal Jean Chrétien, then-federal minister of justice, and Conservative Bill Davis, premier of Ontario, and his attorney general Roy McMurtry. I spoke to all four for the landmark Charter anniversary. Chrétien, Davis and McMurtry spoke glowingly about how the Charter has made Canada a more equitable society. It certainly has, said Romanow. But it’s also opening the door to a more self-centred society. “Before the Charter, we essentially looked for the resolution of federal-provincial disputes more from a provincial perspective, a regional perspective and a communitarian perspective.

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“Now after 30 years we have empowered individuals and they have tried to enforce individual rights. “We have a new generation of Canadians who don’t see Canada the way I saw it. My generation looked to over-arching Canadian values being predominant. And that meant that there were more opportunities of sharing, accommodating and compromise. “When I teach today, I notice that these Charter kids think more individually. They have less of a historical connection to the notion of communitarian impulses. It’s almost like a different country now. “They see Canada through an individual lens, whether it’s their gender rights or health rights. It’s worrisome because the answers are not always either/or.” Romanow cited a 2005 Supreme Court decision rejecting Quebec’s prohibition against individuals buying private health insurance for publicly available health services. A Montreal man waiting for a hip replacement had mounted a Charter challenge against the ban. The court’s ruling in his favour was seen as opening the door for private health case, thereby undermining medicare. While medicare is a powerful national tool of collective Canadian action, Romanow said, “in its actual application, the impulses are all individualistic. This is the result of the culture of the Charter. “This case is a cautionary tale that we may be weakening the ties and the fabric that bind this nation together and provide us with such programs as the Canada Pension Plan, the Quebec Pension Plan and national health care. “In effect, the court was obligating the state on an elective procedure, regardless of the state’s ability. If you obligate the state to provide services at any cost, you inevitably end up going the privatization route.” That leads to the American way. “Canadians see medicare as a social good. Americans see it as a commodity. That’s the sharp, sharp contrast between our societies.” The lesson to be drawn, he said, is that governments must provide “social services in a timely and affordable fashion. If they don’t, the courts will get more and more into this game,” thereby redefining our social programs.

France: When Health Care Is Downsized by Austerity Tuesday, April 17, 2012 Translated Sunday 15 April 2012, by Gene Zbikowski and reviewed by Bill Scoble L' Humanite April 15, 2012 In mid-March, the unions at the teaching hospital in Toulouse learned of an “anticrisis performance plan.” On the menu: grouping, outsourcing of services and reconsideration of the pertinence of health care acts. It is an austerity plan that conceals its name and endangers the provision of

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health care. “Don’t let the crisis enter the teaching hospital without forewarning.” Management’s “anticrisis performance plan”, which was presented in mid-March to the Committee on Hygiene, Safety and Working Conditions (CHSCT) of the Toulouse teaching hospital, has put all the staff on alert. It talks, pell-mell, about “restructuring”, “grouping”, “the proper distribution of staff”, “the organization of work”, “the outsourcing of services”, “optimization”… It is an austerity plan which conceals its name, but which is all the more alarming as, for the past few years, the staff at “the best teaching hospital in France” have been subjected to many restructuring projects and “the setting up of mechanisms to ease the breaking up of the public hospital,” according to the CGT union. Emilien Abbal, the coordinator of this great “anti-crisis” plan at the teaching hospital, tries to be reassuring: “We want to anticipate the reduction of the hospital’s resources, foreseen in 2012, in the interest of the patients. Not doing anything would allow the hospital to go into decay.” This talk is not at all reassuring to the CGT union at the teaching hospital, which is particularly concerned by the chapter on “the pertinence of health care acts.” According to the “anti-crisis” plan, management is indeed rethinking “the pertinence of expensive therapeutic acts and/or the narrow or uncertain therapeutic margin.” For Emilien Abbal, it is “just a matter of not dispersing money and thus avoiding doing the same examination twice, the over-consumption of health care acts that do not add anything, etc.” In sum, it is a matter of “improving productivity in the best sense of the word.” Julien Terrié, the deputy general secretary of the CGT union, interprets this orientation differently: “For us, there is something more. Aren’t we going to wind up reacting to statistics on the rate of cure, as in Great Britain? We know that this is the beginning of the slippery slope.” Selecting patients as in the private sector. “With a plan that defines the pertinence of health care acts, one may ask oneself if we’re not going to select patients, the way the private clinics do,” points out Cécile Pomies, the secretary of the CGT health care union in the Midi-Pyrénées region of France. “Of course, the question of pertinence must be raised, but it is very dangerous to approach it from the angle of cost management, because in that case, people’s health is endangered.” A turn in orientation that the management of the teaching hospital denies: “What we want is to avoid reducing health care provision, the better to distribute it and to avoid having to arbitrate among the patients. In no case are we talking about profitable and unprofitable patients.” A logic of cost management. Yes, but under what conditions? “They tell us: ‘There’s a crisis and we have to anticipate it.’ Except that we’re already in a crisis from the point of view of the workload. The rate of occupation of the beds is nearly 100%, we don’t have any margin of maneuver in terms of staffing levels. Just last year, over 20 cases of imminent and serious danger were filed with the CGSCT, for example! In all of the wards, we are confronted with worsening problems, and this plan isn’t going to help at all,” said Julien Terrié. Although in Toulouse “we didn’t expect this,” the anti-crisis plan is not an isolated 28

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strategy. It is the local consequence of national directives. Today, “efficiency” and “cost management” have become the government’s leitmotiv in health policy. Thus, in a “strategic guidebook” intended for regional health agencies (ARS), the general office for health care provision (DGOS) indicates that in the coming years’ financial constraints must henceforth be anticipated: “The setting up of regional schemes for the organization of health care (SROS) must be realized in a context of continual tightening of financial constraints, constraints which will be applied to every sector of health care provision.” This means that the SROS is to become the tool of choice for the rationalization of health care provision. Since it is no longer possible to lower government financing despite increased activity or to increase employee productivity, the solution is an overall reduction in capacity in the provision of health care. “A health catastrophe” The CGT union at the Toulouse teaching hospital “will fight against the adoption of the anti-crisis performance plan.” Julien Terrié, the deputy general secretary of the union, repeats that “in the present context, the solution does not lie in austerity and a reduction in health care provision. A plan like this one amounts to a health catastrophe for a metropolitan area of 850,000 inhabitants. The hospital, patients, health, territories law (1), financing according to activity (T2A) and government policy endanger the provision of health care in the entire Midi-Pyrénées region.”

(1) The hospital, patients, health, territories law is the official name of a law presented in October 2008 by Roselyne Bachelot, the Health minister. The law is the first stage of Nicolas Sarkozy’s Hospital 2012 Plan, which aims at revamping the health care system.

UK: After the health bill, the end of the NHS as we know it Wednesday, April 18, 2012 With the health bill passed, the government is now setting about forcing the market into the NHS. Colin Leys looks at what is likely to happen next Red Pepper April 2012 Photo: DulcieLee/Flickr Andrew Lansley and the Tories continue to claim that under their plans to privatise the NHS ‘services will still be free at the point of use’. But this is seriously misleading. They fail to add a key proviso – provided the service is still available on the NHS. In reality, a growing list of services will not be available, and so won’t be free. This is already happening. People who suffer from a range of conditions that are not lifethreatening, but are often painful and even disabling, are being told to pay for treatment or go without. The health bill will make this more common, and taking out private insurance for such problems will become widespread.

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At the same time the government plans to expand the use of personal health budgets, administered for us by ‘intermediaries’. Coupled with the normalisation of private health insurance, personal health budgets could easily become a tax-funded subsidy for private healthcare for the better-off, triggering a further contraction of free NHS care for the poor. New charges or ‘co‑payments’ also look likely for some aspects of NHS care. It has become urgent to see how this chain of developments is likely to evolve. Under the bill, clinical commissioning groups, or CCGs, which are unelected and unaccountable, only need arrange for the provision of hospital or community healthcare services that they consider necessary to meet patients’ ‘reasonable requirements’. There will be limits to their power to restrict coverage, but since the justification for introducing CCGs is supposed to be that GPs ‘know what patients need’, a good deal of discretion is going to be left to them. And the private sector ‘support organisations’ that are going to do most of the actual work of commissioning will urge that the list of treatments the CCG will pay for should be kept as short as possible, both to save money and because their personnel will tend to favour private provision. Services are already being withdrawn It is already happening, in a semi-secret way. The practice began in 2006 when a primary care trust in Croydon, desperate to save money, put together a list of 34 procedures it considered ‘not necessarily performed for medical reasons’, which it said did not have to be offered to patients in cases where they were ‘ineffective’ or cosmetic. The list included non-cosmetic procedures, including surgery for cataracts, hips and knees, on the grounds that the benefits were minimal in ‘mild’ cases. Obviously, what is considered a ‘mild’ case of a cataract or an arthritic hip or knee is liable to be modified by financial pressures and by April 2011 the Croydon list was being widely used to save money. According to one well-informed commentator at the time, in some areas only “urgent” treatments – cancer, fractures and A&E – were funded. All other procedures were either delayed or the patient was denied funding. So the ‘postcode lottery’ that used to apply to some prescription drugs now applies to some treatments, or even whole medical conditions, such as varicose veins or disfiguring skin conditions. Some of the conditions listed may sound unimportant, but to a person who suffers from them denial of treatment is far from trivial. Besides these services there are others that are supposed to be available but are increasingly being denied in practice. Some GPs have been restricted to making four referrals per week, regardless of how many patients in need of a referral they may see. Other GP referrals are intercepted and denied before they reach a hospital specialist. This is being done, explicitly to save money, by privately-run ‘referral gateways’. One of the first was in west London, where the giant US health insurer UnitedHealth has been given the job of vetting, and in some cases overturning, GPs’ judgments. One west London patient, who had been referred for a replacement after her knee collapsed, was told by the referral gateway to have physiotherapy and painkillers instead. It took more than £1,000 worth of private x-rays and surgeons’ opinions for her to finally prove that she needed a knee replacement and get it done on the NHS. Many patients are less fortunate, or determined. For them, NHS treatment is not free. They must pay to get it privately, if they can. If not, they don’t get treated.

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As a result of the health bill, it may not just be GPs’ referrals that are diverted or denied. The more expensive treatments recommended by hospital specialists, which the CCGs are going to have to pay for, could also come under review, and the CCGs could refuse to pay – just like healthcare maintenance organisations in the US. (Remember the doctor in Michael Moore’s film Sicko explaining to Congress how she was paid a bonus related to how many treatments she denied?) Personal health budgets Another major change already taking place, and which may have crucial consequences as a result of the health bill, is the rolling out of personal health budgets. At the moment these are to be allocated to some 53,000 people in England who are receiving NHS continuing care for a chronic condition. The personal budgets already used in social care have revealed their inherent problem: they are limited – and financial constraints mean that they are not generous. If a personal budget proves inadequate, the patient has to top it up – if they can afford to. For NHS care, such ‘top-ups’ will be payments for what was previously free. It is significant that the government describes patients in receipt of continuing care as the ‘first group’ to be eligible for them, implying that personal budgets will be extended to other sorts of patient. The NHS Future Forum, set up by the government in April 2011, went further, recommending that, ‘Within five years all those patients who would benefit from a personal health budget should be offered one.’ The government accepted the forum’s report, and the Department of Health’s impact assessment for commissioning speaks of every patient having a budget allocation. This raises the possibility that personal health budgets, with personally-paid top-ups, will become the basis of most, or conceivably all, NHS care. This approach is strongly backed by advocates of health insurance. They propose that everyone should have a personal health budget, sometimes called a ‘health protection premium’, paid for by the state, equivalent to the NHS’s average annual spending on healthcare per person. This would entitle everyone to a defined package of entitlements. Anything beyond that would have to be paid for by the individual. For most people that would mean taking out medical insurance for a wide range of other conditions and treatments – if they could afford to, and if insurance was available (pre-existing conditions may not be insurable). Since 2010–11 the funds distributed by the Department of Health for spending on patients’ acute (hospital) care have been calculated on the basis of the actual health status of every single patient registered with a GP, as reported annually to the department – in just the same way that insurance companies assess whether to offer someone insurance, and if so for what level of premium. This makes a wholesale shift to private healthcare via personal health budgets even easier to manage, especially since insurance companies are going to be involved in the commissioning support groups that will be handling all such data. The normalisation of private health insurance To see how this could work, we must start by noting that in 2009, 10 per cent of the UK population already had some form of private medical insurance. This proportion had been more or less static for several years. Greatly increased NHS funding from 2002 onwards had led to a big drop in waiting times and other improvements, which reduced the main incentive to ‘go private’; and then the 2008 financial crisis cut people’s spending power, Medicare's 50th Anniversary Volume 2

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leading to a small decline in the numbers privately insured. The insurance industry is confident that there will eventually be a big increase in demand as a result of the health bill. The targets of the costly advertising campaigns recently mounted by health insurance companies are not the rich but people in ordinary jobs. The companies clearly expect private health insurance to become widespread and normal. This could then easily mesh with personal health budgets to produce a state-subsidised private health insurance system. It would work as follows. Personal health budgets will usually be held and administered by ‘intermediaries’, as they mostly are in social care, and the intermediaries could be insurance companies. Patients with NHS personal budgets held and managed by these companies could then have full private health insurance, with much of their premiums covered by their personal health budgets. They would only have to pay the difference. This would leave CCGs with the uninsurable patients – those with costly chronic illnesses, and those too poor to pay any premiums. And since the CCGs would no longer have the unspent personal health budgets of the healthier and wealthier patients, who would have been cherry-picked by the insurers, the result would be further restrictions on care for those who remained. The government will also be under pressure from private providers and the Treasury to allow charges or ‘co-payments’ for some aspects of the NHS care that would still be available free. These would probably begin with charges for consulting a GP and for the so-called ‘hotel costs’ involved in being in hospital, both of which have long been urged by the advocates of privatisation. If and when this happens, the principle of a comprehensive, universal free service will have been comprehensively abandoned.

Colin Leys is an honorary professor at Goldsmiths University of London. He is the author of Market Driven Politics: Neoliberal Democracy and the Public Interest and, with Stewart Player, The Plot Against the NHS (Merlin Press, 2011).

A Healthy Society: How a Focus on Health Can Revive Canadian Democracy Thursday, April 19, 2012 By Ryan Meili $22.00, 144 pages, index, paper, 6 x 9, spring 2012 ISBN 978-1895830-637 Purchase book HERE. Join the conversation! www.facebook.com/HealthySociety

CONTENTS Foreword by Roy Romanow Preface: Determining Health 1: A Healthy Society

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2: Medicine On a Larger Scale 3: Growth and Development 4: The World Around Us 5: The Equality of Mercy 6: Learning to Live 7: Heading Downstream 8: Less Politics, More Democracy 9: Our Future Together References Acknowledgements Index

The impact of the social determinants of health is well known to governments and to health care organizations. The major challenge before us lies in turning this understanding into concrete actions that have an impact on individual Canadians and communities. - Hon. Roy J. Romanow, former Saskatchewan Premier, from the foreword Drawing on his experiences as a family physician in the inner city of Saskatoon, Mozambique, and rural Saskatchewan, Dr. Meili argues that health delivery too often focuses on treatment of immediate causes and ignores more fundamental conditions that lead to poor health. Income, education, employment, housing, the wider environment, and social supports: far more than the actions of physicians, nurses, and other health care providers, it is these conditions that make the greatest difference in our health. Brought to life by patient stories, A Healthy Society explores a number of specific health determinants, and ends in a discussion of democratic reforms that could help reshape the way we organize ourselves to create a truly healthy society. Through a mix of scholarship and story, the author proposes a new approach to politics. The use of human health as a measure of our success as a society, and the application of the ideas of the social determinants of health to public policy, appeals beyond political lines to common values. By synthesizing diverse ideas into a plan for action based in the lived experiences of practitioners and patients, A Healthy Society breaks important ground in the renewal of politics toward the goal of better lives for all Canadians. Ryan Meili is a family doctor at the West Side Community Clinic in Saskatoon and head of the Division of Social Accountability at the College of Medicine at the University of Saskatchewan.

We know it in our hearts: poor health is intimately linked to poverty, abuse, and lack of social services. Yet in all these areas, Canada is marching steadily backward. In A Healthy Society, Ryan Meili, a practicing doctor who knows this first hand, sounds a clarion call to all Canadians. We will not have a healthy society until we put social justice and universal social security for all back at the top of our political agenda. - Maude Barlow, National Chairperson, Council of Canadians.

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Council of Canadians to push provincial governments on public healt... Thursday, April 19, 2012 By Brent Patterson April 19th, 2012 The Council of the Federation is made up of the premiers of Canada’s thirteen provinces and territories. Its main function is to provide a united front among the provincial and territorial governments when interacting with the federal government. It meets twice a year. The Council of Canadians was present at their January meeting in Victoria, and we will be visibly present again at their summer meeting - this July 25-27 in Halifax. Where is the Harper government on federal funding of health care? The Harper government has promised to maintain health care increases of 6 per cent for the next five years to the provinces. Their intention to drop those increases and then tie them to GDP - which is currently at 4 per cent (after the October 2015 federal election) will cost the provinces approximately $31 billion over the period of the new 10-year ‘accord’, says parliamentary budget officer Kevin Page. He also says that if the funding formula stays in place beyond 2024, the federal share of health care spending would fall from its current 20.4 per cent, to 13.8 per cent by 2052, and 11.9 per cent by 2072. What do the provinces have to say about this? Mark Kennedy of Postmedia News reported in January, “(This) new approach from Ottawa has left premiers scrambling with different reactions. Western premiers don’t necessarily mind Harper’s hands-off strategy, while some other premiers have voiced concerns that medicare could be headed toward a patchwork-quilt system that lacks equity between regions.” Several CBC and Globe and Mail articles have reported: “British Columbia Premier Christy Clark says announced changes to federal government health-care transfers to the provinces won’t work for British Columbia, where a rapidly growing senior population is dramatically increasing medical costs to the province. (Clark says) that provinces will need ‘an age-adjusted per capita formula implemented’ in order for the federal plan to work sufficiently.” “Alberta Premier Alison Redford similarly talked about the importance of moving beyond haggling over dollars.” “Saskatchewan Premier Brad Wall is planning to push his provincial colleagues to band together and ask Ottawa for a health care innovation fund that would provide extra money for projects to improve patient care.”

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“Ontario, Quebec and Nova Scotia, New Brunswick, Prince Edward Island, and Newfoundland are arguing that Ottawa has not addressed the fact that these federal transfers cover a shrinking percentage of provincial health-care costs. …The premiers of Canada’s four Atlantic provinces (have called) on Ottawa to cover 25 per cent of all provincial health costs.” “Nova Scotia Premier Darrell Dexter believes the new funding formula will hurt smaller and less wealthy provinces such as his.” What do we want? The Council of Canadians believes: the Canada Health Act must be enforced to stop private health care services the federal government must commit to a 10-year health transfer plan that would see at least a six per cent increase in funding annually public health care must be broadened to include pharmacare, continuing care, dental care, mental health services and strengthen Aboriginal health there should be a single omnibus health care accord, not bilateral deals with the provinces. What can we do? The Council of Canadians has launched a multi-year campaign to ensure that the new Canada Health Accord — which must be implemented by March 2014 — meets our demands above. Our next interventions will be June 23 (to be confirmed) for a leafleting & lobby day aimed at provincial governments in advance of the July 25-27 premiers meeting in Halifax. At the Council of Federation meeting itself, we have a number of exciting actions being planned - more details on that soon! To see our ‘2014 Canada Health Accord’ campaign web-page, please go to http://canadians.org/healthcare/issues/accord/.

Event: Remembering the Future – Can Medicare and Pensions Survive? Friday, April 20, 2012 Remembering the Future – Can Medicare and Pensions Survive? Saskatchewan Seniors’ Mechanism Annual Conference Guest speaker: Louise Simard – The History of Medicare (May 16 – 10:30 a.m.) When: Wednesday & Thursday, May 16 -17 Where: Hotel Saskatchewan, Regina Full conference registration is $50 (age 55+) or $60. Register early as interest is high. For further information contact Sask Seniors’ Mechanism – 306359-9956, ssm@skseniorsmechanism.ca, website:

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www.skseniorsmechanism.ca. Conference brochure PDF HERE.

Envisioning the Future of Medicare: A Citizens’ Conference Wednesday, May 02, 2012 Saskatchewan CCPA Envisioning the Future of Medicare: A Citizens’ Conference 9 am to 3 pm,Friday June 15th, 2012 Arts 134 University of Saskatchewan, Saskatoon Dear Sir or Madam, On behalf of the Board of Directors of CCPA Saskatchewan, I am pleased to invite you and members of your organization to a unique citizens’ conference on the future of medicare in our province. This conference offers participants the rare opportunity to engage with leaders and policy experts on the future of universal healthcare, including former Saskatchewan premier Roy Romanow, Canadian Centre for Policy Alternatives Senior Economist Armine Yalnizyan, Dean of the College of Medicine Dr. William Albritton, Health Policy and Research Consultant Steven Lewis, Medical doctor and community organizer Ryan Meili, long-time public health activists Dr. John and Betsy Bury and former Vice President, Community Services of Saskatoon Health Region, Shan Landry Unlike other conferences, this event will offer participants the chance to engage in interactive discussion groups on the prominent issues and challenges facing our public medicare system. The participants themselves will drive these discussions in five key issues of importance to the healthcare debate. Participants will then have the opportunity to receive feedback and insight from prominent experts acting as “respondents” to the group discussions. This is a rare and unique opportunity for persons concerned with the future of public medicare in our country to engage in a lively and spirited discussion with some of the brightest minds on the issue of healthcare. Space is limited, so we ask you to please register by May 21, 2012 to ensure your participation. Please find attached a registration form with a listing of the five discussion sessions. Please rank your preference for which session you would most like to attend from 1 to 5 with 1 indicating your greatest preference. Coffee and Lunch will be provided.

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We look forward to your participation,

Simon Enoch, PhD CCPA Saskatchewan G-2835 13th Avenue Regina, SK CCPA Saskatchewan S4T 1N6 306 924 3372 ccpasask@sasktel.net Registration form below...

Click to enlarge

Debt Panels By Stephen Colbert Thursday, May 03, 2012 The Colbert Report

Start at 9:30 minutes in videoHERE.

