Editing Medicare (Canada) (section)

==History==
{{Main|History of medicine in Canada}}

Prior to [[World War II]], health care in Canada was privately funded and delivered, with the exception of services provided to the sick poor that were financed by local governments. The [[Great Depression in Canada|traumatic experience of the 1930s]] left many Canadians in challenging financial situations.  As personal financial situations deteriorated, the municipal governments were overwhelmed. Though the provinces provided relief payments for food, clothing, and shelter, additional medical costs were beyond the capacity of most of the provincial budgets.  Many Canadians were not receiving adequate medical care, and those that did were overwhelmed with the associated costs. As such, preventable diseases and deaths were still common occurrences.<ref name = "Taylor">Taylor, Malcolm G. (1978). ''[http://mqup.mcgill.ca/book.php?bookid=2351 Health Insurance and Canadian Public Policy]'', McGill-Queen's University Press, Montreal.</ref>

Ten years of economic depression, followed by six years of worldwide war, formed the social context of ambitious federal Green Book proposals. In a bid for unprecedented cooperation between the federal and provincial governments, these initiatives formed the foundations of a national program for social security, including provisions for health insurance. However, the failure to come to a consensus on the required allocation of tax resources at the [[First Ministers' conference|Dominion-Provincial Conference]] in August 1945 precluded adoption and delayed subsequent action.<ref name = "Taylor" /> Although the Green Book proposals were not adopted, they effectively created an appetite for government-funded health services.<ref name="Civilization">Canadian Museum of Civilization (2010). [http://www.civilization.ca/cmc/exhibitions/hist/medicare/medic-5h02e.shtml Making Medicare: The history of health care in Canada, 1914–2007].</ref>

Following the Green Book proposals, Saskatchewan in 1947 and Alberta in 1950, under provincial governments led by the [[Co-operative Commonwealth Federation]] (CCF) and the [[Social Credit Party of Canada|Social Credit party]] respectively, led initiatives to implement publicly funded health care at the provincial level.<ref>{{cite book|last=Quinlan|first=Don|title=The Canadian Challenge|year=2008|publisher=Oxford University Press|location=Canada|isbn=978-0-19-542647-2}}</ref> The first implementation of public health care at the federal level came about with the ''[[Hospital Insurance and Diagnostic Services Act]]'' (HIDS), which was passed by the Liberal majority government of [[Louis St. Laurent]] in 1957,<ref name="Turner">{{Cite journal | last = J. Gilbert Turner | title = The Hospital Insurance and Diagnostic Services Act: Its Impact on Hospital Administration | journal = Canadian Medical Association Journal | volume = 78 | issue = 10 | pages = 768–770 | pmc = 1829926
| year = 1958 | pmid = 13523526}}</ref> and was adopted by all provinces by 1961. The HIDS implemented a high degree of federal regulation of the provincial health systems.<ref>[https://www.historymuseum.ca/cmc/exhibitions/hist/medicare/medic-4h21e.html Canadian Museum of History – Making Medicare: "Achieving National Standards for Hospital Insurance".]</ref>

[[File:Tommy_Douglas_crop.jpg|thumb|upright=0.5|Premier Tommy Douglas, who introduced the medicare bill in Saskatchewan]]
[[File:Woodrow Stanley Lloyd-M. West, Regina.jpg|thumb|upright=0.5|Premier Woodrow Lloyd, who implemented medicare in Saskatchewan]]

The fight for a broad publicly funded system began at the provincial level, and was originally led by Saskatchewan Premier [[Tommy Douglas]] and the CCF,<ref>[https://www.historymuseum.ca/cmc/exhibitions/hist/medicare/medic-5h02e.html Canadian Museum of History – Making Medicare:  "Saskatchewan Leads the Way".]</ref> who won the [[1960 Saskatchewan general election]] on a campaign promise of publicly funded health care, over the opposition of the medical profession.<ref>[https://www.historymuseum.ca/cmc/exhibitions/hist/medicare/medic-5h03e.html Canadian Museum of History – Making Medicare: "Medical Opposition in 1960".]</ref> When Douglas resigned to become the leader of the new federal [[New Democratic Party]] in 1961, the task of implementing Medicare fell to [[Woodrow Stanley Lloyd]], who succeeded Douglas as premier.<ref>[https://www.historymuseum.ca/cmc/exhibitions/hist/medicare/medic-5h06e.html Canadian Museum of History – Making Medicare:  "Conflict and Compromise".]</ref> Lloyd overcame considerable public opposition to the plan, including a [[Saskatchewan doctors' strike|strike by the province's doctors]], who withdrew their services from the public in opposition to the proposed medicare plan.<ref>[https://www.historymuseum.ca/cmc/exhibitions/hist/medicare/medic-5h07e.html Canadian Museum of History – Making Medicare: "The 1962 Doctors’ Strike"]</ref> The resolution of the dispute was assisted by mediation by a British Labour peer, [[Stephen Taylor, Baron Taylor|Lord Taylor]], who had been involved in the development of the National Health Service in Britain.<ref>[https://www.historymuseum.ca/cmc/exhibitions/hist/medicare/medic-5h10e.html Canadian Museum of History – Making Medicare:  "Mediation through Shuttle Diplomacy".]</ref>