Making Medicare: New Perspectives on the History of Medicare in Canada Thursday, May 17, 2012 Edited by Gregory P. Marchildon University of Toronto Press, Available Aug 2012 $39.95 The Canadian health care system is so indisputably tied to our national identity that its founder, Tommy Douglas, was voted the greatest Canadian of all time in a CBC television contest. However, very little has been written to date on how Medicare as we know it was developed and implemented. This collection fills a serious gap in the existing literature by providing a comprehensive policy history of Medicare in Canada.

Making Medicare features explorations of the experiments that predated the federal government’s decision to implement the Saskatchewan health care model, from Newfoundland’s cottage hospital system to Bennettcare in British Columbia. It also Medicare's 50th Anniversary Volume 2

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includes essays by key individuals (including health practitioners and two premiers) who played a role in the implementation of Medicare and the landmark Royal Commission on Health Services. Along with political scientists, policy specialists, medical historians, and health practitioners, this collection will appeal to anyone interested in the history and legacy of one of Canada’s most visible and centrally important institutions. Due in Stock: August 31, 2012

For-profit Tailor Medical health centre shuts its doors Friday, May 18, 2012 By Tom Blackwell National Post May 18, 2012

Tyler Anderson/National Post The door to Tailor Medical's now empty office at 330 Bay Street, Toronto. One of the most ambitious for-profit health-care ventures launched in Canada recently has gone out of business, barely a year after reportedly investing $4- to $5-million in an opulent “executive health” clinic in the heart of Toronto’s financial district. Customers who arrived for appointments at Tailor Medical recently found the doors locked shut. Neither the facility’s two founders nor its landlord could be reached for comment Thursday. Other sources, however, say the company is already looking for someone to take over a 12year lease on 24,000 square feet of space in a Bay Street office tower, and buy the expensive equipment inside it. “They were just bleeding money and enough was enough,” said one source familiar with the situation. For a block annual fee, customers to Tailor Medical would receive an initial “head-to-toe” medical that included genetic screening and other diagnostic tests, a plan to address health problems identified by the examination, and regular check-ups every two months. Such clinics — which are operating across Canada in various forms — must bill their provincial medicare systems when they provide medically necessary services, but can charge patients out of pocket for extras like diagnostic screening. Many of the patients are executives whose employers purchase memberships on their behalf. Taking up a full floor of the Bay-Adelaide Centre tower, Tailor Medical is replete with rich wood trim, granite and stylish furniture. It included a state-of-the-art gym, as well as areas for yoga and meditation, according to the company’s website, which gives no indication the clinic has closed. Dianne Carmichael, a health-care analyst with experience in the private health sector, said she was not surprised to hear the service had closed after touring the facility at the invitation of John Cape, Tailor’s CEO, a couple of months ago. ‘Other than me and him and the receptionist, there wasn’t anybody there’ “Other than me and him and the receptionist, there wasn’t anybody there.” Mr. Cape could not be reached for comment. On Thursday, the hallway outside the 24,000-squarefoot facility was dark, the doors were closed and there was no sign indicating what had transpired with the business. “The clinic is empty but I honestly don’t know its current status as a business,” Dr. Tim Cook, Tailor’s medical director until April, said via email

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Thursday, adding that he is now just keen to move on. “From my perspective the medical protocol was a big success – lots of positive feedback about its unique components. We were growing but, for many reasons, not fast enough.” Ms. Carmichael, former head of the Best Doctors health-advocacy service, noted that the Toronto branch of the famed, U.S.-based Cleveland Clinic, one of a handful of other private health clinics offering similar services in the city, also has beautiful quarters in the financial district, and has also seemed very quiet during her visits there. Despite widespread discontent about shortcomings in the public health-care system, she questioned how much demand there is for private, fee-charging services like Tailor. “I don’t know that people are knocking down the doors for that,” she said. “I think there is some frustration on the part of many people, who are concerned about access and that sort of thing. Those clinics appeal to the higher end of the financial income bracket, and they’re appealing more to executives in corporations, and there’s a limited market.” The MedCan Clinic, one of Tailor Medical’s most established competitors, however, argued the demand remains strong, though convincing Canadians they should pay out of their own pocket for health care can take some effort. “The whole idea of private medicine is in a sense counter-intuitive to people, so it takes a while for people to understand well and truly what it is you’re offering,” said Bronwen Evans, MedCan’s vice-president of marketing. “It would be different in the U.S. because people are used to paying out of their pocket. But here, you still have to get over that hurdle.” In fact, MedCan has recorded double-digit annual revenue growth for the last number of years, and now employs 55 doctors and about 250 other staff, said Ms. Evans. Other types of private health businesses, such as surgical centres in Quebec, Alberta and B.C., appear to also have fared well. Mr. Cape and Dr. Cook had both worked at MedCan when they helped launch Tailor last year. Also listed as a director of the defunct clinic is Michael Scot-Smith, a former real-estate developer and current head of the Slimband chain of weight-loss surgery clinics and Credit Medical Corp., which provides loans to obtain cosmetic surgery.

Medicare Anniversary Calendar Saturday, May 19, 2012

Fans of medicare: I just wanted to let everyone know about our 50th Anniversary Medicare Calender coming out in early June. We are currently only taking bulk orders but will have online sales available soon. A draft of the calender is below Individual calenders: $18.00 30 calenders for the price of 25: $450.00 50 calenders for the price of 40: $720.00 Simon Enoch, PhD Director - CCPA Saskatchewan Medicare's 50th Anniversary Volume 2

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G-2835 13th Avenue Regina, SK S4T 1N6 (306) 924 3372 CAW Local 567

Open publication - Free publishing - More canada

Medicare Month Proclamation Sunday, May 20, 2012 Saskatchewan Health Coalition

Fifty years ago this July, Saskatchewan people made history by establishing the first universal public health insurance program in North America. Saskatchewan’s Medical Care Insurance Act took effect on July 1, 1962. Other provinces and the Canadian government followed Saskatchewan’s lead. Medicare quickly became a cherished national program and a defining characteristic of what makes us Canadian. To celebrate the 50th anniversary of Medicare in Saskatchewan, the Saskatchewan Health Coalition would like the ______ of __________ to proclaim July 2012 as Medicare month. The Coalition has produced streets banners and signs to mark this important occasion.

Encourage your community to support our Proclamation.

50 years of Medicare! Friday, May 25, 2012 CUPE Saskatchewan

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Allan Blakeney on the Media During the 1962 Medicare Fight Friday, May 25, 2012 Queen's Quarterly

Open publication - Free publishing - More ccf

The Year We Became Us: Saskatchewan Book Tour Friday, May 25, 2012 The Year We Became Us: A Novel About the Saskatchewan Doctors Strike Written by Gary Engler Fernwood Publishing Click image above to enlarge

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Privilege and Policy A History of Community Clinics in Saskatchewan Friday, May 25, 2012 By Stan Rands Series: Canadian Plains Reprint Series 15 Year: 2012. Pages: 180 Binding: Paperback The introduction of medicare in Saskatchewan marks a dividing point in the history of the province and Canada. Before 1962, access to medical care was predicated on ability to pay and private health insurance. After 1962, access to needed medical care became a right in Saskatchewan, later extended to the rest of Canada. The battle to establish medicare was hard fought and in the front lines were the community clinics. Stan Rands was one of the key individuals who established and managed community clinics in Saskatchewan. Here is his story of how the medicare battle was fought by those who not only wanted to eliminate money as a barrier to care but also wanted to change the way health care was delivered. Privilege and Policy: A History of Community Clinics in Saskatchewan is the inside story of a more radical vision of medicare, one that has still not been achieved in Canada.

Stan Rands A Rhodes scholar, Stan Rands worked as a senior civil servant in the Psychiatric Services Branch of the Department of Public Health in Saskatchewan for over a decade before becoming the first executive director of the Community Health Service (Sask) Association months after the Doctors' Strike of 1962. For the next decade, he recruited new doctors who were sympathetic to the ideals of the community clinics and he struggled in favour of a physician payment system that would encourage better care for patients. In his later years, he was a university professor and community clinic board member as well as social justice activist. Stan Rands died in 1985.

Premiers meet to discuss pan-Canadian healthcare strategy Thursday, May 31, 2012 By Brent Patterson Council of Canadians Thursday, May 31st, 2012 The Globe and Mail reports, “(Canada’s premiers) are collaborating on (the development of) a pan-Canadian healthcare strategy. It comes in the wake of the federal government’s no-strings funding formula for health care, one that leaves it up to the provinces to shape social policy. …It’s 42

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an ambitious agenda for a country where the provinces have autonomy over health care and where premiers are not used to co-operating on developing social policies. But with health-care costs consuming a growing chunk of program spending in every region, the premiers are under pressure to tackle reforms as a group.” “Saskatchewan Premier Brad Wall and Prince Edward Island Premier Robert Ghiz will lead a two-day meeting of provincial and territorial health ministers beginning Thursday evening in Toronto. …Mr. Wall and Mr. Ghiz plan to submit a report to their provincial colleagues at the premiers’ annual meeting in July.” “As co-chairs of a working group on health-care innovation, Mr. Wall and Mr. Ghiz will look at everything from how many doctors and nurses should graduate each year to adopting the best clinical practices across Canada. …The working group is focusing on such areas as making greater use of nurse practitioners. Policy makers believe nurse practitioners can improve access to care and reduce costs by doing work that was once done solely by physicians. …The group is also looking at speeding up the development and adoption of the best clinical and surgical guidelines so that all Canadians benefit from up-to-date practices.” “The initiative takes the premiers into unchartered waters, but they are filling a void left by the federal government, said CMA president John Haggie. ‘The CMA really do feel the feds have walked away here and abandoned health, and it’s the premiers who have opted to try and step up and provide a national framework,’ Dr. Haggie said.” The Council of Canadians has argued that while the Harper government promises to maintain health care increases of 6 per cent for the next five years to the provinces (until after the October 2015 federal election), their intention is then to drop those increases and tie them to GDP - which would cost the provinces approximately $31 billion over the period of a new 10-year accord. Parliamentary budget officer Kevin Page says that if the funding formula stays in place beyond 2024, the federal share of health care spending would fall from its current 20.4 per cent, to 13.8 per cent by 2052, and 11.9 per cent by 2072. We believe the Canada Health Act must be enforced to stop private health care services; the federal government must commit to a 10-year health transfer plan that would see at least a six per cent increase in funding annually throughout the duration of the accord; public health care must be broadened to include pharmacare, continuing care, dental care, mental health services and strengthen Aboriginal health; and that there should be a single omnibus health care accord, not bilateral deals with the provinces. The purpose of the Council of the Federation, referred to as the premiers’ annual meeting in the news story above, is to provide a united front among the provincial and territorial governments when interacting with the federal government. The Council of Canadians was present at their January meeting in Victoria, and we will be visibly present again to make our demands at their summer meeting - this July 25-27 in Halifax. For more on the ‘Canada Health Accord’ we want please go to http://canadians.org/healthcare and http://canadians.org/blog/?s=%22health+accord%22.

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50 Years of Medicare Thursday, May 31, 2012 Dear Sisters and Brothers, You are cordially invited to share an evening with former Premier Roy Romanow as we celebrate 50 Years of Medicare and look forward to the next 50 years. This special event happens on Saturday, June 23, 2012 as part of the 75th Annual Convention of the Saskatchewan New Democratic Party in Saskatoon. The 50th anniversary of the implementation of Medicare in Saskatchewan is July 1, 2012. Today, Medicare is something that all Canadians take pride in and unfortunately most take for granted. The implementation of Medicare did not happen easily or without significant protest and opposition. The CCF Government, led by Woodrow Lloyd at the time, was immediately faced with a doctors’ strike opposing public health care. This was an incredibly difficult challenge for the CCF Government of the day and many members of that administration received death threats and other attempts at intimidation. The Government held its ground and prevailed, planting the seed which has now become our national Medicare program and a point of pride for Canadians. Join us as we celebrate the creation of Medicare by our predecessors and look towards the next 50 years. The dinner will be held on Saturday, June 23, 2012 at TCU Place, 35 22nd Street East, Saskatoon. The cash bar featuring free champagne for the first 30 minutes will open at 5:30 p.m. with an opportunity to view a collection of art by Saskatchewan artists available by silent auction. Dinner will be served at 6:30 p.m. immediately followed by the program featuring former NDP Premier Roy Romanow as we celebrate 50 years of Medicare and look to the next 50 years. Tickets are $100.00 per person and there are several sponsorship options available. All proceeds from the event will go to the Saskatchewan New Democratic Party. Please inform your colleagues and friends of this important event. To ensure your reservation or sponsorship, please complete and return the attached form at your earliest opportunity by mail, fax or email. If you have any questions, or prefer to purchase your tickets by phone please call me at 306-525-1322 ext. 1. I will respond to your questions promptly. Sincerely,

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John Tzupa on behalf of The 50 Years of Medicare Planning Committee John Tzupa Director of Organization Saskatchewan NDP 1122 Saskatchewan Drive Regina SK S4P 0C4 (306) 525-1322 ext. 1 jtzupa@saskndp.ca

Labour activists fight against privatization and contracting out of... Thursday, May 31, 2012 NUPGE News May 31, 2012

"These workers should not be tossed aside in a drive to reduce costs and increase profits.” - Darryl Walker, BCGEU President.

Over 100 activists from all sectors of the labour movement rallied in Kelowna on May 25 in support of the 130 workers from Spring Valley Care Centre who have all been given lay off notices. The rally, which took place outside the office of Kelowna-Mission Member of the Legislative Assembly (MLA) Steve Thomson, also raised awareness. “The passage of Bill 29 in 2002, allowed care facilities to contract out care and support services to reduce wages. This is one more example of how B.C. Liberal policies have failed seniors and their families,” says Darryl Walker, B.C. Government and Service Employees' Union (BCGEU/NUPGE) President. “At the same time it continues to drive down the wages of health care workers, most of whom are women. These workers should not be tossed aside in a drive to reduce costs and increase profits.” BC Federation of Labour President Jim Sinclair called on Premier Christy Clark to intervene and protect the jobs of the Spring Valley care home workers and the quality of care for seniors throughout the province. "Our seniors and their families deserve better from this government," said Sinclair. "Bill 29 has done nothing but line the pockets of facility owners at the expense of seniors and the people who serve them."

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Budget Blackout Sunday, June 03, 2012

Nine million Italians deprived of healthcare as austerity and priva... Wednesday, June 06, 2012 BY REVOLTINGEUROPE JUNE 6, 2012

‘The right to heath is guaranteed only to those who can afford it’, say pensioners Nine million Italians are being deprived of healthcare because they can’t afford it. That’s the conclusion of a new report report by RBM-Salute Censis that also shows that spending on the public health system has halved since the onset of the financial crisis. New and rising healthcare charges, long waiting lists and diagnostic appointments that are in practice near impossible to get in the public sector have prevented poorer Italians from obtaining medical treatment. The vulnerable are the hardest hit by the cuts and a creeping privatisation process: four million in the south, 2.4 million pensioners and 2.5 million with families and children, the study shows. Those will deep pockets have increased expenditure on private healthcare by 25.5% in the past 10 years. But funding for the public health system has fallen from an average growth rate of 6% in 2000-2007 to 2.3% in 2008-2010. 77% of those who coughed up from their own purses said it was because of waiting lists. Now 31.7% are unhappy with the public health system, up from 21.7% three years ago. ‘Cuts to public health lower the quality of services and create inequality. For these reasons it must be a priority to find additional funding to stop less public spending leading to greater private expenditure and worse health for those who can’t pay,’ stated the

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report. Commenting on the study, Carla Cantone, general secretary the SPI CGIL union of pensioners said: ‘The number of elderly that are forced to renounce healthcare will soon increase dramatically because of the deepening of the crisis, the government’s failure to respond and the dramatic situation in the public health system. ‘We have got to unsustainable situation in which the right to heath is guaranteed only to those who can afford it and those who go private. We call on the govermment to act with urgency, boosting public health and guaranteeing access to health to those who need it.’

Health care authors in Moose Jaw Wednesday, June 13, 2012 Gary Engler on left, Ryan Meili on right By Aaron Stuckel Moose Jaw Times Herald June 12, 2012 Two Moose Javian authors were at Java Express Tuesday evening for a double book launch that featured both fictional and non-fictional insight on Canadian politics as they relate to health and health care. “There’s a connection between the two books in that one is a work of non-fiction about the health care system and politics and one is a novel sort of about the history of how our health care system came to be,” said Gary Engler, author of The Year We Became Us. Engler’s fictional novel is set in Moose Jaw in 1962 during the doctor’s strike in Saskatchewan that occurred as the province began it’s move towards Medicare. Through the eyes of a 12-year-old boy and a 13-year-old girl with two very different views, the novel is a snapshot of one of Canada’s defining moments. “American writers have all kinds of novels set during important events of American history. It seems to me that it’s an important thing for Canadians to do the same thing,” said Engler. “The strike of 1962, it seems to me, is one of the pivotal events in Canadian history. Most Canadians today, when asked what makes this country better than the United States, say Medicare.” Born in 1953, Engler spent the first 13 years of his life in Moose Jaw before the closing of the Robin Hood flourmill sent his family elsewhere. But the impressions left on him during those years have filtered their way into the book, becoming what Engler describes as a “third character” in itself. “When I grew up, there was a lot of rivalries between kids from different parts of town, to the point where we would have fights just because we were from different sides of town,” he said. “Moose Jaw made things clear to people. There were stark divisions.” Engler’s take on the history of Medicare and the politics that occurred around that Medicare's 50th Anniversary Volume 2

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formative time blended nicely with his cohort in the double book launch, Ryan Meili.

For more on this story, read an upcoming edition of the Times-Herald.

50 years! Friday, June 15, 2012

50 Years of Medicare Conference: Romanow says medicare needs federa... Saturday, June 16, 2012 Urges frank discussion with Ottawa By Betty Ann Adam Saskatoon StarPhoenix June 16, 2012 The unifying force medicare has played in Canada is being eroded by Ottawa's decision to make health care transfer payments to the provinces without overall national goals attached, former premier Roy Romanow says. "The federal government is out of the picture and this opens the door to huge disparities. I don't think that's the way you build a modern day health care plan and for sure it's not a way to build a more unified, progressive and strong Canada," Romanow said after speaking to a public policy conference at the University of Saskatchewan on the future of medicare. Canada needs a national vision for health care to prevent provinces with greater wealth benefiting from enhanced care while poorer provinces receive less, Romanow said. "This not only makes a disparate national program, but it raises the prospect of a disunifying dimension to Canadian unity, which is always a very important aspect of Canada's life," he said. A country as spread out and diverse as Canada won't have identical care everywhere, but it should have programs to ensure "roughly similar principles and quality of outcomes

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as a right of citizenship," he said. "I would like to see our premiers generally, take the position of standing up to (Prime Minister Stephen) Harper and saying, 'Look, we want a federal-provincial conference. We want to talk about these costs-driver factors. We want to see what the new programs are, which can ease the cost and improve our health care, and we want a public debate about it.' " With the federal government "unwilling to take a role for itself " in shaping medicare, premiers are left "scurrying to innovate," Romanow said. "You have 10 premiers, 10 different economies, local circumstances, varying ideologies, how are you going to bring this all together - since the flood of technology and drugs keep coming on stream - in a cohesive, coherent fashion?" Medicare began 50 years ago with the federal government transferring 50 per cent of health budgets to provinces with conditions that they all agree to similar objectives as to what that funding will achieve. "Medicare is so central to our national narrative that how we reform it will determine the future nature of our country," Romanow said. Ottawa's decision represents "a very serious loss of direction," by the federal government, Romanow said. The federal government's plan to link health transfers to the GDP places too much weight on the production of goods and services, while ignoring other indicators of quality of life, he said. The GDP does nothing to measure things like whether the quality of education meets current requirements, whether the environment matters or whether people are so busy they can't spend time with their families, he said. "The preoccupation with the GDP, which has become the all-encompassing surrogate for everything with respect to well-being, is wrong," he said. The conference was organized by the Canadian Centre for Policy Alternatives, the college of medicine, the department of community health and epidemiology, the Saskatchewan Health Coalition and the Saskatchewan Union of Nurses.

Envisioning the Future of Medicare Sunday, June 17, 2012 Speaking Notes for The Hon. Roy J. Romanow, P.C., O.C, Q.C. Co-Chair, Canadian Index of Wellbeing Advisory Board Senior Fellow, Political Studies, University of Saskatchewan; Former Commissioner on the Future of Health Care in Canada; Former Premier of Saskatchewan To Envisioning the Future of Medicare: A Citizens’ Conference Saskatoon, Saskatchewan Medicare's 50th Anniversary Volume 2

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June 15, 2012 Open publication - Free publishing - More ccf

Saskatchewan: Birthplace of medicare! Thursday, June 21, 2012 Highway billboard being placed by the Saskatchewan Health Care Coalition

Celebrating 50 years of medicare in Saskatchewan Thursday, June 21, 2012

Saskatchewan cities and towns proclaim Medicare Month Friday, June 22, 2012 Saskatchewan Health Care Coalition The cities of Prince Albert, Moose Jaw, Swift Current, Saskatoon and Regina are proclaiming July as Medicare Month. The Health Minister also wrote Marlene Brown of the Saskatchewan Health Coalition this week to confirm the Province of Saskatchewan is doing the same. And today, the town of Birch Hill has confirmed they are proclaiming July as Medicare Month.

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Medicare Birthday Bash - Saskatoon Saturday, June 23, 2012 Sponsored by Saskatoon Community Clinic

WHEN Tuesday, July 3 – 6:00 (Optional Walking Tour) and 7:00 p.m. (Program) WHERE Saskatoon – Delta Bessborough Dramatic readings, presentations, cake cutting, displays and more. Optional Medicare walking tour commencing at 6:00 p.m. meeting outside the Bessborough. Program begins at 7:00 p.m. in the William Pascoe Room at the Bessborough. No cost – donations appreciated. For further info phone 652-0300, ext. 243.

Sask. 50th anniversary of medicare Sunday, July 01, 2012 Sunday, July 01, 2012 1:22 PM Saskatchewan residents are not only celebrating Canada Day on July 1st, but are also marking the 50th anniversary of the first public health care program in North America. Photo Credit: Saskatchewan Health Coalition , Supplied Today marks the 50th anniversary of medicare in Saskatchewan. Public health care systems were eventually adopted by every province, but they weren't popular with everyone in Saskatchewan on July 1st, 1962. More than 600 doctors walked off the job in a strike that lasted 23 days. July has been declared medicare month in Saskatchewan.

Medicare’s 50th Anniversary BBQs Sunday, July 01, 2012 Sponsored by SEIU West Come out and celebrate 50 years of publicly funded, publicly delivered, and Medicare's 50th Anniversary Volume 2

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publicly owned health care in Saskatchewan. Moose Jaw Start: July 22, 2012 Venue: Happy Valley Park Address: Oak St and 6th Ave NE, Moose Jaw, SK, Canada

This Barbeque is scheduled to go from 11 am to 5 pm at Happy Valley Park in Moose Jaw Medicare BBQ Poster – Moose Jaw Saskatoon BBQ on July 6, 2012 at Friendship Park in Saskatoon from 11 am to 5 pm Medicare BBQ Poster – Saskatoon - July 6, 2012 Swift Current BBQ on July 15, 2012 at Market Square in Swift Current from 11 am to 1 pm Medicare BBQ Poster – Swift Current – July 15, 2012 Read the Barb Cape’s President’s Message: Medicare’s 50th Anniversary

Lessons from medicare’s stormy birth Sunday, July 01, 2012 By Gary Engler Toronto Star June 30, 2012

A 'closed' notice is posted on the door of a Saskatchewan doctor's office, 1962

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If, as philosopher George Santayana commented, those who cannot remember the past are condemned to repeat it, then Canadians may soon face serious attacks on our most cherished social program. Few of us remember that 50 years ago, from July 1 to July 23, 1962, the doctors of Saskatchewan withdrew their services in an attempt to prevent Canada’s first socialized medical care plan from being born. Despite the “strike” receiving worldwide media attention while it was happening, very little has been written since about events that determined the shape of Canada’s medical care system. Given the importance of medicare to our collective consciousness — Canadians overwhelmingly judge it to be the single most important thing that makes this country better than the United States — why have our academics, novelists, filmmakers, playwrights and media pundits mostly ignored its difficult and dramatic birth? After spending hundreds of hours immersing myself in 1962 to write a novel called The Year We Became Us, my conclusion is that we ignore the doctors strike because it embarrasses too many powerful interests. In 1960 the Saskatchewan CCF (forerunner to the NDP), with Tommy Douglas as leader, ran for re-election promising a province-wide socialized medical care plan. The provincial College of Physicians and Surgeons, with funding from outside groups such as insurance companies, the American Medical Association and other Canadian doctors, spent more than either of the two main parties to oppose the government’s plan. Despite the volume and vitriolic tone of the negative campaigning, the CCF was reelected with an increased majority. The government then wrote legislation and announced the plan would be implemented on April 1, 1962. Meanwhile, Douglas left provincial politics to become federal leader of the recently created New Democratic Party and was replaced as premier by Woodrow Lloyd. When the doctors demanded more consultation, Lloyd delayed implementation until July 1 and offered to talk. Instead, the doctors escalated their rhetoric and announced they would withdraw their services if the plan proceeded. Keep Our Doctors committees were formed, mostly supported by business owners, and the province was polarized like never before or since. On July 1 the “strike” began. The vast majority of the province’s approximately 1,000 doctors withdrew their services and only some emergency services were provided. The government responded by recruiting doctors, mostly from Great Britain, to work in community clinics that were quickly established by unions and other community groups. After a pro-doctor rally in Regina flopped, the college finally began talking to the government and a deal was reached that ended the strike. Medicare was finally delivered. Throughout the strike, and before, the Saskatchewan media, especially newspapers, Medicare's 50th Anniversary Volume 2

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were hysterical in their support of the doctors. In its first edition after the strike began, the Moose Jaw Times Herald had a lead editorial with the headline “The Day That Freedom Died In Saskatchewan,” followed the next day by “Ugly Image of Dictators” then “Neutrality Never Won Any Fight For Freedom” and a little later came “Legal Profession Next to be Socialized.” If your sole source of information were Saskatchewan newspapers you’d have thought everyone hated medicare and it was being imposed by a dictator. So who is embarrassed by the strike, now that medicare is Canada’s most cherished social program? Some doctors, political parties, the business community and right-wing ideologues, certainly. If it were only a question of embarrassment perhaps the doctors strike should be forgotten. But there are important political lessons to be learned by remembering. In fact, forgetting damages us. It makes a repeat more likely. So what should we learn from 1962 and the extreme resistance to the implementation of Canada’s first socialized medical care plan? First, that the freedom to conduct business your way does not trump all other rights. Second, that powerful interests are sometimes wrong and can be overcome. Third, don’t believe everything you see, hear or read in the media.

Gary Engler, the author of The Year We Became Us, a new novel set during the 1962 Saskatchewan doctors strike, spent 20 years as a journalist with the Vancouver Sun.

Standing on guard for medicare Sunday, July 01, 2012 Federal lack of support strikes at system's heart By Maude Barlow And Linda Silas edmontonjournal.com June 30, 2012 Fifty years ago on Canada Day, Saskatchewan passed the Medical Care Insurance Act, under the leadership of Tommy Douglas. This bold move birthed medicare and helped shape the Canadian identity. The passage of medicare federally four years later did for Canada what the national railway did almost a century before. It helped define us from coast to coast. When Canadians are asked what institutions make them proud of their country, health care is consistently No. 1. No wonder Douglas beat out Don Cherry and Wayne Gretzky, among others, to be named CBC's Greatest Canadian because of his role in the creation of medicare. To this day, it is hockey, weather and medicare that dominate national conversations. The debate on medicare is as old as medicare itself. Douglas warned Canadians to be vigilant because there will always be people who claim we can't afford it. As the argument 54

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goes, if we can't afford it, we need to let the private sector fund and deliver health care. The 2002 Royal Commission on the Future of Health Care in Canada called for evidence that for-profit health care would be cheaper and provide better quality care and more access. It received none and called on governments to step up for medicare, noting that medicare is as sustainable as we want it to be. Governments did, signing a health accord and reinvesting in public health care. The Ten-Year Agreement to Strengthen Health Care expires in 2014. The current federal government, which has largely ignored the agreement since its election in 2006, has made no signs of pulling together for public health care in Canada. Instead, it unilaterally declared changes in the federal transfers to the provinces, reducing the federal share of health-care spending over time. Federal health-care spending on refugees and on the RCMP has been cut. Adding to provincial budget stress, the federal government is negotiating the Comprehensive Economic and Trade Agreement with the European Union, which could increase the cost of prescription drugs by $2.8 billion a year. And ignoring all evidence, the prime minister himself is on record calling for more "experimentation," in other words, for-profit involvement in health care. The lack of federal leadership strikes at the heart of medicare and the Canadian identity. At the heart of both is the desire to collectively pool risk across the country and the belief that no matter where we live in Canada, or how rich we are, that we have comparable access to high-quality public services. Canadians expect premiers and the federal government to sit down together and agree to a vision and plan of action to go forward with medicare. Without the federal government at the table ensuring a comparable quality of and access to services, the result will be both the end of medicare and the smashing of the Canadian identity into a dozen or so pieces. On this Canada Day holiday, vow to stand on guard for thee.

Maude Barlow is the national chairperson of the Council of Canadians. Linda Silas is the president of the Canadian Federation of Nurses Unions.

Roy Romanow: Medicare is part of us Monday, July 02, 2012 Health care is fundamentally intertwined with Canada's values and future By Roy RomanowGlobe and MailJuly 2, 2012 July 1, the birthdate of our great nation, is also the birthdate of Canada's emblematic health-care system. And this weekend we celebrated the 50th anniversary of the introduction of medicare in Saskatchewan. Now often referred to as unsustainable, this milestone provides an opportunity to reflect on the hard fought accomplishments of the past, to re-evaluate today's system and to consider the growing debate about its future. Until 50 years ago, Canada's health-care system was based on the private, for-profit model. Patients individually paid for the services of medical professionals and hospitals. Often, those who could not afford health care did not receive it, and even some who could did so by deferring treatment, hoping to save their family budget. Since then we have built a national system, lauded around the world, that allows us all access to highMedicare's 50th Anniversary Volume 2

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quality care. The achievement of universal health care took a long, acrimonious and protracted road. It is no surprise to me that Saskatchewan was at the forefront of this journey. The province's citizens learned many hard lessons during the desperation of the Great Depression and the sacrifices of the Second World War. They learned about generosity, about hardship and fairness, about boom and bust. They learned about the imperative for co-operative action. They came to understand that the notion of shared destiny was key to our existence. And so it is with other regions in Canada, where geography and demographics may vary, where many waves of immigration began with an initial sense of isolation, but where we all learned to see survival and progress as a test of our ongoing ability to come together and to remain united around shared values. Canada's history offers a strong and rich legacy of success that has forged our country. It is this legacy of a shared destiny that is key to understanding our young but dynamic history. Today, as we find ourselves living in complicated times, I believe it is this same legacy that remains the road map to our future, at home and abroad. Before we give in to despair around the present-day mantra that our system is unsustainable, there are a few things we must consider. First, a universal, single-payer, public insurance model is both less costly and produces better population health outcomes than multipayer systems like the one that exists in the United States. This has been proven time and time again by study after study. Questions of sustainability can never be successfully addressed by moving incrementally backward to a private, for-profit model, at least not the sustainability of a system that remains accessible to all of us. Second, if our political leaders are genuine in their desire to rein in health costs while maintaining a system for all of us, our task is clear, if not without difficulties. We must lay the groundwork for including catastrophic drug costs and bringing aspects of home care, long-term care and access to advanced diagnostic services into our not-for-profit system. Otherwise, costs will continue to escalate – without restraint and with relentless abandonment of those in need. Third, we must also recognize that the well-being of our citizenry goes beyond health care; it is dependent on preventing illness and tackling the more fundamental barriers to good health, including social, economic and environmental factors. How we treat the environment has a direct impact on our health and the longevity of a sustainable economy. The growing gap between the rich and poor directly affects our health and the fiscal demands on our health-care system. Every day, Canada faces new challenges that prompt key questions about what kind of people we are and what kind of future we wish to shape. As we celebrate the birth of our nation and of medicare, we must ask ourselves: What kind of Canada do we want? Because, as I see it, the choice Canadians make about health care is fundamentally intertwined with our values and future. 56

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Roy J. Romanow is co-chair of the Canadian Index of Wellbeing advisory board and a former commissioner of the Royal Commission on the Future of Health Care in Canada.

Medicare must not be taken for granted Wednesday, July 04, 2012 By Pat Atkinson The StarPhoenix Roy Atkinson July 4, 2012 Medicare is synonymous with our Canadian identity. It has been so successful that we often take it for granted. In Saskatchewan there are many whose lives have been shaped by the fight for universal access to health care. Fifty years ago, in the summer of 1962, I was living on the family farm west of Biggar. As a nineyear-old I was hardly aware of the political drama that was being played out across the province, but knew something "important" was happening. In a sense our farm was at the epicentre of that debate, given that the Biggar constituency was represented by premier Woodrow Lloyd, who had just implemented Canada's first universal medicare program on July 1. Most doctors in Saskatchewan were vehemently opposed to medicare and wanted to continue to be paid by their patients. They did not want the "government" to pay them for their services and so began a 23-day strike. The response from the people of Biggar and surrounding area was immediate. On July 4, 1962, my dad along with other farmers, teachers and railroaders raised more than $42,000 to start the Biggar Community Clinic. They were going to recruit their own doctor. As the strike wore on, doctors were recruited from the United Kingdom to provide health services. One of them came to the Biggar clinic, and others joined community clinics that sprang up across the province. Four of those clinics still exist, with the Saskatoon Community Clinic celebrating its 50th anniversary. The introduction of medicare was the most divisive issue Saskatchewan has seen. On the one side of the fierce debate were most members of the physician community, who were supported by "Keep our Doctors" groups. On the other side were farmers, trade unionists, teachers and some small business people. For the Lloyd government the successful implementation of the Medical Care Insurance Act was a matter of principle, one that it had been elected upon in the 1960 provincial election and one that had been a core tenet of the CCF government from its historic victory in 1944. Too many families had gone without a doctor's care because they couldn't pay, or had gone bankrupt because of healthcare debts. Medicare's 50th Anniversary Volume 2

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As we mark this 50th anniversary we do so knowing that it was our province that had the courage to implement Canada's first publicly funded medicare program, and it was our people who brought this program to Canada. John George Diefenbaker, a Conservative prime minister from Saskatchewan, appointed Supreme Court Justice Emmett Hall from Saskatchewan as chair of the Royal Commission on Health Services, which recommended in 1964 that Canada adopt national medical insurance. Saskatchewan's success with our medical insurance system was crucial to his recommendation. The federal minority Liberal government of Lester Pearson, with CCF leader Tommy Douglas's support, introduced the Medical Care Act of 1966 with the four principles of public administration, universality, portability and comprehensiveness. Fifty years on, many look at the fight for medicare as something from the past. I disagree. Today there are those who believe that wait times for surgery and diagnostic tests can be fixed by moving these and other services to private enterprise, and having individuals pay more of their health care costs. Others believe there needs to be continued reform, and these issues can best be addressed within our public system. They note that individuals already pay 30 per cent of the cost of their health care for services not covered by medicare. I subscribe to evidence-based policy making - publicly financed, administered and delivered health services make the most sense in terms of cost and quality of care. To pass more costs to the individual increases disparities, while the overall percentage of GDP devoted to health care rises. Continued reform of our healthcare system is imperative. Let's hope that our political leaders will be guided by evidence-based policy making and the enduring values of those that brought us medicare half a century ago. We simply can't slide back to pre-medicare days when citizens individually pay more for their health care as a percentage of GDP, but get less coverage. That would be a betrayal of all that was sought 50 years ago.

Saskatoon community clinic marks 50 years Wednesday, July 04, 2012 By Jeremy Warren The StarPhoenix July 4, 2012

People tour the Saskatoon Community Clinic. The small group of doctors and citizens established the member-owned clinic in 1962 and started seeing patients on July 3 of that year. On Tuesday, the clinic hosted a 50th anniversary event. 58

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Photograph by: Gord Waldner, StarPhoenix , The StarPhoenix Fifty years ago this week the Saskatoon Community Clinic welcomed its first patients as hundreds of doctors across Saskatchewan went on strike to protest the province's new medicare plan. A small group of doctors and citizens established the member-owned clinic in 1962 and started seeing patients on July 3 of that year. On Tuesday, the clinic hosted a 50th anniversary event to commemorate the opening and the people and places that played a role in its creation. Bonnie Lawrence's parents were among the clinic's first supporters and patients, but she was too young at the time to understand the emotional debates going on around her. On Tuesday, she joined a walking tour organized by the clinic to visit the historical sites connected to those early battles.

"My parents were supporters of the idea of medicare from the beginning," Lawrence said at the event in the Delta Bessborough Hotel. "They grew up without it and realized there was a great deal of hardship they and their friends endured in the 1930s and 1940s that could be avoided." The Saskatoon Community Health Services Association launched the clinic in the Avenue Building with two doctors, and has since moved to two locations in the downtown and on 20th Street West. The non-profit, which receives most of its funding from the provincial government, has close to 10,000 members in Saskatoon and surrounding area. Fifty years on and the clinic's core mission has not changed, said executive director Tim Archer. "What hasn't changed is the fact that this is delivery of care through a team," Archer said. "Our team is bigger now, but putting the patient at the centre of care has always remained." The patient-owned clinic is unique in that its members direct care and the types of services offered by physicians, Archer said. At a recent annual general meeting, for example, members passed a resolution requiring the clinic to investigate the possibility of introducing house calls as part of its service. The clinic employs doctors, nurses, mental health counsellors, nutritionists, occupational therapists, pharmacists and diagnostic technicians so the range of services offered covers most aspects of a patient's life, Archer said. "We're trying to fill in the cracks where they exist in the system," he said. An important expansion came with the opening of the Westside Clinic on 20th Street West, which helps serve a marginalized population often lost in the health care system, Archer said. "We're serving some of the most complex patients in the province," he said. Medical professionals are paying more attention to social determinants of health, which look at the role a patient's background - such as income, education and living situation Medicare's 50th Anniversary Volume 2

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to determine care, said Dr. Ryan Meili, a Westside Clinic physician and author of A Healthy Society: How a Focus on Health Can Revive Canadian Democracy. More medical graduates are looking at community clinics as preferred places to work, Meili said. "Education is probably a step or two ahead of practice," he said at the event. "It's education that explains social responsibility. They are interested in providing the best care and (the community clinic) model can probably do the best job." Dr. John Bury started practicing in the clinic in 1963 after arriving from England, where he heard about the community clinic and the medicare battle in Saskatchewan. He came to Saskatoon "caught in the slipstream of the strike," he said. "It was a unique thing in its time, being owned by the patients," Bury said before the event, adding that the new health care model divided the medical community. "People forget what a painful experience it was during that time, and Canada has never thanked us for that. Although we were very much appreciated by the patients we had." The 1962 doctors' strike, formed by physicians opposed to the government's medicare plan, led to strained relationships and strong emotions, which are still felt today. The community clinic started taking patients two days after the 23-day strike began. "It was a shameful thing what the doctors did," Bury said. "You should never refuse care for a patient when they need it."

Grateful for medicare Wednesday, July 04, 2012 BY PAMELA COWAN LEADER-POST JULY 4, 2012 Todd Richter holds up a photo of himself as a young boy and it is believed he may be the first baby born in Saskatchewan under medicare. (TROY FLEECE / Regina Leader-Post) Medicare is near and dear to Todd Richter’s heart. The 50th anniversary of the Saskatchewan Medical Care Insurance Act on July 1 marked the Regina man’s 50th birthday. Richter’s mother recalls giving birth to him at 12:02 a.m., so conceivably he was the first of 73 babies born in the province on the day that socialized medicine was delivered in Saskatchewan — a Canadian first. Ahead of her due date, Arlene Richter was admitted to the Grey Nuns Hospital, now the Pasqua Hospital.

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“I went in early because I was worried like everybody else was,” said the Regina woman. July 1 marked the beginning of tumultous times in Saskatchewan’s health-care history. Many residents worried about what medical services would be available when the Saskatchewan Medical Care Insurance Act came into effect. Protesting the move to medicare, many doctors closed their office practice. Arlene’s physician refused to provide hospital services. “I knew ahead of time that he wasn’t going to be there for (the delivery),” she said. Induced on June 30, she gave birth to her third child shortly after the clock struck midnight. So began a new life and a new form of health-care in the province. “It was two minutes after twelve and the doctor said, ‘Congratulations, you have had the first baby born under medicare’ — I’m not sure if that’s true or not because we’ve never been able to check it,” Arlene said. Being one of the first children born under medicare never meant much to Richter until he hit middle age. “I don’t know what I’d do without medicare,” he said. “After I turned 40, my body started to fall apart.” He had surgery on his left knee in 2006 and two years later required an operation on his right knee. In 2009, he needed lower back surgery, which was followed by open heart surgery in 2011. “My heart procedure involved the replacement of my aortic valve with a mechanical device and an aortic graft,” Richter said. “Now I feel like a million bucks — better than ever and not bankrupt thanks to medicare ... I’ve Googled the cost of the heart surgery and in various parts of the world, it varies from $250,000 to $300,000.” His experiences with Saskatchewan’s health-care system have been “second-to-none.” “I waited quite a while to get my knees done and I was on a waiting list for a little while for my back, but then I went on an emergency list and I got in right away,” Richter said. His heart surgery was extremely speedy. “When it’s life threatening, you’re in and out as quick as they can get you in and out,” Richter said. “All of the surgeries were 100-per-cent successful and I’m like a new person now and it didn’t cost me a dime out of my pocket ... Needless to say, I am very grateful and appreciative of the health-care system we have in this fine province of ours.”

Tommy Douglas stamp commemorates universal medicare Saturday, July 07, 2012 Saturday, July 07, 2012 1:30 PM

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Former Saskatchewan premier Tommy Douglas’ picture put on stamp to honour universal medicare in Canada. Photo Credit: Canada Post , Supplied

RELATED • Sask. 50th anniversary of medicare • Video: Sask. medicare anniversary Canada Post has issued a stamp to honour former Saskatchewan premier Tommy Douglas, the father of universal medicare in Canada. The stamp marks the 50th anniversary of the passing of Saskatchewan's 1962 Medical Care Insurance Act. Douglas was the leader of the first socialist government in North America. In 1947 Douglas introduced universal hospitalization in Saskatchewan and in 1959 announced a Medicare plan for people in the province.

Canadian Dimension: The Limits of Medicine in a Sick Society Monday, July 09, 2012 Canadian Dimension magazine July/August 2012: Volume 46, Issue 4 Medicare was born in conflict. The notorious Saskatchewan Doctors’ Strike aimed to abort it. That was 50 years ago. This issue of Dimension offers an historical perspective on that birth with an essay by Lorne Brown and Doug Taylor (who are preparing a book on the 50th anniversary of Medicare.) Ulli Diemer exposes “Ten Myths about Medicare,” and health economist Robert Chernomas discusses one of those myths in detail: the controversial sustainability question. But this issue is about more than Medicare. It’s about the limits of medicine in an ailing and toxic society. Broadcaster and social commentator Jill Eisen writes about poverty and other social determinants of health. David R. Boyd, one of Canada’s leading experts in environmental law and policy, looks at the impact of environmental hazards on human health. Finally, Richard Barnet, himself a medical doctor, reflects on the radical views of Ivan Illich, who saw modern medicine as invading daily life in dangerous and disabling ways. Click HERE.

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The Dawn of Medicare Monday, July 09, 2012 By Kim Peterson Dissident Voice July 9, 2012 A highly risible tactic of the Tea Partyers in the United States has been criticism of president Barack Obama as a “socialist”1 (insulting to Obama but more so to socialists), particularly since he attempted to reform a medical care system in a country where over 50 million were without medical coverage. North of the border, the situation is a little different. A defining characteristic of Canadian society is its universal healthcare system, called Medicare. Medicare is readily identified by most Canadians as something that sets it apart from its neighbour, the United States. Medicare had its birth in the prairie province of Saskatchewan. The province had a socialist party, the Cooperative Commonwealth Federation (CCF), that formed the government there for many years. A major plank of the CCF was to provide universal healthcare coverage for all residents of Saskatchewan. In 1961, the CCF introduced legislation to implement full Medicare in Saskatchewan. The doctors were unhappy, and a doctors’ strike loomed in July 1962. Author Gary Engler captures the youthful and polarized mood of 1962 Saskatchewan in his novel, The Year We Became Us. The main protagonists are a 12-year old boy, Roy Schmidt, and a 13-year-old girl, Katherine Anderson, living in Moose Jaw, a small city in the middle of southern Saskatchewan. Roy is a baseball and hockey-playing son of a working class family. He is already a socialist, with a precocious grasp of social justice issues. Katherine is the daughter of an accomplished head of surgery. She has already read Ayn Rand and embraces rugged individualism. Conveyed through their letters to the US president John Kennedy, childhood shenanigans, and a nowadays encounter between Roy and Katherine, a back-and-forth occurs as to what is the preferential political-economic system. Roy favors solidarity and caring for the masses while Katherine prefers a go-it-on-your-own approach, seeing socialism as stymying intelligent and gifted people. As cavorting adults, Roy and Katherine continue their polemical exchange. Roy quips, “Right-wingers always think it takes courage to engage in violence, but the truth is, it takes a whole lot more not to.” Katherine espouses elitism: “… smarter people used stupider people and that’s the way life worked.”The Year We Became US explores a gamut of social justice issues ranging from imperialism, internationalism, prejudice, the dispossession of “Indians” (as there were called in 1962), pacifism, and – naturally – class, starkly represented by the doctor’s Medicare's 50th Anniversary Volume 2

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strike against Medicare. The physicians are supported by the business community and press and opposed by the government and working class. The press had depicted the doctor’s strike as a “fight for freedom.” Roy could not let such go unchallenged: Freedom for a doctor to tell a worried mother: Pay me what I want or your son will die …. You think that’s a freedom worth going on strike for? Or freedom to refuse an operation if people can’t afford it? Freedom for doctors to make as much money as they want, even if it means that poor people have to go without proper care? … Roy was never a revolutionary, though. Today he believes, “Compromise is the only way to real, lasting change.” This is strange given that right-wingers are not about compromise, while the political parties of left-wingers (to the extent that any parties genuinely were leftist) have vacated any space they ever occupied on the Left. Federally, the Conservatives are clearly right-wing, the Liberals are also on the Right, and the New Democrats (the successor to the CCF) are hardly socialists any longer; I would classify them as to the Right-of-Center.

The Year We Became Us is a little uneven at times. For example, it was not always clear whether a letter written to president Kennedy had ended or whether it had segued into story-telling narrative. Also, the political astuteness of the adolescents stretches credulity. Nonetheless, Engler draws in the reader, and this reviewer didn’t want to put the book down until the last page was read. The publishers, RED and Fernwood Publishing, have as a motto: “Critical books for critical thinkers,” and Engler’s novel certainly does encourage this with its engaging right-left dialectic. 1. The tactic of using a word as a smear reflects poorly on the intellectuality of the smearers. Implied is that being a socialist is a terrible thing without providing any rationale as to why this might be so. [↩] Kim Petersen is co-editor of Dissident Voice . He can be reached at: kim@dissidentvoice.org. Read other articles by Kim.

Celebrating the 50th anniversary of medicare in Saskatchewan Monday, July 09, 2012 By Retiree Matters Janice M. Bernier Rabble.ca July 9, 2012 When medicare was introduced in Saskatchewan in July of 1962, I was six years old and about to start Grade 1. When I look back, I am amazed at how much a child will absorb, remember and learn. Growing up in Saskatchewan during the health-care debates helped shape who I am today. In the 1930s and 1940s, my dad's father operated the dray service hauling wood, ice, coal and other goods between farms and small towns. He also drove the horse and buggy in the summer or cutter (sleigh) in the winter to take the local doctor out to deliver babies or treat the sick. Dad vividly recalls both his father and the doctor being paid in

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vegetables, chickens, grain or other goods. My dad's mother ran the local telephone office and besides regular calls, served as the central call for all doctor, fire, police and community emergencies. My grandparents eventually moved to Prince Albert, but continued to farm 20 miles south of the city. When I was a child growing up on the family farm, trips to the doctor or the hospital were for life-threatening emergencies, to have babies, or to die. I remember some major illness going through our family and everyone having to make the trip to the doctor's office in Prince Albert. I remember the receptionist saying it was going to be three dollars for each of us to see the doctor, and there were six of us kids. A visit to the doctor took a big chunk out of our family's monthly budget. During the late 1950s and early 1960s, the Prince Albert area was considered a hotbed of political activity. Dief was Chief (Prime Minister John Diefenbaker), and Douglas, Lloyd, Thatcher and Hjertaas were all well-known names. Tommy Douglas promised a public medicare system in 1959, but left before it was implemented, to take up the leadership of the federal New Democratic Party in Ottawa in 1961. So while Douglas, the first leader of the provincial CCF, is considered the "Father of Medicare", Saskatchewan premier Woodrow S. Lloyd actually brought medicare legislation to the province. Shortly after Douglas's departure, the Lloyd government introduced the Saskatchewan Medical Care Insurance Act on October 13, 1961. As the new premier and leader of the provincial NDP, Lloyd shuffled the cabinet and appointed former labour leader Bill Davies (Moose Jaw MLA) as the health minister and Allan Blakeney (Regina MLA) as provincial treasurer. Dr. Orville Hjertaas, who worked at the Prince Albert Community Clinic, was a member of the CCF, and a Wheat Pool and Co-op supporter, and was also a key player in the fight for medicare. When doctors refused to participate in a special commission to administer medicare, Hjertaas was the only practicing physician in the province to step forward to serve. It was left to Lloyd, Davies and Blakeney to turn the Douglas vision into a reality. The doctors went on strike on July 1, 1962. Lloyd and many of his cabinet members received personal threats and harassment. The government's decision to bring in 100 doctors from overseas and across the country, and the quiet return to work of many of the striking doctors helped end the strike on July 23, 1962. Allan Blakeney took over the duties of the health portfolio to mend fences and to make the new medicare program work. In his biography, Blakeney noted that the political consequence of premier Lloyd and his government bringing medicare to Saskatchewan was losing the April 22, 1964 provincial election to Ross Thatcher's Liberals. Medicare's 50th Anniversary Volume 2

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Although the Thatcher Liberals ferociously attacked the CCF over medicare, they did not repeal the Medicare Act when they came to power. They found other ways to attack the system. The three-dollar fee my parents paid for doctor visits was Thatcher's utilization fee implemented in 1968. The fee became known as Thatcher's deterrent fee -- a tax on the sick -- and so named because it deterred most folks, especially the poor, from seeking the medical attention they needed. The user fee was removed after Allan Blakeney became Saskatchewan premier on June 23, 1971. During the Blakeney years, I came to realize the importance of our medicare system when I was diagnosed with ovarian cancer. On this 50th anniversary of medicare in Saskatchewan, I celebrate the accomplishments of Douglas as visionary, Lloyd as implementer, and Blakeney as innovator. Yes, it is amazing what a young child will absorb, remember and learn, and how our experiences help shape who we are today, and those things for which we are prepared to fight.

Canadian Health Care Under Neoliberal Assault Tuesday, July 10, 2012 By Milton Fisk Solidarity THE RECENT GROWTH of obstacles to getting health care here in the United States has led to a renewed interest in Canada's system of universal access, called Medicare. (See note 1) Premium inflation has accelerated after stabilizing in the mid-1990s. Employers, who had trusted Health Maintenance Organizations (HMOs) to limit their expenses for employee health care, are either limiting employee coverage or simply not contributing to it. The steady rise in the number of uninsured in this country is a reminder that a robust economy doesn't mean generalized affluence. It is ironic though that, just when interest in the United States is rising, the Canadian system itself has become more vulnerable. Emergency room overcrowding has reached crisis proportions in Ontario and Quebec; hospital closings have devastated rural communities in Saskatchewan and Alberta; the provinces are begging for federal health care cuts to be restored to prevent a collapse of the system.

For the past fifteen years, Canada has been ruled by neoliberal governments that have cut back the overall social security system, and Medicare with it. Still, in Canada, Medicare gets approval from 80% or more, and 60% reject the idea of replacing it with a 66

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two-tier system in which the government insures those who can't afford private insurance. Politicians are then unwilling to attack Medicare directly; they prefer stealth rather than confrontation. But the cumulative effect of stealth attacks has been to reduce the system's ability to provide services, which has led to a rash of for-profit health care companies operating outside Medicare along with the private insurers needed to pay for their services. How could a popular program like Canada's Medicare be put in such danger? Both domestic and international capital have had a hand in it. In the stealth attack, Canadian capital strengthened its hand through international agreements. This was not done so much by explicit provisions for cuts or privatization as by spreading the competitive and privatizing spirit that shaped negotiations leading to the agreements signed by Conservative and Liberal governments alike-the 1989 Canada-U.S. Free Trade Agreement (FTA), the 1994 North American Free Trade Agreement (NAFTA), and the 1994 World Trade Organization (WTO) agreement. The conflict over Medicare created by trying to implement this competitive and privatizing spirit has shown a decided class character. One side finds it in their direct interest to defend a system of health care with the character of a public good, since with limited resources it is difficult or impossible for them to afford private insurance. This side is primarily working class. The other side, however, doesn't find it in their personal interest to defend such a system, since they can easily afford private insurance or are rich enough to take their chances without insurance. Instead, this side wants to capitalize every sector, including the health sector.

Their Morals and Ours The Canadians are said to have a more solidaristic moral culture than we have in the United States. (See note 2) For this reason it is said to be inappropriate to try to adapt their single payer system to the U.S. situation. Such moral differences, however, are hard to reconcile with the seriousness of the neoliberal threat to Canadian Medicare. In fact, instead of pervasive solidarity, there is a fissure in the Canadian ethos clearly revealed in business-promoted attacks on social security by both federal and provincial governments beginning in 1984. Canada is a class society, after all, with all the strains on solidarity that implies. Every wealthy individual is aware that he or she pays more in taxes for universal health care than it would be necessary to pay for a private insurance plan. Working people are fragmented not just by the perennial competition within the labor market but also by the recent intensification of national sentiments. Neoliberalism has attacked both working class organizations and state-supported social services in order to advance the allegedly common interests of deficit control and export sales against the special interests of working people. The sum of these tendencies, whether between classes or within the working class, fashions a society that can't be described as solidaristic without gross simplification. What, though, of the overwhelming consensus in Canada approving Medicare? One should pair this with the consensus in the United States finding fault with the U.S. health Medicare's 50th Anniversary Volume 2

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care system. This indicates a similar level of concern for others. (See note 3) But this pairing can't support the conclusion that there is a high level of solidarity in each-for what is being judged is not just the success or failure of each system to provide for others, but also its success or failure from the perspective of competing self- interests. Even the fact that Medicare came into being in Canada doesn't show a basic difference in moral culture. It shows, rather, an important difference in political institutions: Without a significant third party to join, the forces for single payer in the United States were smothered within the Democratic Party. The Southern Democrats rejected Truman's effort to get single payer between 19451949; Democratic majorities in both houses during the 91st Congress failed to rally support for the Kennedy-Griffiths single payer bill in 1970; and with ninety-some cosponsors in the House, Jim McDermott's 1994 single payer bill was ignored by leading Democrats, already committed to some version of corporate health care. In contrast, the Canadian New Democratic Party was a third party committed to national health insurance. It could keep the Liberal Party from compromising its earlier commitment to this principle or from stalling in moving to legislate it. When the Liberals came to power with a minority government in 1964, the NDP held the balance of power. Had the Liberals not moved on national health insurance as NDP conceived of it, they faced the defeat of their broad legislative program and a shift of left Liberals to the NDP. (See note 4) The capturing of U.S. labor by a mainstream party contrasted with the close ties the NDP as a third party was able to forge with Canadian labor in the 1960s. With the Democrats making a right turn, the AFL-CIO felt in 1991 it had to give up its traditional support for single payer if the door to Democratic leaders were to stay open for it on other issues. Even the NDP had its right turn, a symptom of which was the effort by the NDP premier of Saskatchewan to crush a 1999 strike by over 8,000 nurses protesting a severe nursing shortage. (See note 5) Ironically, Medicare got started in 1961 in his province with NDP's predecessor party, the Cooperative Commonwealth Federation (CCF), in power.

The Stealth Attack Through Cuts The attack on Canadian Medicare with the most far-reaching consequences has undoubtedly been the relentless reduction in federal support for provincial health plans. By the mid-1990s, federal spending on health care was actually surpassed by private spending on it. Slashing federal cash transfers to the provinces reduced federal health spending from 6.18% of total federal spending in 1986 to 4.24% in 1992. Provinces and municipalities have not made up for these federal cuts. The private share of total health expenditures rose from 24% in the 1970s to 30% in the mid-1990s. (See note 6) Big employers are paying for employee insurance for a growing list of items not covered by Medicare. The rising cost of medicines has made employee insurance more expensive for employers, and has decreased utilization among the sickest. This has created calls for turning the pharmaceutical program, Pharmacare, which now covers only the elderly and various categories of the needy, into a single payer program for everyone, which would then be able to bid down the prices of medicines. (See note 7) It is no surprise that the main force in heading off this reform was the multinational pharmaceutical companies. 68

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In arguing for his 1995 budget, Liberal Prime Minister Jean Chértien said it was necessary to control health spending. But what was increasing was private spending on health care, not public spending. Overall government spending on health care actually declined in 1996 for the first time since the founding of Medicare, dropping Canada to 17th among OECD (advanced industrial) countries in per capita public spending on health care. Provinces are finding it more and more difficult to realize Medicare's goals of accessibility and comprehensiveness for health care. The condition for receiving federal money is that these and the other goals of Medicare be met; but the imperative to meet them weakens as federal money diminishes. Why, though, has it been made so difficult for Medicare to remain a public good? (See note 8) The answer that gave momentum to the movement for federal cuts was that the deficit had to be reduced. In 1984, the Business Council on National Issues-Canada's most powerful lobby with CEOs from 150 of its largest corporations-published a position paper calling for deficit reduction, which it claimed could come about only through tax increases or expenditure cuts. The Council recommended not an elimination of popular social programs but cutting them back, by among other things cutting the transfers to the provinces for Medicare and higher education. (See note 9) The Conservative government of Brian Mulroney then made deficit control its policy. The deficit argument had to be set aside as low interest rates and prosperity led to a federal surplus in the late 1990s. But this made no difference since the chief thing in the eyes of all the neoliberal regimes remained the same. This has been to limit the role of government in order to open up opportunities for capital. Limiting government was seen as, among other things, a step toward enhancing competitiveness in order to sustain Canada's highly export-dependent economy. (See note 10) Reducing expenditures on social services would reduce the cost of exports. Nonetheless, since the deficit argument played a decisive role in starting the federal cuts, it is of interest to note that it was a hoax. Statistics Canada, in a study suppressed by Mulroney's government until a copy was obtained under freedom of information legislation, showed that: • Half the deficit from 1975-1991 came from tax breaks-a half-a-million dollar lifetime exemption on capital gains taxes and an 8% reduction in federal corporate taxes, benefiting mainly corporations and the rich. • Another 44% came from high interest rates-a 6.1% real interest rate over the 19831992 period on long-term government debt, as contrasted with the 1935-1984 average of 1.4%-resulting from the Bank of Canada's monetarist policy of fighting inflation to please bondholders. • Only 6% of the deficit came from government spending-but there was no net increase of the ratio of social spending to GDP from 1975 to 1991. Social spending, Statistics Canada concluded, was not the problem. (See note 11)

The Onset of Privatization There has come to be more to the neoliberal program for Canadian health care than federal cuts. There are other opportunities to be opened up for capital by limiting government. The subtext of the cuts has become getting a greater share of the $(C)75 Medicare's 50th Anniversary Volume 2

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billion health care industry into the hands of profit-making outfits. The cuts have proven merely a convenient indirect means toward such a privatization. It may, though, be U.S. multinational health corporations, rather than Canadian capital, that get to take advantage of privatization within Canadian health care. Privatization takes many forms, and in Canada's health care system one isn't faced now with privatization by sale to for-profit firms. Rather, one is faced with a growth of competitors to Medicare. Thus one has a growth in business for private health insurers, and as well a growth in business for providers whose services aren't covered under Medicare. These forms of competitor privatization are politically more expedient than a sell-off of what Medicare "owns," which is almost exclusively the human bodies insured under provincial plans. Yet these privatizations are promoted by the cuts and do threaten Medicare's ability to carry out its mission of universality, accessibility, comprehensiveness, portability, and public accountability, as defined in the 1984 Canada Health Act. Private insurance is getting a boost in several ways. As a result of underfunding, some services have been taken off the provincial lists of covered services. Thus in Manitoba and Quebec free dental services for children were dropped. Other provinces have dropped coverage for eye examinations. Moreover, in many provinces listed services have not been updated to include non-physician services that can reasonably be considered necessary for health, such as home and rehabilitative care. (See note 12) Those who favor making private insurance available for coverage of as many services as possible appeal to the fact that the Canada Health Act itself requires coverage only of "medically necessary" hospital and physician care. Such an appeal accompanies efforts, like those spearheaded by Alberta premier Ralph Klein, to get around the legal restriction that a service paid for by the provincial plan-"listed" by it-cannot be billed to a patient and hence cannot be covered by private insurance. Can, for example, a service that a provincial plan pays for be covered by a private insurer when it is performed in a clinic that announces it has cut its ties with Medicare? Physicians sometimes leave hospitals, complaining of low compensation, to offer services only to those willing to pay for them without relying on their provincial health plan. If their work is rehabilitation, they can argue that it is perhaps not "medically necessary" and thus need not have been listed in the first place. Recently this minimalist view of medical necessity has been pushed to an absurd limit. Physicians have been successful in court against an Ontario Ministry of Health challenge to their billing patients for preoperative tests that under any reasonable interpretation are constituent parts of procedures insured under the provincial plan. (See note 13) In these various ways, private insurance is given the opportunity to fill in a growing number of holes in provincial plans. The provincial health ministries with which hospitals funded by provincial plans have to negotiate their global budgets are to act as the guardians of the principles of Medicare. This discourages the handful of for-profit hospitals funded under those plans from having ambitious goals for increasing market shares or attracting profit-hungry investors. Thus far, then, for-profit privatization tends to work around the edges rather than to increase the number of for-profit hospitals working within provincial plans. (See note 14)

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Here are some of the ways privatization is growing. With cuts in hospital nursing staffs and with the employment of hospital therapists not keeping up with demand, numerous for-profit extended care and rehabilitation centers have sprung up. Often their services are not covered by provincial plans-not because they are delivered in for-profit centers but because the service is both non-physician and non-hospital care. Cuts in hospital laboratory staffs cause long waits for test results financed out of hospitals' budgets. For-profit laboratories provide quicker service, at least for those who can afford to pay for it either out of pocket or with private insurance. In some cases, hospitals form joint ventures with for-profit laboratories, using the revenue to offset inadequate global budgets. In New Brunswick, four for-profit multinational firms have taken over the administration of the provincial health plan, in violation of the publicadministration condition of Medicare. Finally, hospital funding itself is being privatized. In Ontario, continuing support for hospitals became incompatible with the desire of its Tory premier Mike Harris to slash taxes. His government wants Toronto's hospitals renovated through a hospital bond issue rather than with funds from taxes. This method of "renovation" begins to modify the goals of the hospitals to conform to the interests of lenders rather than to the public interest in having a healthy society. These and similar privatizations lead toward a health care system with a public outer shell covering for-profit functioning parts.

Harmonizing Down with Free Trade The Canadian single payer system is anathema to the liberalizing spirit that led Canada to sign recent trade agreements. There is an ongoing battle between those with this liberalizing spirit and those with a more solidaristic spirit-unions, churches, nurses, senior citizens, and a variety of reform organizations, such as the Canadian Health Coalition. The trade agreements are simply another front in this battle, a front on which the liberalizers aim to level down the greater role of government in Canada to its level in the United States. I comment on three issues in the battle on this front: (1) user fees, (2) the concept of social services, and (3) property rights. (1) The health care system, it is argued, can be run with lower taxes if it is modified to permit provincial user fees. Lower taxes are a way of leveling downward government supports that the trade agreements try to eliminate. With lower taxes, Canada may begin to reduce the 40% of the GNP spent by government at all levels, bringing it nearer to the 35% of GNP spent by government in this country. In 1996, premiers from the four western provinces called for "flexibility" in regard to user fees. Provinces could then compete among themselves for foreign investments by touting lower tax rates. Since free health care makes labor more expensive, businesses would be able to make their exports more competitive if there were provincial user fees. Canada might then be able to reduce government's share of the cost of health care from 70% to something a bit closer to the U.S. level of 40%. So far, however, the argument that user fees save less in taxes than they cost in delayed health care for lower income patients seems to have mobilized enough people to deny victory to this neoliberal attack. (See note 15)

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(2) The NAFTA exempts "social services" from liberalization (i.e. privatization) provided they are established or maintained for a "public purpose." Canadian trade negotiators interpret this proviso broadly to allow exemption for a social service that is privately delivered in order to realize a public goal. They seem to accept the common view that a public goal is one that would benefit the society as a whole. It couldn't, then, be realized by a service sold on the market, which the poor couldn't buy. But they see no clash between serving the public goal set by Medicare and delivering health services privately, as most of them are in Canada. (Outside VA and psychiatric hospitals, which are public, physicians are not public employees. Hospitals are overwhelmingly private, though not for profit.) The U.S. Trade Representative, in contrast, interprets the proviso narrowly so that only publicly delivered social services can be for a public purpose and hence qualify for the exemption. As to the health care system, Canada, unlike Britain, is only the payer not the owner. If this U.S. interpretation of the NAFTA wins out, each and every provincial health plan would have to close down. It is certainly true that each provincial plan creates a government monopsony (singlebuyer-ed.) that prevents or discourages the entry into basic health care of private competitors. It prevents the entry of private insurance into the greater part of health care since there can be no billing of private entities for listed services; it severely limits the entry of private providers operating outside provincial plans, since everyone is already covered by a provincial plan. What's going on here is not a bit of metaphysics but an insistence on policy. The U.S. government is not saying that private providers are inherently market creatures. It knows full well there is nothing about private providers that prevents them from functioning as part of a public good rather than a market. The real point is that the not-for-profit private providers in Canada are occupying places that could otherwise be occupied by U.S.-style for-profit corporate health corporations and the hospitals, clinics, laboratories, and physicians that have contracts with them. All that needs doing is to end the control of those places by a single payer. So the U.S. Trade Representative is simply using established neoliberal policy to narrowly interpret the proviso for exempting social services from privatization. For political reasons, the United States has so far not used NAFTA to destroy Medicare in Canada. Should this happen, the move inside Canada to repeal NAFTA would be irresistible. Curiously, though, Canadian trade negotiators to the Multilateral Agreement on Investment (MAI) talks allowed a proviso on the exemption from liberalization for health and other social services identical to that in NAFTA. It is clear that Canadian neoliberals still want to keep an international threat to Medicare hanging over the heads of its defenders. (See note 16) (3) As noted, seniors, the poor and the disabled have some of their pharmaceutical expenses paid under Pharmacare. Others are covered for medicines by employer programs. Free trade agreements have been responsible for a large part of the dramatic rise in what Pharmacare and employers are paying for medicines. Beginning in 1969 Canada allowed its generic industry to copy brand name imported 72

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medicines. Negotiations in 1986 with the United States for the FTA led to a Canadian promise to provide patent protection to new brand-name drugs, for what turned out to be ten years. In 1993, as a result of GATT talks in which the United States was pushing Canada to "level up" to its own level of patent protection, Canada extended patent protection up to twenty years. Just for emphasis, U.S. pharmaceutical companies insisted that the twentyyear protection also be a part of the NAFTA's affirmation of property rights. Without benefit of competition from the Canadian generic industry, Canadians would spend $(C)400 million more on medicines in 1994 than in 1993, a 12% increase. As Senator David Pryor of Arkansas wisely noted, NAFTA's pro-monopoly and anti-competition clause on patent protection locks the United States itself into high drug costs. Which Road Ahead?

There are three general ways of responding to the erosion of Canada's single payer system. The first is the neoliberal way of accepting the trend toward the government's withdrawal from its commitments in the area of health as good for both the economy and health care in Canada. As the trend continues, competition will come to both insurers and providers, leading, on this view, to greater efficiency in health care. The second is the way of those who think that less is better for health care. They see the erosion of state support as an opportunity to enhance Medicare's ability to act as a public good. Less money will lead the way to replacing what are widely seen as genuine sources of inefficiency. For them it will lead to replacing the fee-for-service system with capitation fees, replacing the medical model of health care with interdisciplinary teams and more emphasis on public health, and replacing the reliance on hospitals with building more community health centers. The third way is that of those who recognize the trend as eventually making it so difficult for Medicare to deliver universal and comprehensive health care that Medicare will simply become the lower level of a tiered system. This recognition lays the basis for organizing to fight inadequate funding and slow privatization, not for accommodating to them or treating them opportunistically. Those who adopt the third way generally favor enhancing Medicare by reforming fee-forservice, the medical model, and hospitals. But they reject as an illusion the idea that the neoliberal stealth program wants an improved Medicare rather than one whose mission has been gutted.

Notes • A campaign for a single payer health care system in the United States was in augurated in June, 1999, by the recently formed Labor Party. Within the last year, leading health journals have dedicated space to Canadian Medicare-Health Affairs 18, 3; Journal of Health Politics, Policy and Law 23,6; andJournal of Public Health Policy 19,3. In March, 1999, a study reported in the New England Journal of Medicine found that whereas 57% of academic physicians in the United States favored single payer only 22% favored managed care. (Back to text) • Daniel M. Fox, "Policy and Politics of Research," Journal of Health, Politics, Policy, and Law 15 (1990): 481-499. (Back to text) • Humphrey Taylor and Uwe Reinhardt, "Does the System Fit?" Health Management Quarterly (3rd quarter, 1991): 2-10. (Back to text) Medicare's 50th Anniversary Volume 2

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• Malcolm Taylor, Health Insurance and Canadian Public Policy: The Seven Decisions That Created the Canadian Health Insurance System (Montreal: McGill-Queens University Press, 1978), 360. (Back to text) • Cheryl Buswell-Robinson, "Nurses Strike for Better Staffing and Patient Care," Labor Notes (June 1999): I, 14-15 (Back to text) • Health Canada, National Health Expenditures in Canada, 1975-1993 (Ottawa: Services Canada, 1994), tables 3C and 4C. (Back to text) • Joel Lexchin, "National Pharmacare Conference," Medical Reform, (Newsletter of the Medical Reform Group of Ontario) 106 (March 1998): 1-3. (Back to text) • A fuller response to this question than that given below can be found in Reweaving Canadas Social Programs (Toronto: Ecumeni cal Coalition on Economic Justice, 1993), chapter 2. (Back to text) • On the BCNI, its assault on Canadas social programs, and its successful campaign to reduce corporate taxes, see Maude Barlow and Tony Clarke, "Canada: The Broken Promise, The Nation (July 15/22, 1996): 23-26. (Back to text) • A quarter of Canada's GDP results from trade; three-quarters of its exports are to the United States. See Maureen Appel Molot, "The Canadian State in the International Economy," in Political Economy and the Changing Global Order, edited by R. Stubbs and G.R.D. Underhill (New York: St. Martin's Press, 1994): 511-523. (Back to text) • H. Mimoto and P. Cross, "The Growth of the Federal Debt," Canadian Economic Observer (Ottawa: Statistics Canada, June1991): 1-17. (Back to text) • Carol Kushner, "Long Term Care Reform," Medical Reform 112 (September 1999): 10-14. (Back to text) • Rosana Pellizzari, "Ontario Docs Excel at Creative Extra-Billing," Medical Reform 108 (September 1998): 1-2. (Back to text) • The Canada Health Act does not preclude public budgeting for performing listed ser vices in for-profit hospitals. For-profit hospitals of all kinds are, though, only about 5% of the total. On hospitals in Canada, see Pat Armstrong and Hugh Armstrong, Wasting Away: The Undermining of Canadian Health Care (Toronto: Oxford University Press, 1996), 51-58. (Back to text) • Michael Rachlis and Carol Kushner, Strong Medicine: How to Save Canada's Health System (Toronto: Harper Collins, 1994), chapter 6. (Back to text) • Canadian Health Coalition, "The MAI and Market Threats to Medicare," reprinted in Medical Reform 107 (June 1998): 3-5. (Back to text) Milton Fisk is a retired philosophy professor at Indiana University in Bloomington. His Towards a Healthy Society: The Morality and Politics of American Health Care Reform is due out from Kansas University Press in March, 2000.

Making Medicare: New Perspectives on the History of Medicare in Canada Tuesday, July 10, 2012 Edited by Gregory P. Marchildon University of Toronto Press Scholarly Publishing Division © 2012 World Rights 368 Pages 17 Images Paper ISBN 9781442613454

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Available Dec 2012 $39.95 This Book Is Not Available Yet Preorder yours today. Due in Stock: December 01, 2012 Browse Inside Request an Exam Copy The Canadian health care system is so indisputably tied to our national identity that its founder, Tommy Douglas, was voted the greatest Canadian of all time in a CBC television contest. However, very little has been written to date on how Medicare as we know it was developed and implemented. This collection fills a serious gap in the existing literature by providing a comprehensive policy history of Medicare in Canada. Making Medicare features explorations of the experiments that predated the federal government’s decision to implement the Saskatchewan health care model, from Newfoundland’s cottage hospital system to Bennettcare in British Columbia. It also includes essays by key individuals (including health practitioners and two premiers) who played a role in the implementation of Medicare and the landmark Royal Commission on Health Services. Along with political scientists, policy specialists, medical historians, and health practitioners, this collection will appeal to anyone interested in the history and legacy of one of Canada’s most visible and centrally important institutions. Gregory P. Marchildon is Canada Research Chair in Public Policy and Economic History and a professor in the Johnson-Shoyama School of Public Policy at the University of Regina. He is also the author of Health Systems in Transition (UTP/WHO).

Saskatchewan's Struggle for Medicare: A Timeline Tuesday, July 10, 2012 Courtesy of the Regina Leader Post

ClickHEREto review.

The Saskatchewan Doctors' Strike Tuesday, July 10, 2012 The Canadian Encyclopedia In 1959, Premier T.C. DOUGLAS announced his intention to provide medical care insurance, based on pre-payment, universal coverage, quality service and government administration, and through a scheme acceptable to both doctors and patients. The

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election of 1960 was fought on this issue, the doctors campaigning against it. A commission, established to recommend a plan, reported in Sept 1961. Members of the Saskatchewan College of Physicians and Surgeons met with the government, stating that they could not work with a compulsory, government-controlled scheme. The Saskatchewan Medical Care Insurance Bill was introduced in the Legislature 13 Oct 1961, and received royal assent 17 Nov 1961, after Woodrow S. LLOYD had replaced Douglas as premier. It was to come into force April 1, but this was amended, later, to 1 July 1962. While the bill was still being debated, the college emphasized its refusal to co-operate with the scheme, claiming that it would bring regimentation and would interfere with the doctor-patient relationship. At a meeting in May 1962, the doctors resolved not to practise should the Act come into force. In Regina, a group of mothers formed a committee to support their doctors. Similar committees were organized throughout the province, encouraged by doctors and joined by political opponents of the government. These KOD (Keep Our Doctors) Committees, with support from the media, launched a well-organized campaign against the government and the medicare plan. Rallies, petitions, panels and advertisements raised the emotional climate to a white heat. On 1 July 1962, when the Act came into force, most doctors closed their offices, some took holidays or educational leave, while some staffed emergency centres. A few left the province for good. The Medical Care Insurance Commission brought doctors from Britain and encouraged others to come from the US and other parts of Canada to meet the emergency. Local citizens groups organized medical clinics and hired doctors to attend them. By mid-July much of the KOD support had dissipated. Some doctors were returning to work; the force of the strike was spent. Lord Taylor, a physician who had been active in introducing Britain's health-care scheme, was brought to Saskatchewan by the government. He acted as mediator and the 2 sides signed an agreement in Saskatoon 23 July 1962. On 2 Aug 1962, amendments to the Act were passed allowing doctors to practise outside the plan. Payments by the government would be 85% of the college fee schedule, as was common in doctor-sponsored insurance schemes. In addition, the number of doctors on the Medical Care Insurance Commission was increased to at least 3. The powers of the commission were more limited, and certain other sections and phrases were amended or omitted to relieve the doctors' fears of interference. The doctors returned to work after the Saskatoon agreement, but hostilities long remained. Patients resented their doctors' desertion, while doctors objected to government involvement in medical care. Nevertheless, a 1965 survey found that most doctors favoured continuing the plan.

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Beyond Acute Care: Covering Seniors and the Disabled with the Medic... Wednesday, July 11, 2012 Beyond Acute Care

Looking back: 50 years after Saskatchewan's medicare crisis Wednesday, July 11, 2012 CBC News Posted: Jul 11, 2012 People supporting doctors in the medicare crisis rallied at the legislature on July 11, 1962. It's been 50 years since a pivotal event in the evolution of Saskatchewan's health care system. At the height of the "medicare crisis," on July 11, 1962, about 4,000 people attended a pro-doctor rally at fhe provincial legislature. Doctors, some who stated medicare would make them employees of the state, had gone on strike earlier in the month when the province's Medical Care Insurance Act became law. The rally, which organizers hoped would attract 40,000, turned out to be a turning point in the crisis, as CBC Saskatchewan network producer Sean Prpick explains. Related Stories Medicare adopted in Saskatchewan 50 years ago Knowlton Nash reports on medicare crisis HERE.

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July 18: National Day of Action for a 2014 health accord Wednesday, July 11, 2012 Rabble.ca In December 2011, the federal government announced that it would cut $31 billion from public health care by 2024 effectively downloading much of the responsibility for health care onto the provinces and territories. After that announcement, the federal government walked away from the 2014 Health Accord negotiating table. Without a 2014 Health Accord, it is unlikely that we will be able to protect, strengthen, and extend public health care. Canadians need to act now to protect public health care by demanding that Harper return to the negotiating table. Otherwise, it will be every province for itself and many of us simply can’t afford it. Come participate in the National Day of Action! Please participate by joining us to partake in a human formation – we will be forming a giant red umbrella for Medicare (we’re covered). This event will happen one week before the premiers of every province and territory will meet in Victoria to discuss what their next step will be for the 2014 Health Accord. We need to send the premiers to this meeting with a strong mandate from their constituents to protect public health care by standing up against cuts. The Ontario Health Coalition, The Council of Canadians and Canadian Doctors for Medicare are joining forces with other provincial coalitions across Canada to encourage the premiers to call Harper back to the 2014 negotiating table. In Toronto: Join us on July 18 for a National Day of Action for a 2014 Health Accord! We will be forming a giant red umbrella to symbolize Medicare (we're covered)

Meet across from the Holy Eucharist Ukrainian Catholic Church on Bain and Broadview Ave (just south of the Danforth) in Riverdale Park East at 11:40 am to participate in this exciting human formation! The more the merrier.

In British Columbia:

Link HERE.

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Medicare’s 50th Anniversary Sets Important Context for N.S. Legisla... Thursday, July 12, 2012 By Ian Johnson Behind the Numbers, CCPA July 11th, 2012 July 1 of this year marks the 50th anniversary of Medicare in Canada. On June 29, Nova Scotia’s Minister of Health and Wellness released for public input proposed new legislation to replace the outdated Health Services and Insurance Act. Are these two events related? Probably not, but I think they should be. For it was on July 1, 1962 that insured medical services started in Saskatchewan. This did not happen overnight. A number of important preparatory steps took place over almost 20 years. This included creating the first health region in the province, and setting up insured hospital services in 1947. Nor did it happen without major struggle. There was a bitter provincial election campaign in 1960, and there was a lengthy and controversial debate on the Saskatchewan Medical Care Insurance Act before it was passed in 1961. And when Medicare began, so also did a three-week doctors’ strike. And throughout that period, there was strong opposition by the established medical profession, the insurance industry, the mainstream media, and the provincial Liberal Party of that time. There was intense pressure applied to the government to back away and withdraw the Act.

But once the strike was settled through a negotiated settlement between the government and the Saskatchewan Medical Association called “The Saskatoon Agreement”, it quickly became the focus for a possible move to the rest of the country. This was due especially to the Hall Commission Report of 1964, continued public pressure, and the efforts of all parties to approve federal legislation in 1966. By 1972, insured hospital and medical services were in place across Canada. In Nova Scotia, insured hospital services were in place by 1958 and insured medical services by 1969. Here also, there was vigorous Medicare's 50th Anniversary Volume 2

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debate and rallies organized in part by Medicare Now Committees. So we should remember and thank the tireless efforts of the CCF/NDP government of 50 years ago led by Tommy Douglas and Woodrow Lloyd and of the people of Saskatchewan to help put in place our most prized social program. But that remembrance should not be observed with simply quiet reflection, but with an active and ongoing campaign to ensure that Medicare nationally and provincially is protected, strengthened and extended. The recent release of proposed new legislation for Medicare in Nova Scotia provides an important opportunity to put our collective remembrance into effect. Building on the efforts of our predecessors in Saskatchewan and in Nova Scotia, we must ensure that the new legislation enshrines the principles of earlier Medicare legislation including most notably, the Canada Health Act, that it stops privatization in all its forms, and that it moves us forward to a stronger, more comprehensive public health care system as was originally envisioned for Medicare. What we have achieved mostly thus far is what has been called Phase One, that is, to remove financial barriers to receiving hospital and medical care through universal public insurance. As was made clear at the recent conference on Medicare in Saskatchewan, where we need to make progress now is Phase Two, that is, to extend Medicare to cover many other important services such as home care, long-term care, dental care, pharmacare and other initiatives to address the social determinants of health, while, at the same time, managing health care better by waitlist management, teamwork, evidence-based initiatives, and community-based care including community health centres. The new legislation should help us achieve this next major step. The key lessons of our experience with Medicare going back at least 50 years should be that we have advanced with several key steps (not everything at once), that struggle and debate have been with us from the beginning, and that we can’t stand still, we must always move forward. As has often been said, “eternal vigilance is the price of progress” which is certainly true for the history and development of Medicare in Canada.

Ian Johnson is a Servicing Coordinator/Policy Analyst with the Nova Scotia Government and General Employees Union. He has been a Research Associate with the Nova Scotia office of CCPA since it was established in 1999. He is also the Vice-Chair of the Nova Scotia Citizens’ Health Care Network and a past Chair of the Community Health Services (Saskatoon) Association, better known as the Saskatoon Community Clinic.

Video: A History of Medicare in Saskatchewan Thursday, July 12, 2012 CTV

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Video: Envisioning the Future of Medicare - Roy Romanow Thursday, July 12, 2012 Canadian Centre for Policy Alternatives

Canada's Health Care "Crisis": Accumulation by possession and the n... Saturday, July 14, 2012 By Heather Whiteside Studies in Political Economy Autumn 2009 Public health care in Canada (“medicare”) is based on five principles, and its realization balances precariously on the method by which this public service is provided. At one end of the delivery spectrum, medicare could be a fully decommodified public service similar to the public education system; at the other end, public health care insurance could exist alongside the private, for-profit delivery of services and infrastructure. However, these varied delivery options are not interchangeable equivalents, since the increased commodification of health care serves to erode the five principles, a process that has been steadily underway since the 1980s. Thus, while medicare may remain formally tied to its core commitments, the Canadian landscape is now dotted with publicprivate partnerships, privatized support services, and newly sprouting private clinics, and it has been subject to chronic underfunding. Addressing the various stages through which medicare has passed — the struggle over its formation, its eventual implementation and brief stabilization, and its current internal erosion — is a complex issue that may be approached in a variety of ways, ranging from the synchronic to the diachronic.3 While much can be gained from a slice-in-time approach, a policy that aims to provide free and universal public health care to all citizens is not one that operates in a vacuum, as it is intimately bound up with the prevailing social relations of power and thus with developments occurring within capitalism itself. In this regard, the growing exposure of medicare to the logic of capitalist profitability underscores the need to explore the relationship between crises, fixes, and the framing of public policy bound- Studies in Political Economy 84 AUTUMN 2009 79 aries. This leads to the conclusion that commodification has less to do with the often-lamented efficiency problems of medicare than it does with a crisis of accumulation. Furthermore, it is a reminder that Canada is not alone in its reforms, given that crises are global in their reach, and thus restructuring is a national phenomenon only in a limited sense.

Read moreHERE. (pdf)

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Making Medicare: The History of Health Care in Canada Saturday, July 14, 2012 Canadian Museum of Civilization

Making Medicare: The History of Health Care in Canada, 1914--2007 is a new online exhibition produced by the Canadian Museum of Civilization. It offers a thorough, reliable and engaging account of the birth and development of Canada's publicly-funded health care system. It is an essential resource for anyone interested in Medicare's past, present and future in Canada: www.civilization.ca/medicare. LinkHERE.

Rich-poor gap is making Canadians sick Monday, July 16, 2012 By Rob Rainer and Linda Silas TheStar.com July 15, 2012 What does the Occupy movement have to do with the Council of the Federation? The growing gap between the rich and the poor is making people sick — literally. The Council of the Federation has an opportunity at its upcoming meeting July 25-27 in Halifax to commit to a co-ordinated plan of action to improve the health outcomes of Canadians, and in so doing address growing inequality. The top determinants of health in order are income status, education, social support networks, employment and working conditions, early childhood development, physical environment, personal health practices and coping skills and biological and genetic factors. Access to health care is ninth as a determinant of health. Income status tops the list for good reason: poor people die younger. In the landmark Code Red project in Hamilton, researchers documented a 21-year difference in life expectancy between residents of lower and higher income neighbourhoods. Education is next for good reason: Code Red found that 662 of every 1,000 adults in a high income neighbourhood have a university degree while in the low income neighbourhoods, only seven of 1,000 adults completed university. By tackling each of the social determinants of health with intelligent public policy informed by evidence-based best practices, our governments will knock down Canada’s unconscionable poverty rates ranging from about 4 to 45 per cent or more, depending on the demographic group and measurement tool chosen. For example, UNICEF recently 82

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reported that Canada’s child poverty rate is 13.3 per cent, placing us 24th of 35 developed countries on this telling metric of progress. By tackling the social determinants of health our governments can promote human capital, creativity and productivity while reducing health-care costs. For inspiration they should know that an estimated 20 per cent of health-care costs are attributable to health inequities such as poor health brought on by poverty. They should know that poverty costs Canada an estimated $72 billion to $86 billion per year, about 5 to 6 per cent of our GDP. How can our premiers get started? First, for a convincing case statement, read A Healthy Society: How a Focus on Health Can Revive Canadian Democracy, by Saskatoon family physician Dr. Ryan Meili. Second, set the goal of being in the top five nations for five key health outcomes by 2017 by, among other things, implementing the recommendations of the World Health Organization Commission on Social Determinants of Health, as advocated by the Canadian Nurses Association’s National Expert Commission: • Improve the conditions of daily life — the circumstances in which people are born, grow, live, work and age. • Tackle the inequitable distribution of power, money and resources — the structural drivers of those conditions of daily life. • Measure the problem, evaluate action, expand the knowledge base, develop a workforce that is trained in the social determinants of health, and raise public awareness about the social determinants of health. Third, agree to a whole-of-government approach at all levels. Co-operate nationally to create and implement a national poverty prevention and health promotion strategy shared by the federal, provincial, territorial, aboriginal and municipal governments, engaging business and civil society. Fourth, agree to use — as recommended by the Canadian Medical Association and already in place in Quebec — health impact assessment as a tool to assess the costs and benefits of major public policies in which health is implicated. On this, CMA pastpresident Dr. Jeff Turnbull has said that “evidence shows that every action with a negative effect on health will incur heavier costs to society down the road. Looking at policy development through a health lens would have a dramatic impact with regard to poverty which hinders both Canada’s human potential and economic growth.” The great Dr. Norman Bethune believed that “the protection of the people’s health should be recognized by the government as its primary obligation and duty to its citizens.” In this spirit, when they meet soon in Halifax, Canada’s premiers can make health attainment the highest priority of their governments — and request the federal government do the same.

Rob Rainer is executive director of Canada Without Poverty. Linda Silas is the president of the Canadian Federation of Nurses Unions.

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Unsung health heroes Monday, July 16, 2012 By Del Hancock Letter to the Editor: Regina Leader Post July 16, 2012 Also read HERE. During the recent celebration of the 50th anniversary of medicare in Saskatchewan, we paid homage to Tommy Douglas for his great contribution to health care in Canada. There are also the unsung heroes of the fight for medicare who warrant the Order of Canada or at least recognition for their devotion to duty. During the absence of doctors in their protest against the health-care changes, communities relied on the help of nurses. They didn't worry about lawsuits and I doubt "standing orders" even existed. Common sense was more prevalent. We, personally, were recipients of outstanding help from a nurse in Fillmore. Her name happens to be Eileen Nurse. She is past 90 now and living in retirement in Regina. There are probably thousands of people who would agree that she went far beyond the call of duty to help people. There must be other communities who remember people like Eileen, who during that time were called upon to help with the sick. Let's honour those people and name others who were on the "front lines" in time of crisis.

Del Hancock, Fillmore

Sick People or Sick Societies? Monday, July 16, 2012 By Jill Eisen Canadian DimensionJuly/August 2012 The words “health care” and “crisis” have become inseparable in any discussion about health policy in Canada. Stories about long waiting lists for surgery, interminable delays to see specialists, spiralling costs and the spectre of a two-tier system flood our media. With baby boomers reaching their senior years, things are only going to get worse. As numerous studies and Royal Commissions have pointed out, there’s much that can be done to make the system more efficient and responsive. But unless we do more in the way of prevention, the system threatens to collapse under its own weight. Our healthcare system is more aptly named our sickness care system. It does a pretty 84

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good job of treating illness, but when it comes to prevention, it’s mostly up to us: don’t smoke, eat lots of fruits and vegetables, keep physically active, take time to relax. It’s hard to avoid the messages that bombard us from the media and our doctors that our health is our responsibility. Healthy lifestyles are no doubt good for us, but it turns out that the social conditions in which we live and work are more important in determining our health than either the health care system or our personal habits. It’s hardly a new idea. Back in the mid-19th century, the Council of Berlin asked the brilliant German pathologist Rudolph Virchow to investigate a typhus epidemic in Upper Silesia. He reported back that the problem was caused by “mismanagement of the region by the Berlin Government.” Among his recommendations were full democracy for Upper Silesia, a shift in the burden of taxes from the poor to the rich, universal education, and the separation of church and state. Needless to say, the members of the Berlin Council were not pleased. They claimed that Virchow’s report wasn’t a scientific document at all, but was rather a political tract. To which Virchow retorted, “medicine is a social science and politics is nothing but medicine writ large!” He added, “If medicine is to fulfill her great task, then she must enter the political and social life. Do we not always find the diseases of the populace traceable to defects in society?” Indeed, some of the greatest gains in health have come from laws addressing those defects; laws banning child labour, setting minimum wages, creating the 40-hour work week, establishing social safety nets, and mandating universal access to education. None of these reforms were passed in the name of health, but all have contributed enormously to our health and longevity. Unfortunately, our political leaders today are as reluctant as the Berlin councillors to recognize the connection between social conditions and health, preferring instead to blame the victim. To drive home the point, the diseases that plague North Americans today have been labelled lifestyle diseases. Heart disease, stroke, obesity, diabetes and even cancer have been blamed on our wayward habits — too many fatty foods and sweets, too much alcohol, too little exercise. But a large body of research over the last 30 years has confirmed the importance of the social realm in determining our health. The heart of the matter Leonard Syme is considered the father of the discipline known as the social determinants of health. He’s an epidemiologist at the University of California at Berkeley who has spent much of his career exploring the causes of heart disease. For the last half century, the reigning theory has been the diet/heart hypothesis — the idea that a diet high in saturated fat and cholesterol raises blood cholesterol levels, which, in turn, leads to heart disease. The diet/heart hypothesis is received wisdom in both lay and medical populations, yet Syme says there’s not a shred of evidence to support it. After doing an exhaustive search of the medical literature, he failed to find a single study proving that the amount of fat in your diet has anything to do with either serum cholesterol or heart disease. In a groundbreaking study in the 1970s, Syme and his colleagues followed a group of Japanese men who migrated from Japan to California. They found a staggering five-fold increase in heart disease rates among the California migrants. Their first assumption, given the diet/heart hypothesis, was that adoption of a fatty Western diet was the main culprit. Yet, according to Syme, “the Japanese in California did eat a more Western diet than they did in Japan, but that didn’t in any way explain the five-fold increase.” In fact, the increase couldn’t be fully explained by any of the usual risk factors, including diet, Medicare's 50th Anniversary Volume 2

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smoking, high blood pressure or high cholesterol levels. What the researchers did discover, to the surprise of all, was that those men who retained “traditional Japanese ways,” who kept strong ties with the Japanese community, attended Japanese churches, went to Japanese doctors, lawyers and the like, had only one fifth the heart disease rates of their counterparts who integrated more fully into American life, despite the fact that both groups were eating a more fatty diet. In trying to understand why, Syme made several trips to Japan and interviewed hundreds of people. Wherever he went, he says, people kept telling him, “the real problem is that Americans are so lonely.” The Japanese migrant study spawned a whole new line of research demonstrating that social support and human connectedness are more important in determining people’s health than any of the usually cited risk factors. Preventing diabetes Type 2 diabetes is the disease that’s most directly linked to people’s personal behaviours. It’s also the fastest growing chronic condition in Canada and threatens to overwhelm our health care system. According to Richard Glazier, a family physician and senior scientist at the Institute for Clinical Evaluative Sciences in Toronto, with a proper diet and sufficient exercise, the disease is highly preventable. Yet, despite years of advice about healthy lifestyles, the incidence of type 2 diabetes is only getting worse. To come to grips with the problem, Glazier and fellow physician Gillian Booth headed a 2007 study mapping the incidence of diabetes in the City of Toronto. They weren’t surprised to find that diabetes rates were highest amongst low-income groups and recent immigrants, but what did surprise them was how the incidence varied by neighbourhood. The suburbs and outlying areas had far higher rates than many downtown neighbourhoods, even though these housed some of the lowest-income groups and highest concentrations of recent immigrants. On further investigation, they found that the areas with the highest diabetes rates had very poor access to healthy food, fewer amenities like parks, community centres and bike paths, poorer access to public transportation and greater dependence on cars. Those factors, combined with low income and a food system that makes junk food cheaper than healthy alternatives, have created a perfect storm when it comes to type 2 diabetes. According to Glazier, addressing what he calls “upstream factors” would do far more to prevent the disease than focussing exclusively on diet and exercise. The social gradient in health The biggest upstream factor when it comes to health is income. It’s been known for as long as we have had records that those at the top of the social ladder are healthier and live longer than those at the bottom. In Canada, there’s a four-and-a -half-year gap in life expectancy between the richest and poorest quintiles for men, and a two-year gap for women. If you look at premature deaths before age 75, the gap is considerably bigger. The poor bear a greater share of the burden of virtually every disease and condition, from heart disease, diabetes and cancer to addictions and mental health problems. It makes intuitive sense that this would be so. The poor live in substandard housing and blighted neighbourhoods, can’t afford healthy food, are more likely to drink and smoke, and live stress-filled lives with little economic security. But research over the past 30 years has shown that it’s not just a matter of a gap between the poor and everyone else. In every society that’s been studied there’s a social gradient in health; for almost every disease and disorder, the higher you are on the social ladder, the healthier and longer-lived you’re likely to be.

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According to Richard Glazier, in Canada “even those earning over $100,000, who live in wonderful homes, take expensive vacations and can afford healthy food, don’t do as well as the super rich.” For some diseases, he says, the gap between the middle and upper income groups is as big as that between the middle classes and the poor. While researchers don’t know exactly what’s causing the gradient, Glazier says there’s obviously something beyond diet and exercise that is affecting us all to varying degrees. He believes it has to do with our level of psychosocial stress, which in turn is affected by the amount of control we have over our lives, the amount of social support we have to buffer whatever stresses we encounter and how we feel about ourselves and our place in society. These are all strongly related to our position in the social hierarchy. Inequality matters Social hierarchies will always be with us, so it’s unlikely we’ll ever completely eliminate the social gradient in health. But we can do something about its steepness. In their 2009 book The Spirit Level: Why Equality is Better for Everyone, British epidemiologist Richard Wilkinson and co-author Kate Pickett analyzed health and social data for 22 of the world’s developed countries and from the 50 American states. Their findings were consistent and stunning. On almost every measure of human health and well-being, from life expectancy, infant mortality, obesity and mental illness to teenage birth rates, addictions and homicides, they found that more equal societies performed better than less equal ones. What’s more, the gradient in health was steeper. Even those at the top of the economic ladder were worse off in more unequal societies than their counterparts in more equal societies. Wilkinson and Pickett stress that the differences between countries have nothing to do with absolute levels of income. What the data shows is that, once a country reaches a certain level of development, what matters is not how rich the country is, but how equal it is. The US, one of the world’s richest countries and also one of the most unequal, scored at or near the bottom of the scale on almost every indicator Wilkinson and Pickett examined, while Japan and the Scandinavian countries, which are among the world’s most equal countries, did best. As usual, Canada was somewhere in the middle. Although the US has the world’s highest per-capita spending on health care, it ranks 50th in global life expectancy. Within the country, there’s an enormous gap in life expectancy between the rich and poor. The gap is as large as 20 years between rich whites living in Maryland and poor blacks living just 20 miles away in Washington, DC. That’s one year of life for every mile. While the dismal mortality rates among the US poor can be attributed, in part, to people’s personal behaviours, the gap has everything to do with the conditions under which people live and work. According to a report by the World Health Organization’s Commission on the Social Determinants of Health, “Unequal distribution of healthdamaging experiences is not in any sense a ‘natural’ phenomenon, but is a result of the toxic combination of poor social policies and programs, unfair economic arrangements and bad politics.” But those variables are amenable to change. Nancy Krieger, a professor at the Harvard School of Public Health, investigated changes in the rate of premature mortality and infant death in the US from 1960 to 2002. She found that inequities shrank from 1966 to 1980, at the same time as socio-economic disparities in the US were declining. She credits the creation of Medicaid and Medicare, community health centres, the US war on Medicare's 50th Anniversary Volume 2

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poverty and the Civil Rights Act of 1964. Since the 1980s with the advent of neoliberalism, the mortality gap has steadily widened, in tandem with the growth in income inequality. Similar changes have taken place in Britain. Not coincidentally, the health gradient got steeper during the Thatcher years, which were accompanied by social cutbacks, employment insecurity and a growing income gap between rich and poor. According to Michael Marmot, Director of the International Institute for Society and Health at University College, London and head of the WHO Commission on the Social Determinants of Health, there was a five-and-a-half-year difference in life expectancy between the richest and poorest men in 1970. By the end of the Thatcher years, that had grown to a nineand-a-half-year difference. Why greater inequality leads to worse health As Marmot says, it’s not how much you have that counts, it’s what you can do with what you have. If a society provides social security, education, health care, transportation, recreational opportunities, child care, parental leave and so on, than income doesn’t matter that much. But if you have to buy all those things yourself, income makes a huge difference. The less you have, the greater your stress load. And yet, as societies become more unequal, those with the power to influence public decisions are less likely to support investment in the public sphere. Alex Himelfarb, former Clerk of Canada’s Privy Council, puts it this way: “When inequality grows too great, you cannot find a public interest, because people’s experience of society is so diverse.” As a result, the rich secede from the public sphere and support declines for everything from public infrastructure and education to social security and health care. The growth of income inequality has other insidious effects which undermine people’s health. The widening of the gap between the rich and the rest of us exacerbates the consumer anxiety that is so pervasive in our culture. As the rich get richer, they spend more; they build bigger mansions, install fancier kitchens and throw more elaborate parties. Cornell University economist Robert Frank says this ups the ante for everyone and sets up what he calls a series of spending cascades. The average house size in the US is now 50 percent larger than it was 30 years ago. The average wedding costs $28,000 compared to $11,000, adjusted for inflation, in 1980. But while incomes for the top 1 percent have soared, incomes for the vast majority have stagnated or declined. For the middle classes, the pressure to “keep up” has meant going ever deeper into debt, and with more debt comes more anxiety and stress. For the poor, the pressures of growing inequality are even worse. As the standards rise for what constitutes a good life, the poor are increasingly left behind. As Michael Marmot says, “if those lower down on the income scale can’t fully participate in what it means to be part of society, that creates a huge amount of stress. If your neighbour’s kid has the latest sneakers and goes on skiing holidays, you want that for your kid too — you want to be a full social participant.” Where does Canada stand? In 1974, former Liberal Minister of Health Marc Lalonde published a report titled A New Perspective on the Health of Canadians. It was the first public document in any country to emphasize that the major determinants of health lay outside the health care system. Since then, Canada has been a leader in the field of social determinants of health. 88

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Academics and health policy analysts have held major conferences and published scores of papers dealing with everything from the importance of early childhood education, to the need to rebuild our cities and fix our broken food system, to the need to give workers more control in the workplace, to the impacts of poverty and isolation in old age. The evidence is compelling, yet for the last three decades government policy has moved in precisely the opposite direction. Since the mid-1980s, following the election of Brian Mulroney and the imposition of his neoliberal agenda, social programs have been slashed and income inequality has grown. Fully one third of all economic growth in Canada has gone to the top 1 percent, while wages and incomes for the majority of Canadians have stagnated. At the same time, life has become far less secure for the majority of Canadians as job security vanishes, pensions come under fire and the social safety net weakens. The Harper government’s attack on unions and its planned cuts to Old Age Security will only worsen these trends. A World Health Organization document on the Social Determinants of Health states that “if policy fails to address the links between social inequality and health, it not only ignores the most powerful determinants of health in modern societies, it also ignores one of the most important social justice issues.” By working toward a more fair and just society our health will follow. So too might our happiness. - Jill Eisen is a freelance writer and documentary radio producer, primarily for CBC Radio’s Ideas program.

Get back to the table! Tuesday, July 17, 2012 Health care activists send Premiers and Harper a message on National Day of Action on 2014 Health Accord NUPGE News July 17, 2012 The federal government is turning its back on health care at a time when we need elected leaders to help build a caring future for Canada, say advocates of publicly-funded health care who are organizing a National Day of Action on the 2014 Health Accord set for July 18. Many are concerned that the federal government has already walked away from the negotiating table before negotiations have even started with the provinces. The current Health Accord expires in 2014. At a meeting of Finance Ministers from across the country in December 2011, Flaherty announced that the federal government would extend the six per cent escalator clause, part of the 2004 Health Accord, for the Canada Health Transfer (CHT) only until the 201617 fiscal year. After that, until at least 2024, annual increases in the CHT will be tied to nominal gross domestic product (GDP) growth. James Clancy, National President of the National Union of Public and General Employees (NUPGE), criticized the Harper government for acting unilaterally rather than Medicare's 50th Anniversary Volume 2

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working in partnership with the provinces to improve health care. "Canadians want the federal government to work in partnership with the provinces. not dictate terms and conditions," says Clancy. "Where was the consultation or negotiations? How are the provinces health care needs and priorities reflected in this announcement?" Now, in the lead up to a premiers meeting on health care in Halifax on July 25 - July 27, Clancy is urging the provinces to work with Canadians to pressure the government to go back to the table and negotiate fairly. "There is still much more to be accomplished at the negotiating table," Clancy noted. "The provinces will find common ground with Canadians on this issue. In addition to more investment, Canadians want the federal government to work with the provinces to fill in the gaps in the continuum of care. They want to see new programs and services in the areas of home care, long term care, prescription drug coverage (pharmacare) and mental health." Some provinces have already come forward in opposition to the federal government’s actions. If the provinces work together to get the federal government back to the negotiating table, they can get down to the work of creating a new accord and building a caring future for health care in Canada. More information: NUPGE's Negotiating Federal Transfers to the Provinces report: Here they go again: Less sharing, more inequality

Fighting back against health inequity and its origins Tuesday, July 17, 2012 By Ted Schrecker CHNET-Works! 17 July 2012 Despite rising inequality of market incomes and solemn assertions by governments that compensatory social policies are unaffordable, there are Canadian voices calling for change, within and outside the health research and policy community. One of the most important of these is the Canadian Women’s Health Network (CWHN), which has just launched a new, user-friendly web site. CWHN has been going since 1993, functioning as a clearinghouse and information broker on a variety of women’s health issues ranging from depression to domestic violence. “Health is a human right that, because of poverty, politics and dwindling resources for health and social services, eludes many women” is part of its mission statement; recent links on its website connect users with a feature article and archived webinar on women and alcohol and a Conference Board of Canada report on the generally mid-pack performance of Canadian

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health care among OECD countries. CWHN is now seeking alternative sources of funding since support from our national government will end in 2013, as part of a larger pattern of funding cuts to women’s health research and advocacy. Gotta pay for those fighter jets and new prison cells somehow. Another source of dissenting voices is the trade union movement. The Canadian Auto Workers, now Canada's largest private sector union representing workers in all sectors of the economy, has released a new study that tracked the economic trajectories of 260 workers laid off from three Ontario manufacturing plants. Not surprisingly, the study found that major economic hardship followed; loss of incomes, benefits and security was routine. A long line of Canadian studies going back at least to Paul Grayson's work on manufacturing plant closures in the 1980s (1) has found a similar pattern, as have many in the United States. The landmark Code Red study in Hamilton did not directly track worker earnings, but documented the consequences of manufacturing job losses in a city especially hard hit by deindustrialization. Depending on the future of this blog, a bibliography of key sources on what sociologists call 'downward mobility' as a consequence of economic restructuring, and the health effects, will be provided in a future posting. Few people now question the fact that earnings and economic opportunity in North America are rapidly polarizing, with consequences for health over the life course and across generations that we can only begin to anticipate. A more dramatic and accelerated preview is now unfolding in parts of Europe, with (for example) official unemployment rates of more than 20 percent overall, and more than 50 percent among young people, in Greece and Spain. Can economic polarization that consigns a substantial proportion of a nation’s population to permanent uncertainty and insecurity be recognized as a public health issue of overwhelming importance? Or are the public health professionals whose voices might drive that recognition already too solidly entrenched in the ranks of the comfortable? Just asking, as they say.

(1) Grayson P. Corporate Strategy and Plant Closures: The SKF Experience. Toronto: Our Times, 1985. Now apparently out of print, and certainly hard to find.

A Healthy Society: Interview with Ryan Mieli Wednesday, July 18, 2012 By Am Johal Rabble.caRyan Mieli July 18, 2012 Q. In your book, A Healthy Society, you argue that a focus on health can revive Canadian democracy. How so? The book starts with a discussion of the disordered state of Canadian political discourse , from media coverage to the way in which parties present ideas. There is a general lack of focus, a lack of a common project for society. The WHO defines health as not just the absence of disease, but full social, mental and physical wellbeing. In A Healthy Society I propose that health is a useful shorthand for our goals as a society, and one which we can measure our success in reaching. Medicare's 50th Anniversary Volume 2

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Such a focus on health must move beyond healthcare to the upstream elements that impact health outcomes: the social determinants of health. Income, education, employment, social supports, housing, nutrition, these are the elements that make a greater difference in health and wellbeing. While these are disparate areas, the common thread of health allows us to address them in an evidence-based fashion. In A Healthy Society, I take stories from my experience working with patients in inner-city Saskatoon, rural and Northern Saskatchewan, and rural Mozambique, and use them to illustrate the impact of the social determinants of health. I then dig further into specific determinants and ways in which changes in public discourse and the policies that flow from those changes could lead to better lives for my patients and for all Canadians. This leads to a discussion of democratic reforms that could help make the focus on social determinants of health a more effective and engaging tool for social change. Q. With governments implementing neo-liberal policies over the last thirty years, there has been a massive erosion of social programs such as employment insurance and a national housing program. How have cuts in these areas impacted the health of Canadians? These cuts are examples of direct failures to meet key health determinants and improve the wellbeing of Canadians, they also contribute to increased inequality and disparity in wealth. Greater inequality, as demonstrated in research such as that of Wilkinson and Pickett in the UK, results in worse health outcomes not only for the poor, but also for the wealthy. While this is tempered somewhat by economic growth, health and wellbeing outcomes have not kept pace with increases in GDP as demonstrated by the Canadian Index of Wellbeing project . Cuts to key services and government policies that have led to increased levels of inequality, have played a key role in undermining the impact of economic success on health outcomes. Improvements in health will not be reached through health care spending; this trend away from effective, universal social programs has to be reversed. Q. What is the role of community health centers in the public healthcare system? Community health centres, like the West Side Community Clinic where I work, offer an example of health care services that stem from an understanding of the interconnectedness of the determinants of health. Rather than simply providing medical care, they often incorporate multiple disciplines of health services (counselling, physiotherapy, dentistry, social work) with upstream work such as patient outreach, health education programming, and active connections with community services such as addictions treatment or housing authorities. This allows for an approach that goes beyond a narrow medical model of health, and is one key element in moving to a model that emphasizes prevention and wellbeing rather than putting all resources in treatment. Having community boards also allows CHCs to be more responsive to community needs and to act as gathering points for information about changes in those needs. CHCs are an essential part of a primary health care strategy that leads to more comprehensive and cost-effective care. Of course, however, they can only be partially effective in improving health outcomes if the rest of the determinants of health that are outside their sphere of influence, are not addressed. This is one of the frustrations of working in a setting that offers excellent care but is limited by its scope, and is part of what led me to write A Healthy Society as a means of exploring the upstream changes needed to make good primary health care effective. 92

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Q. Child vulnerability rates continue to increase across the country. What is the best way to address these issues? Like any social issue, the causes and responses are multiple and complex. Recognizing healthy children as the goal, and recognizing the impact of the social determinants in reaching that goal, gives us a starting point. From there we can dig into policy choices to improve child health. These could range from improving income supports for low income families, to availability and quality of early childhood development programming, and increased investment in affordable housing. Q. Seniors poverty continues to be on the rise particularly in the current economic environment. What are some innovative approaches that can be taken to address the demographic shift that is happening in the country? Similarly, the issues for any vulnerable group need to be dug into and understood in order to make effective, evidence-based policy changes. A number of the options raised in the Romanow Report, including increased home care and pharmaceutical coverage, could alleviate some of the pressures on seniors, allowing them to stay in their homes longer and be able to afford the medications that can help to keep them out of hospital. This results in decreased costs for the health system, which ultimately should be reinvested in ensuring that the social determinants of health are met for Canadians, young and old. Unfortunately, excellent evidence-based recommendations such as these have often been left to languish as funds have been diverted to acute care in hospitals rather than preventive or primary care. This is part of why it's so disappointing to see the federal government moving away from the health accord and from establishing national standards in health, rather than applying funds in a targeted fashion to achieve substantial change. Q. Policies and programs directed towards the Aboriginal community too often are not culturally sensitive nor are they delivered by Aboriginal organizations. Do you see a shift in health care delivery related to Aboriginal communities. What changes would you like to see? The transfer of control of health services to First Nations communities has been a mixed blessing. The ability to make decisions about health services offered and to be directly involved in identifying community health needs is a necessary and important step. We can and should involve communities even more in determining the best means to address the health issues they face.Unfortunately, this policy has too often also served as a means for governments to wash their hands of responsibility, including the key responsibility of adequately funding health services. Many bands have seen their health funding frozen at 1990s levels, despite populations that have grown quickly and despite new health challenges that have emerged. This results in an underfunding of key services and worse health outcomes. A responsible approach to health transfer needs to include transparency not only around decision-making in service provision and human resources, but also around the availability of sufficient funds to provide services. Too often on and off-reserve Aboriginal communities receive services that are less than those received by the rest of Canadians, which, given that they also are over-represented in terms of illness, is exactly the opposite of health equity. Involving communities at all levels of decision-making, including resource allocation, would lead to more effective and equitable service delivery.

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Q. Anything else? This month marks the 50th anniversary of the introduction of Medicare in Saskatchewan. At that time physicians went on strike, withdrawing their services in objection to universal health insurance. The single-payer, publicly funded system has proven to be a positive development, resulting in high quality services regardless of ability to pay, with physicians recognizing within a few short years that it was a great improvement on the previous system. What has often been lamented, however, is the failure to have proceeded to what Tommy Douglas called the Second Phase of Medicare, where we truly focus on keeping people well, not just treating them when they're ill. 50 years later, groups like Canadian Doctors for Medicare advocate strongly for an improved public system and will participate in the July 18, 2012 Day of Action for a 2014 Health Accord. This summer, Doctors for Refugee Care has led protests across Canada against cuts to health care services for refugees. What a glorious change to see physicians taking to the streets in favour of universal care and in defense of the most vulnerable. One of the reasons for this change is the fact that social accountability, health equity and the social determinants of health have become staples of academic theory and medical education. However, these concepts have not necessarily penetrated into the public consciousness and the media and political discourse. It's my hope that A Healthy Society, by combining accessible and engaging patient stories with evidence-based reflection on policy options, can be part of bridging that gap between knowledge and practice, and of fueling the political will to reach the Second Phase of Medicare and build a truly healthy society.

July is officially Medicare Month in Saskatchewan Wednesday, July 18, 2012 Click above to enlarge

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Pharmacare: Campaign for a National Drug Plan Wednesday, July 18, 2012 Canadian Health Coalition About the Campaign Pharmacare means a national drug plan that would be publicly funded and administered, control costs, provide universal access and ensure the safe and appropriate use of drugs. It would cover medically necessary drug costs in the same way that Medicare now covers hospitals and physicians. The Canadian Health Coalition is a public advocacy organization dedicated to the preservation and improvement of Medicare. ClickHEREto visit their website.

Harper Hacks Down Our Medicare Thursday, July 19, 2012 By Danielle Martin Board Chair of Canadian Doctors for Medicare Huff Post July18, 2012 Canadians can feel it -- something's not right in our country when it comes to health care. We know our public system is fundamentally sound, but we also know that there is much work to be done to improve it and ensure it's as sustainable as we want it to be for generations to come. We see our health care providers and provincial governments struggling to improve services in the context of tight public budgets and an aging population. Almost everyone is trying to make medicare better. But one critical player is missing from the effort -- where is our federal government when it comes to health care? Democratically elected leaders are expected to represent the views of their constituents. And in this case it's clear: Canadians want our federal government to be part of the solution to the national challenges we face in health care. Public opinion research conducted for Health Canada released in May reinforced this message. There is so much we could accomplish with federal leadership. We're getting a raw deal on our pharmaceuticals; the federal government could coordinate a bulk-purchasing Medicare's 50th Anniversary Volume 2

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strategy and a national public drug formulary. As First Nations, refugees, rural, and innercity populations grapple with challenges to health equity, the federal government could be the leader in improving the health of society's most vulnerable. And as interprovincial inequities deepen in a number of areas, the federal government could ensure that all Canadians are able to expect timely access to a common basket of services, such as long-term care and home care, particularly as provinces are striving to meet the changing needs of an older population But instead of facing these challenges, in December 2011, the federal government announced that it would shift to a per capita transfer system that ties funding increases to economic growth. It then walked away from the 2014 Health Accord negotiating table, shirking a critical responsibility to provide leadership in transforming our health care system, and abandoning a commitment to ensuring that Canadians have comparable levels and quality of health care from province to province. Why does the change in the funding formula matter? Originally, cash transfers were distributed on a formula that ensured that all provinces could meet national standards without the burden being more onerous on some than on others. A straight per capita tax transfer was seen as unfair because provinces with fewer resources would carry a heavier burden than more wealthy provinces. The same is still true today. But health care isn't just about dollars and cents. No one wants a health care system that consumes endless pots of money. What the government of Canada is really saying with this transfer is that it doesn't want to be involved any more. They're not interested in making sure that Albertans get the same standard of care as Nova Scotians, or that a successful new approach for wait times in Victoria is used in St. John's as well. And that is what's truly unacceptable. There are already inequities in health care, with different levels of coverage for pharmaceuticals, long-term care, and dental care from province to province. Currently, pharmaceutical coverage for seniors varies widely across the country; we need leadership to help ensure that our seniors are treated equitably from coast to coast. Moving forward without the federal government's involvement in national standards will lead to deepening inequalities between provinces. The 2004 Health Accord drove meaningful change for health care in our country, committing to increased federal funding, and importantly, setting benchmarks and making progress on issues like wait times. Although there's still more work to be done on wait times, we at least know how the provinces stack up against each other, and waits have improved over the lifespan of the Accord because of the coordinated goal-setting with the federal government. In late July, our country's premiers will be meeting in Halifax at the Council of the Federation, where both health care innovations and funding will be on the agenda. Our premiers need to work together, but also to work at bringing the federal government back to the table. The federal government's current strategy seems to be diminishing the expectations of Canadians, offloading all responsibility to the provinces, and letting the chips fall where they may. The idea that we will simply get used to health care being the sole responsibility of provinces is na誰ve. Canadians believe deeply in a society that takes care of each other, and one way that we express that belief is through medicare - it's the 96

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highest expression of Canadians caring for one another. That aspiration is a national one, and it deserves the attention of our national leaders. We need leaders who will rise to the challenge of protecting and improving medicare, not shirk their responsibilities. Prime Minister Harper, you are needed back at the table for a 2014 Health Accord. Canadians have real expectations of you, not just to cut cheques -and increasingly smaller cheques at that -- but to lead Canada on health care. Your absence will hurt the health of Canadians.

Towards a New Understanding Friday, July 20, 2012 THE RELATIONSHIP BETWEEN SASKATCHEWAN’S CO-OPERATIVE COMMUNITY CLINICS AND THE GOVERNMENT OF SASKATCHEWAN By Rochelle Elizabeth Smith This dissertation is a study of the public policy-making process, the role of ideas and ideology in this process, and their combined effect on the relationship between social economy enterprises, particularly cooperatives, and government. It is also concerned with a central problem for all social economy organizations today: the impacts of public policy on funding, decision-making and strategy. The central focus of this research is the relationship between three of Saskatchewan‘s co-operative Community Clinics and the provincial Government of Saskatchewan. In spite of a seeming congruence between the goals of the Community Clinics and successive provincial governments, the Clinics have not played a significant role in the reform and restructuring of the delivery of health care services in the province. This study seeks to examine this paradox with specific focus on the following overarching concerns:

• What role do ideas and ideology play in the policy-making process related to the cooperative Community Clinics? • What accounts for the ambiguity in the relationship between the Clinics and the government? • Under what conditions can the dominant paradigm in health policy, specifically regarding the co-operative Community Clinics, be changed?

Read this thesisHERE. (pdf)

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Stronger measures needed to crack down on forprofit clinics, say d... Saturday, July 21, 2012 Canadian Doctors for Medicare July 19, 2012 BC’s Medical Services Commission called for an end to extra billing at afor-profit surgical clinic infamous for its illegal billing practices yesterday, in a movedoctors say has been a long time coming. “We’re thrilled that the illegal billing practiced by the Cambie Clinic is finally being calledto account by the Medical Services Commission,” said Dr. Danielle Martin, chair ofCanadian Doctors for Medicare. “But there must be real consequences to chargingCanadians for their publicly-insured services.” After a lengthy audit, the Medical Services Commission concluded that CambieSurgeries Corporation and the Specialist Referral Clinic (Vancouver) Inc. owned by Dr.Brian Day charged illegally in more than 200 cases, charging the BC Ministry of Healthnearly half a million dollars in extra billing. This violates BC’s Medical Protection Act. Although the Cambie clinic’s actions are illegal, the BC government is only seeking toensure the clinic stops these practices in the future. Canadian Doctors for Medicare iscalling for stronger punitive action to create a real deterrent to extra billing by forprofitclinics, and for accountability to BC citizens for their tax dollars. The Canada Health Act stipulates that the federal government may withhold one dollarof cash transfer for every dollar collected through direct patient charges – a penalty thatshould be imposed in a case such as Cambie, where illegal extra billing has been continuously rampant. “This is a prime example of what happens when the federal government doesn’t enforcethe Canada Health Act,” said Dr. Vanessa Brcic, executive member of Canadian Doctorsfor Medicare. “On behalf of Canadians who are emptying their savings accounts into thecoffers of for-profit clinics like Cambie, the federal government should be taking a muchtougher stance on working with the provinces to stop illegal billing practices, andinvesting in care that all Canadians can access in our public system.”

The Birth of Medicare: From Saskatchewan’s breakthrough to Canada‑w... Thursday, July 26, 2012 By Lorne Brown and Doug Taylor Canadian Dimension July 3rd 2012

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The Saskatchewan Doctor’s Strike. Photo courtesy Saskatchewan Council for Archives and Archivists.

Medicare was born in Saskatchewan on July 1, 1962. It would be the first governmentcontrolled, universal, comprehensive single-payer medical insurance plan in North America. It was a difficult birth. The North American medical establishment and the entire insurance industry were determined to stop Medicare in its tracks. They feared it would become popular and spread, and they were right. Within 10 years all of Canada was covered by a medical insurance system based on the Saskatchewan plan, and no serious politician would openly oppose it. The same interests that tried to prevent Medicare and are continually trying to destroy it in Canada have mostly succeeded in stopping similar progress in the United States. After more than half a century of struggle, the American Medical Association (AMA) and the private insurance industry still control the US medical system despite minor steps forward like Medicaid for the very poor and Medicare for the elderly. The latest plan passed by Congress and endorsed by the private insurance industry amounts to public subsidies for the insurance industry. Commentators have often wondered why the campaign for state medicine succeeded in Canada and failed in the United States. The battle for Medicare occurred in the 1960s when our political culture was moving to the left. Medicare’s first breakthrough.

It is not surprising that the first breakthrough would be in Saskatchewan. The province, which was the home base of “agrarian socialism,” had been governed since 1944 by the Co-operative Commonwealth Federation (CCF) led by T.C. (Tommy) Douglas. The CCF had originally intended to socialize much of the economy but, like social democratic formations elsewhere, had retreated from this position and by the 1950s concentrated on building a welfare state within a mixed economy. Medical care had always been a centerpiece of its welfare state program and by 1959 considerable strides had been made. The initial innovation was universal hospital insurance which was introduced as early as 1947, and by 1958 had been adopted nationally as a federal-provincial jointly funded program. This is what made it financially possible for Douglas to announce in 1959 that the province would be launching a universal medical insurance plan. Universal state medical insurance was virtually the only major issue in the Saskatchewan provincial election of 1960. The promise of state Medicare was so popular that the opposition parties dared not oppose it outright, but they were distrustful of what they claimed would be CCF-administered “socialized medicine.” The organized medical establishment was not nearly so reticent and mounted a ferocious propaganda campaign fronted by the local College of Physicians and Surgeons with the support of the Canadian Medical Association (CMA), the AMA, the local economic elite and most of the media in the province. The College wielded tremendous power and discipline because it was the only economic group representing doctors and was also the licensing body which determined who could practice medicine. Doctors who favoured Medicare were isolated and ostracized by the hierarchy of the Medicare's 50th Anniversary Volume 2

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profession. The local medical hierarchy in 1960 took much of their advice from outsiders and adopted tactics which had proved successful in many similar campaigns in the United States. They amassed $100,000 for propaganda purposes, a tremendous sum in 1960 and far more than any party would spend in a Saskatchewan provincial election. Every household received printed propaganda and advertisements flooded the radio and newspapers. Public meetings were held throughout the province and were addressed by prominent doctors and supporters, often under the auspices of local Chambers of Commerce and Boards of Trade. The crudeness of the propaganda appears to have been based on the assumption that the Saskatchewan electorate was as unsophisticated as their American counterparts. There were denunciations of socialism, communism, “socialized medicine” and the evils of “compulsion.” People would not be able to choose their own doctors; there might be compulsory abortion; state bureaucrats might commit people to mental hospitals. It was suggested that many doctors would leave the province and be replaced by inferior foreign practitioners. “They’ll have to fill up the profession with the garbage of Europe. Some of the European doctors who come out here are so bad we wonder if they have ever practiced medicine.” Norman Ward, Saskatchewan’s most prominent political scientist at the time, asserted that the medical hierarchy “betrayed an ignorance of democratic processes in general, and Saskatchewan politics in particular, that would have been excessive in a gaggle of high school freshmen.” The effectiveness of the anti-Medicare campaign can be judged by the results of the June 8, 1960 election. The CCF won 42 percent of the vote in a four-way race and 37 of the 54 seats in the legislature. The government interpreted the results, as did most academics and other neutral observers and even much of the media outside the province, as a mandate to proceed with a universal medical plan. A renewed assault on Medicare It appeared momentarily that democracy would prevail and the medical hierarchy would accept the decision of the electorate. Such optimism proved to be a chimera as the medical hierarchy and their friends in the provincial business class and local media elite prepared for a bitter assault on the principles of responsible government. They were assisted in this campaign by the local Liberal Party and by an array of obscurantist reactionaries who were mobilized for the occasion. The initial purpose of the anti-Medicare campaign was to force the CCF government to go back on their election promise and stay out of the medical insurance field altogether. When it became clear that the CCF would do no such thing, the fallback position was trying to force them to water down government involvement, limiting it to subsidizing existing medical insurance schemes controlled by organized private medicine. Tommy Douglas himself could be considered the first political casualty. He had become the first leader of the newly founded NDP in the fall of 1961, and was replaced by Woodrow Lloyd as provincial leader and premier. Douglas was defeated in a Regina constituency in the federal election of June 1962. The defeat was attributed partly to the campaign against Medicare. The doctors’ strike This article cannot do justice to the infamous doctors’ strike of July 1–23, 1962. Entire books have been devoted to it. It was the most polarized Saskatchewan battle of the 20th 100

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century and it divided the population into warring camps which brought the province to the brink of a civil war. The campaign, which included most of the local media, was based on outrageous lies about the intent of Medicare, racial slurs, red-baiting, acts of violence and threats of blood in the streets. One of the most infamous statements was made by the right-wing priest Athol Murray to an anti-Medicare rally, broadcast by radio to thousands more: “This thing may break into violence and bloodshed any day now, and God help us if it doesn’t.” This was merely one of the incendiary speeches Murray had been making throughout the province, and the Catholic Church to its credit ordered him out of Saskatchewan for the duration. The anti-Medicare campaign gave rise to a rightwing movement known as the Keep Our Doctors (KOD) Committee. The KOD movement had many similarities to today’s rabid Tea Party movement in the United States. It was composed of an active, ignorant and misinformed rank and file, led by manipulative leaders with a right-wing political agenda. Prominent doctors and businessmen and leading lights of the local Liberal Party appeared on platforms with these fanatics. The interests behind the KOD were bent not only on stopping “socialized medicine” but in ridding the province of “socialism.” The Lloyd government held firm despite tremendous pressure, and stared down the North America medical-industrial complex for 23 anxious days. This was made possible by the dedication of CCF rank and file activists and a dedicated core of socialists, trade unionists, agrarian radicals, and of a small minority of courageous doctors who defied the ostracism of their colleagues. They built community clinics with the initial aim of employing doctors who defied the strike. Their long-range aim was to provide a consumer-controlled alternative to entrepreneurial fee-for-service medicine. It was the possibility that the community clinics might become really widespread and popular that really frightened the medical establishment. The same people who organized the community clinics also organized such groups as Citizens in Defense of Medicare and Citizens for a Free Press to counter the anti-Medicare propaganda. Public opinion swung against the anti-Medicare lobby partly due to the work of the proMedicare committees with much help from the Saskatchewan Farmers’ Union and the trade union movement, and partly because of a popular backlash against the excesses of the KOD. The College of Physicians and Surgeons was forced to call off the strike after an arrangement with the government, known as the Saskatoon Agreement, was made on July 23, 1962. The agreement included some compromises and ambiguities which allowed the College to continue harassing community clinic doctors and to hinder the growth of alternatives to fee-for-service entrepreneurial medicine. However, the main point of the agreement was that medical insurance would remain government-controlled, compulsory, universal and reasonably comprehensive. An important beachhead with national significance had been established, and the plan immediately became popular. Unfortunately for Woodrow Lloyd and his government, they did not reap the immediate political benefits. Ross Thatcher, Liberal leader, had used the Medicare crisis to consolidate the disparate right-wing forces of the province around his leadership. The Liberals narrowly defeated the NDP in the provincial election of 1964. But to do so they had to promise to continue the medical care plan as it was. Henceforth no serious Saskatchewan politician could openly attack the principle of government-controlled universal Medicare. How Medicare went national That Medicare would spread so rapidly from Saskatchewan to the national level has often Medicare's 50th Anniversary Volume 2

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puzzled observers. It can be explained mainly by two factors: a miscalculation by the CMA, and the configuration of national political forces in the 1960s. By 1960 the CMA could see that Medicare would soon become a national issue. It hoped to stop any move towards what it called “socialized medicine” by making the case for a continuation of the existing doctor-sponsored medical insurance plans, subsidized by the state if necessary but controlled by the medical establishment. Consequently it pressed the Diefenbaker government to appoint a Royal Commission to examine the whole issue of the medical system. The CMA strategy backfired. Diefenbaker appointed fellow Conservative and old seatmate from law school, Mr. Justice Emmett Hall, to chair the Royal Commission. The Commission was intended to examine all aspects of Canadian health care. However, the public hearings overlapped with the debate then raging in Saskatchewan that was becoming a major issue in the House of Commons and beyond. Dennis Gruending, in his superb biography of Emmett Hall, describes the excitement around the hearings, which played to packed houses around the country. Labour and farm organizations, consumer groups, community associations and many churches recommended a public plan similar to the one introduced in Saskatchewan in the midst of such controversy. The CMA, the private insurance industry and their business allies wanted the government to endorse the plans already operating under the auspices of organized medicine and the insurance companies. People could pay their own premiums, with the government subsidizing the premiums of the poor based on means tests. Gruending points out that Hall examined the evidence objectively and came down on the side of public Medicare, and then convinced those who were skeptical to go along with it. The first volume of the commission report, issued in June 1964, came out in favour of a comprehensive health insurance program to be jointly financed by the federal and provincial governments. “Although he didn’t admit it in the report, Hall’s proposal was essentially the Saskatchewan model on a national scale,” Gruending wrote. The reaction to the Hall Report could probably best be summed up with the expression “all hell broke loose.” The usual suspects mounted a rhetorical battle on a national scale, generally divided along class and ideological lines. Emmett Hall, by now elevated to the Supreme Court, threw himself into the debate in favour of public Medicare, an unprecedented move for a Supreme Court Justice and Chairman of a Royal Commission. By 1964 the pro-Medicare forces in the country were riding the crest of public opinion during a period when the political culture was moving to the left. The political alignment of national parties saw six years of minority governments over three elections between 1962 and 1968, and this favoured those political forces attempting to move the country in a more progressive direction. The NDP was growing and this strengthened left Liberals who argued that their party must protect their left flank. This in turn encouraged the red Tories within the Progressive Conservatives, who argued that the party must move left to remain electorally competitive. All of this was occurring during a minority situation when an election might occur at any time and no party wanted to be caught on the wrong side of a popular issue like public Medicare. It took fierce struggles within both the Liberal and Progressive Conservative parliamentary parties, but in the end the party whips forced the right wing into submission. The National Medical Care Insurance Act was passed in the House of Commons on December 8, 1966, by an overwhelming vote of 177 to 2. The starting date was July 1, 1968, and the Act provided that the federal government would pay about half of Medicare costs in any province with insurance plans that met the criteria of being universal, publicly administered, portable and comprehensive. By 1971 all provinces had 102

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established plans which met the criteria. Forty-five years later, the right to universal and equitable Medicare is now in perhaps the greatest danger it has faced since 1970. The political culture has lurched dangerously to the right and the Harper government has essentially declared that it has no intention of enforcing the Canada Health Act. The popular forces which made Medicare possible will have to be revitalized if we are to preserve the achievements which took decades of struggle to accomplish.

The next 50 years: What does the future hold for Medicare in Saskat... Thursday, July 26, 2012 By Christeen Jesse L-P Specialty Products July 23, 2012 The induction of Medicare into Saskatchewan law 50 years ago has done more than just provide affordable health care - it has also placed importance on the values of equality and democracy. "We have seen a real establishment of an ethic and understanding that people should be treated if they're sick - regardless of how much money they make and of where they are in society," said Ryan Meili, a family physician in Saskatoon and the head of the Division of Social Accountability at the College of Medicine at the University of Saskatchewan. "I think that's a really positive thing to have been developed here and it effects the way we see lots of areas of social investment." Meili, who wrote the recently-published book A Healthy Society: How a Focus on Health Can Revive Canadian Democracy, recognizes the province's past accolades in health care, but says as society evolves, Medicare needs to change with it. "We're very much in the second stage of Medicare and need to move beyond just doctors and hospitals to looking at what really keeps us healthy and makes us sick." "There are definitely areas where we have moved forward - but I think it would be pretty widely accepted that we haven't really gone beyond treatment - we're mostly still dealing with people after they are sick, rather than looking at 'How do we actually organize our society in a way that fewer people get sick'?" After 50 years of developing the Medicare model, Saskatchewan is now at a pivotal point - faced with moving beyond health care that focuses on short-term treatment of immediate cases. Looking beyond just the immune system and into the causes of poor long-term health is the next logical step for the province, says Meili He suggests that in order to achieve that, people must understand how social determinants like income, education and employment affect personal health. "It's all connected. We have the idea that we can just deal with our bodies once they are

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sick, but in our society, that's far too narrow of a view," he said. Factors like housing, nutrition and social support also need to be taken into consideration. "If you look at where health care dollars go, we spend a lot more on people who are at the lower end of the economic scale. We don't have actual primary care services available in an equitable fashion, so people wind up in a hospital, in the emergency room and where things are most expensive. So number one, it's looking at addressing things like poverty, where people are living, the circumstances where people get sick; and number two, it's addressing health equity - making sure that we provide more services for the people who need them most, rather than the way it is right now." Roy Romano, former premier of Saskatchewan, also recognizes the importance of taking these factors into consideration for the future. He is quoted in the foreword of A Healthy Society saying: "The impact of the social determinants of health is well known to government and to health care organizations. The major challenge in us lies in turning this understanding into concrete actions that have an impact on individual Canadians and communities." With a proud past, Saskatchewan is embarking on the next 50 years with a strong foundation. Future government leaders and health care professionals have the task of addressing the current issues with the system, while continuing to build on the successes of its past. If Tommy Douglas's original visions of equality and unanimous access to health care are kept alive, Medicare has a bright future to come. "On July 1, 1962, we had doctors taking to the streets going on strike against the provision of universal health care. On June 18, 2012, we had a national day of action across the country with doctors taking to the streets protesting cuts to refugee health, saying that we need to provide universal health care, and we need to address health equity in the services we provide. So that, to me, says there has been a cultural shift within the health care providing professions, and that gives me hope," said Meili. "And hopefully that continues - [Saskatchewan] having people working in the system having a desire for social change and who are willing to spark a conversation that will help us move beyond treatment to better health care."

50th Anniversary of Medicare Crisis Documentary Thursday, July 26, 2012 CBC The Current Monday, July 23, 2012 Listen On the 50th anniversary of the introduction of medicare, a documentary look at the battle that nearly kept it from happening. We hear from two families from different sides of the dispute look back on the Medicare fight in Saskatchewan, they feel it's shaped the way healthcare is delivered today.

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50th Anniversary of Medicare Crisis - Documentary In the summer of 1962, the Saskatchewan Doctor's Strike brought a bitter fight over medicare to a head. The labour dispute was triggered on July 1st, when Canada's first universal health care plan, the Saskatchewan Medical Care Insurance Act, took effect. Doctors walked off the job and stayed off for more than three weeks. Patients panicked, worried about who would care for them in an emergency. And the provincial government stood its ground, determined to make the new law stick. For three weeks that stand-off produced protests, fear ... even threats of violence. It wasn't settled until a deal called the Saskatoon Agreement was signed 50 years ago today. Today, we're looking back on that dispute to find out how it has shaped the health care we know today. The CBC's Sean Prpick tells the story through the eyes of two families who were on opposite sides of the issue. Sean's documentary is called Days of Decision. Dr. Noel Doig has just published a new memoir of Sasakatchewan's medicare crisis. It's called Setting The Record Straight.

To address health inequalities, look beyond the role of individual ... Tuesday, August 14, 2012 By Iglika Ivanova Progressive Economics Forum August 14th, 2012 A new report by the Canadian Medical Association provides a timely reminder that money buys better health, even in a country with a universal public healthcare system. A poll commissioned by the CMA found a large and increasing gap between the health status of Canadians in lower income groups (household income less than $30,000) and their wealthier counterparts (household income over $60,000). The fact that income affects health is hardly a surprise. A large body of research has shown that both globally and in Canada, income (and socioeconomic status more broadly) is closely related to virtually all health outcomes that one can think of, from life expectancy to mental health. Health experts have coined the term “social determinants of health” to draw attention to the factors outside the healthcare system that affect health, and income is identified as one of the key social determinants of health. And yet, despite all the research advances that we’ve made in understanding health and what makes people healthy, so much of the discussion is still focused on individual responsibility and lifestyle choices. In my 10minute conversation about the CMA report with Bill Good on hisCKNW show Monday

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morning [audio link to follow tomorrow], the questions of poor people smoking and eating fast food came up more than once. But aren’t the poor bringing this ill health on themselves through their own “wrong” lifestyle choices, both Bill Good and a caller asked? It’s easy to blame the poor for their misfortune and it gets us “off the hook”. If the poor make bad choices, then we don’t have to feel bad for them getting sick or do anything about the large health disparities that exist in our country. It’s just not our problem that they have double the rates of diabetes and heart disease and tend to die younger than us, wealthier Canadians. But in reality, lifestyle choices are a relatively small factor in shaping health outcomes, much less important than our living and working conditions. In fact, living and working conditions often constrain our choices to a very large extent. The health research is very clear (p. ix): “Chronic disease can no longer be explained only as an outcome based on engaging in the ‘wrong’ health behaviours. There is a need to look beyond individual responsibility to understand the ways in which the social environment shapes the decisions we make and the behaviours we engage in.” In other words, the income-related health inequalities the CMA report documents represent unfair and avoidable ill health, and it causes enormous human suffering, costs years of the life of our fellow citizens. As one of the Canadian members of the World Health Organization Commission on Social Determinants of Health, Monique Bégin points out: The truth is that Canada – the ninth richest country in the world – is so wealthy that it manages to mask the reality of poverty, social exclusion and discrimination, the erosion of employment quality, its adverse mental health outcomes, and youth suicides. While one of the world’s biggest spenders in health care, we have one of the worst records in providing an effective social safety net. What good does it do to treat people’s illnesses, to then send them back to the conditions that made them sick? This is a national embarrassment and we all have a responsibility to ensure that every Canadian has the opportunity to lead a healthy life. The large body of recent health research shows that if we want to improve health among lower income Canadians, then poverty reduction should become our number one health priority. Solutions focused on individual lifestyle choices and “healthy living” are not only incredibly patronizing to lowerincome Canadians, they are also bound to be ineffective. If you’re concerned that poverty reduction is expensive, consider how much we already spend to treat preventable and avoidable income-related illness today. In a recent CCPA report, I estimate the extra costs of providing health services to the poorest 20% to $1.2 billion in BC alone and $9.1 billion in Canada, or 6.7% of the total costs of our healthcare system. As Andre Picard concludes in an old Globe and Mail article: The most powerful drug we have – money – is pretty plentiful in Canada. But it is not being prescribed to everyone who would benefit.

Physicians take healthier approach Thursday, August 16, 2012 BY GREG FINGAS SPECIAL TO THE LEADER POST AUGUST 16, 2012 Physicians must become stronger advocates for health equity, says incoming CMA President Dr. Anna Reid, an emergency room physician in Yellowknife, Northwest Territories. Just a few short years ago, the Canadian Medical Association's leadership launched a series of direct challenges to Canada's universal public health-care system. Two CMA presidents known for their involvement in private service delivery used the national profile 106

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associated with the organization to pitch their business model. And CMA members came within an eyelash of voting for health care to be at least in part patient-funded. But the effort of one faction within the CMA to shift our health-care system toward a profit-based model didn't do much to sway public opinion or reshape the delivery of health care. (Yes, we've continued to see privatization by stealth - but not at any greater pace than was already under way.) Instead, it was met by the founding of Canadian Doctors for Medicare, who made it abundantly clear that the CMA couldn't claim a professional consensus to dismantle our prized national health-care system. Now, the CMA looks to have changed direction entirely. And there's reason for optimism that Canada's medical profession is headed down a much more viable path. In 2011, the CMA (along with the Canadian Nurses Association) unveiled a set of principles to guide health-care transformation that speak in no uncertain terms about the need to address the corrosive effect of inequality. In keeping with those principles, the CMA has pushed the federal government to include health impact assessments as part of its policy development process. And at a national council meeting this week in Yellowknife, the CMA turned its discussion for the first time toward the social determinants of health. Rather than limiting its focus to the delivery of care, the CMA recognized that medical practice is only one of many factors in overall health outcomes. And it emphasized that physicians need to be aware and active in addressing broader social issues ranging from climate change to housing to the treatment of marginalized groups in order to improve health outcomes. So what does the change of focus from one of Canada's most prominent medical voices mean for our broader political debate? On one view, the CMA could hardly have picked a worse time to adopt a more socially conscious position when it comes to the receptiveness of governments. Stephen Harper's Conservatives have entirely abandoned health care and social programs as anything but an ATM for the provinces - and even there, the federal government is going out of its way to direct money where it's needed least. And at the moment, few provincial governments have both the inclination to pursue social goods and the resources to invest in them. But some of the political barriers standing in the way of a broader view of health might start to crumble in the near future, whether through a renewed Ontario minority government or through an expected change in government in British Columbia. So a message based on health equity and the social deter-minants of health might be nicely timed to inform decision-makers on the cusp of developing and implementing long-term policy goals. Moreover, unlike the CMA's previous advocacy for privatization, its argument to consider the social determinants of health should be relatively non-controversial within the medical community. (At least I wouldn't expect to see a Doctors with Blinders countermovement within the profession.) Medicare's 50th Anniversary Volume 2

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At the very least, then, we should see the CMA's focus on health equity result in a strong professional front. And if Canadians recognize the significance of our medical community uniting to speak to the need for greater social action, then the CMA's new direction could play a part in transforming more than just our health-care system. Fingas is a Regina lawyer, blogger and freelance political commentator who has written about provincial and national issues from a progressive NDP perspective since 2005. His column appears every Thursday. You can read more from Fingas at www.gregfingas.com

Potential for billions of dollars in increased health cost if Canad... Thursday, August 16, 2012 With Europe in a financial crisis the question remains how far is Canada willing to go to achieve a deal? NUPGE News 16 Aug. 2012 While negotiators for the proposed Canada-European Union trade deal say that negotiations are in the final stages, serious concerns continue to be raised about some of the provisions expected to be in the agreement. It is reported that negotiators have reached agreement on 3/4s of the text but that there are some serious issues remaining to be addressed. In particular, Canadian officials say there is a large gap in the negotiations over such issues as investment rules, financial services, and taxation. With Europe in a financial crisis the question remains how far is Canada willing to go to achieve a deal? A number of commentators suggest the intellectual property chapter of the deal as being particularly difficult. According to Michael Geist, the University of Ottawa's Canada Research Chair in Internet and E-Commerce Law, the revelation that "provisions from the Anti-Counterfeiting Trade Agreement may sneak their way into CETA generated widespread headlines throughout Europe last month with politicians and activists expressing exasperation at the clumsy attempt to secretly revive an agreement that was roundly rejected by the European Parliament." "The Canadian opposition to the chapter will come from European demands for patent reforms that could result in billions in additional health care costs due to higher pharmaceutical prices. The pharmaceutical demands are one of Europe's top priorities, but Canada has thus far refused to counter the EU proposals, creating a stalemate that has dragged on for years." Canada's lead negotiator, Steve Verheul, says that the pharmaceutical industries demands won't be on the table during negotiations in September and October.

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While big pharma insists that these reforms are needed to increase research and development investment in Canada, past experience suggests otherwise. In the 1980s, the industry lobbied for patent reforms while promising to increase spending on research and development in Canada to 10 per cent of total sales by 1996. In reality, investment in drug research and development has declined and is as its lowest level since the 1987 reforms. According to Geist, "given 25 years of mostly failed targets, the rational approach is to put a freeze on any further reforms at least until the industry lives up to its commitments. But with the agreement shrouded in secrecy - the government has steadfastly rejected calls to release the draft text - it appears that the major health care decision will be made behind closed doors with no public discussion, debate, or access to the official text."

As medicare turns 50, let’s see the full vision implemented Monday, August 20, 2012 Association of Ontario Health Centres For AOHC, “medicare” is not just the inner workings of our health system. For us, medicare is an inspiring aspiration enshrined in Canada’s Health Act:

… to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial barriers and other barriers. Financial barriers were addressed in medicare’s first stage – a publicly funded health insurance system designed to cover costs for doctors and hospitals. The second stage that Tommy Douglas and medicare’s other founders envisioned was intended to address the other barriers standing in the way of improved health and well-being – the root causes of poor health and out-of-date delivery of care.

In the final years of his life, Douglas reminded Canadians about the importance of completing this second stage. “Let’s not forget,” he said, “the ultimate goal of medicare is to keep people well.” This full vision of medicare underlies AOHC’s own vision of the best possible health and well-being for everyone living in Ontario.

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So even as we celebrate the 50th anniversary of the implementation of medicare, we say it’s time to move forward with real solutions that work for all Ontarians. The good news: scores of these solutions are already underway in our public not-for-profit health care system. But they are not happening widely enough. Our challenge: to break down barriers so we can start spreading these solutions right across the province enabling all Ontarians to enjoy their benefits. Some progress has been made. For instance, this winter AOHC applauded Ontario's new action plan for health care, and especially its commitment to make primary care a cornerstone of health system transformation. AOHC’s executive director Adrianna Tetley committed the province’s 73 community health centres, 10 Aboriginal health access centres, 15 community-governed family health teams and 4 community-governed nurse practitioner-led clinics to meet the challenge Health and Long-term Care Minister Deb Matthews laid out in her action plan. She could have been echoing the founders of medicare themselves as she said: "Now is the time for primary health care to live up to its full potential, focusing on keeping people well and not just treating them when they are sick. We also need to ensure that individuals and their families receive coordinated care as they navigate through different parts of the health care system." This is a very possible vision. It puts people in the centre of the care and services they need, and looks at the person – and the health and social services systems – as a whole. To achieve this, Ontario must move beyond a narrow medical approach that constrains health promotion. Needs-based planning must guide the way. Let’s name the regions have the greatest need for more primary health care services. And where are needs most complex? These are the places where doctors and nurses should be working in close collaboration with the other parts of the health and social service system. This kind of planning and concern that all parts of the system are integrated are hallmarks of people- and community-centred care. Features of people-centred care include: Comprehensive primary health care planning designed to meet the various needs of diverse populations; A more complete set of services and programs that focus on the many different determinants of health at work within families and communities; To improve the health of populations with complex needs, primary care services delivered in partnership with community support, mental health and addictions, social services such as immigrant services and housing, and education; Equitable, timely and continuous care that is comprehensive, evidence-informed and culturally safe; Every Ontarian having access to interprofessional teams equipped and enabled to work to their full scope of practice. When decision makers commit to policy changes that encourage increased innovation in our health system, we can complete the second stage of medicare. And when we 110

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complete the second stage of medicare, Ontarians will be healthier, and our health care system will be more sustainable – now and for generations to come. Resources Tommy Douglas on the second stage of medicare (YouTube) Report on Second Stage of Medicare, 2007 Conference Medicare at 50 blog (focus on Saskatchewan, where medicare first implemented) The role of CHCs in strengthening medicare Medicare is a part of us (Globe & Mail)

Opinion: Time to fight for universal Pharmacare Tuesday, August 21, 2012 A universal program would save Canadians up to $10 billion a year, some estimate By Steve Morgan The Vancouver Sun August 20, 2012 When Prime Minister Stephen Harper, along with the health and immigration ministers, tried to justify cutting refugee health coverage in Canada they argued it was about fairness. Providing prescription drug coverage to refugees was unfair, they claimed, because other Canadians do not have such coverage. They were at least partly right. As a country, we provide universal access to medically necessary hospital care, diagnostic tests and physician services based solely on need. It’s a point of national pride. But Canadian “medicare” — as it is affectionately known — ends as soon as a patient is given a prescription to fill. Provincial drug plans cover only limited populations, such as seniors or social assistance recipients, or limited costs (such as costs exceeding “catastrophic” deductibles). Private drug insurance is a perk not easily obtained by Canadians who are retired, self-employed or employees of small companies. The patchwork of drug coverage in Canada has consequences that cost us all. A recent study found that one in 10 Canadians can’t afford to fill their prescriptions as directed. Such financial barriers often increase costs elsewhere in the health care system — from the public purse. For example, if a parent cannot afford the necessary drugs for a child’s asthma, they may be forced to visit the emergency department when the asthma gets out of control. Thus, the question is not whether it is fair to provide refugees with prescription drug coverage; the question is whether it is fair — and even fiscally responsible — not to provide such coverage to all Canadians. In a recent essay in Healthcare Policy journal, we show how the omission of Pharmacare Medicare's 50th Anniversary Volume 2

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from Canadian medicare came about as an accident of history, the correction of which is long overdue. Canada’s health insurance system was developed in stages, starting with the components of health care that were the most important at the time. Coverage for hospital care and diagnostic tests was established in the 1950s, followed by coverage for medical care in the 1960s. The fathers of our medicare system intended that Pharmacare and homecare be established next. Pharmacare never happened, but the need for it is stronger than ever. The range, use and availability of pharmaceuticals has increased dramatically over the past 30 years. As a result, prescription drugs are one of the most important components of contemporary health care. They are also one of the most costly forms of care. Canadians now spend more money on prescription drugs than they do on all of the services provided by physicians in this country. And, while many drugs are available at modest cost, a new wave of biological drugs is coming to market with price tags of thousands of dollars a year; in some cases, thousands of dollars a month. The need for Pharmacare has not gone unnoticed. In 1997, the National Forum on Health recommended expanding Pharmacare across Canada, but the pharmaceutical industry lobbied against such reforms, arguing that Canada could not “afford� the cost of a national Pharmacare system. Such arguments are repeated today. In truth, a universal Pharmacare program would save Canadians billions of dollars; some estimate up to $10 billion per year. The proof is found in virtually all countries comparable to Canada, countries like Australia, Denmark, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the United Kingdom. In comparison to Canada, pharmaceutical spending is lower and has been growing more slowly in all of these countries. Yet they all provide better, more equitable access to prescription drugs than Canada through universal Pharmacare systems of one form or another. In the 2012 Emmett Hall Memorial Lecture, Dr. Michael Rachlis said that medicare was one of the best expressions of Canadian democracy because Canadian citizens wanted it and had to fight for it. If Canadians take pride in their medicare system, and want to achieve better access to medicines at lower costs than they pay today, then maybe it is time for the original vision of medicare, which included Pharmacare, to be completed as planned. Perhaps it is time to fight for Pharmacare. Not just for refugees, but for all Canadians.

Steve Morgan is an expert adviser with EvidenceNetwork.ca and associate professor and associate director of the Centre for Health Services and Policy Research at the University of British Columbia. Jamie Daw is a policy analyst with the Centre for Health Services and Policy Research.

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272 billion reasons to fear privatization Wednesday, August 22, 2012 Defending Public Healthcare Notes from Leftwords for the Ontario Council of Hospital Unions August 22, 2012 Below is a list of the 11 US health corporations on the Fortune 500 list. They had a combined revenue of approximately $272 billion in 2010. They make about $15 billion in profits. Trying to reform America's largely for-profit health care system is bound to come up against these interests. With such large revenue streams they have incredible power and resources to divert health care reform to match their own interests. They have (literally) billions of reasons to do so. Their influence has not led to good results. The privatized American system is far and away the most expensive health care system in the world. Despite this, tens of millions of Americans have no health care insurance and tens of millions more have inadequate health care insurance. If Canada let's more and more corporations into our health care system, we will more and more face the same corporate interests able and willing to push health care in the same direction that corporate health care pushes the American system. Revenues Profits Rank Company Fortune 500 rank $ millions % change from 2010 $ millions % change from 2010 1 UnitedHealth Group 22 101,862.0 8.2 5,142.0 11.0 2 WellPoint 45 60,710.7 3.2 2,646.7 -8.3 3 Humana 79 36,832.0 8.8 1,419.0 29.1 4 Aetna 89 33,779.8 -1.4 1,985.7 12.4 5 Cigna 130 21,998.0 3.5 1,327.0 -1.3 6 Coventry Health Care 219 12,186.7 5.2 543.1 23.8 7 Health Net 221 11,901.0 -12.6 72.1 -64.7 8 Amerigroup 385 6,318.4 8.8 195.6 -28.4 9 WellCare Health Plans 401 6,106.9 12.3 264.2 N.A. 10 Centene 453 5,340.6 19.5 111.2 17.3 11 Molina Healthcare 500 4,769.9 16.7 20.8 -62.1 Issue date: May 21, 2012

Medicare's 50th Anniversary Signing Off Tuesday, September 04, 2012 NYC September 4, 2012 The 50th anniversary of medicare's fiery birth here in Saskatchewan has now come and gone. The Saskatchewan labour movement, the Saskatchewan Health Coalition, community clinics, the Saskatchewan CCPA, the provincial NDP and others ensured that is was well-marked with lessons learned from the historic battle in 1962. I hope this site has provided an useful resource for those advocating for defending and Medicare's 50th Anniversary Volume 2

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improving Canada's public health care system. The site will be left up for as long as Google lets blogs remain dormant. Please visit the sites listed on the right of this blog for updates for the continuing fight to ensure health care for all, in Canada and elsewhere. Please also visit the articles published in Briarpatch magazine and Canadian Dimension written by Dr. Lorne Brown and myself relating to the 50th anniversary.

Same Fight, New Foes The Birth of Medicare: From Saskatchewan’s breakthrough to Canada‑wide coverage Thank you all for your comments and spreading the word. Doug Taylor Next Year Counrty

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Medicare's 50th Anniversary, Volume 2  

Celebrating the struggle for medicare in Saskatchewan, July 1962

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