The next stage in the development of Medicare was the Royal Commission on Health Services, 1961 to 1964,<ref>[https://www.canada.ca/en/health-canada/services/health-care-system/commissions-inquiries/federal-commissions-health-care/royal-commission-health-services.html Royal Commission on Health Services, 1961 to 1964]</ref> often cited as the Hall Commission, after its chair, Supreme Court Justice [[Emmett Matthew Hall|Emmett Hall]].  The commission was created by another Saskatchewanian, Prime Minister [[John G. Diefenbaker]], who appointed Hall, also from Saskatchewan, to chair the commission.  Both Diefenbaker and Hall were [[Progressive Conservative Party of Canada|Progressive Conservatives]], unlike the CCF government of Saskatchewan.<ref>[https://www.historymuseum.ca/cmc/exhibitions/hist/medicare/medic-5h12e.html Canadian Museum of History – Making Medicare:  "The Royal Commission on Health Services".]</ref> In 1964, after intensive study and public consultations, the Hall Commission released the first volume of its report, calling for federal funding for a national medicare plan.<ref>[https://www.historymuseum.ca/cmc/exhibitions/hist/medicare/medic-5h17e.html Canadian Museum of History – Making Medicare: "Canada’s First Health Charter".]</ref>

By the time the Hall Commission made its report, the Diefenbaker government had been defeated in the [[1963 Canadian federal election|1963 federal election]].  The new prime minister, Lester Pearson, had campaigned on establishing a national health care system.  He began to work towards implementing a plan.  His first Minister of Health, [[Judy LaMarsh]], continued internal reviews and consultations with her provincial counterparts to implement the proposals. Pearson also consulted with the provincial premiers, and encountered provincial opposition.<ref>[https://www.historymuseum.ca/cmc/exhibitions/hist/medicare/medic-5h18e.html Canadian Museum of History – Making Medicare: "Creating Medicare: National Politics".]</ref> Alberta,<ref>[https://www.historymuseum.ca/cmc/exhibitions/hist/medicare/medic-5h19e.html Canadian Museum of History – Making Medicare:Provincial Reactions".]</ref> Quebec,<ref>[https://www.historymuseum.ca/cmc/exhibitions/hist/medicare/medic-5h20e.html Canadian Museum of History – Making Medicare: "Autonomy in ''La Belle Province''".]</ref> and Ontario<ref>[https://www.historymuseum.ca/cmc/exhibitions/hist/medicare/medic-5h21e.html Canadian Museum of History – Making Medicare: "Opposition from Ontario".]</ref> all opposed the initial federal proposals, suggesting that each province should develop its own plan.  Following his initial consultations, Pearson and his government developed a new, more decentralised plan.  Relying on the advice of [[Albert Wesley Johnson|Al Johnson]], the federal Deputy Minister of Finance and former Deputy Provincial Treasurer in Saskatchewan during the development of Medicare, the new plan set out four requirements.  To be eligible for federal funding, a province would have to have (1) a publicly administered funding system, (2) providing universal coverage to residents, (3) for medically necessary services, (4) with portability when people moved.<ref name =FedProp>[https://www.historymuseum.ca/cmc/exhibitions/hist/medicare/medic-5h22e.html Canadian Museum of History – Making Medicare:  "The Federal Proposal".]</ref> Although the provincial premiers were surprised that the proposal lacked central regulation of health care, continuing to leave the operation of the health systems to the provinces, some premiers such as Premier Manning of Alberta continued to oppose the federal proposal.<ref name=FedProp/>

[[File:Allan MacEachen.jpg|thumb|upright=0.5|Allan MacEachen, federal Minister of Health and Welfare, who introduced the bill in Parliament]]
In the [[1965 Canadian federal election|1965 federal election]], the Liberals campaigned on implementing their proposal.  Although they were re-elected, it was with a minority, meaning that they would need at least some opposition support to have their proposed plan passed by Parliament. A split now developed in the Liberal Cabinet and caucus. The new Minister of Health and Welfare, [[Allan MacEachen]], pushed for the enactment of the proposals, introducing the ''Medical Care Act, 1966'' into Parliament.  Although opposed by the MPs for [[Progressive Conservative Party of Canada|Progressive Conservative Party]] and Social Credit, the bill received support from the New Democratic Party, led by Tommy Douglas.  It passed first reading in the House of Commons.<ref>[https://www.historymuseum.ca/cmc/exhibitions/hist/medicare/medic-5h23e.html Canadian Museum of History – Making Medicare:  "The ''Medical Care Act'', 1966".]</ref>

However, when Prime Minister Pearson left the country to attend a Commonwealth conference, the Acting Prime Minister and Minister of Finance, [[Mitchell Sharp]], stated that the government might not be able to afford the new program, in light of the financial state of the country, and called to defer passage.<ref name=Next>[https://www.historymuseum.ca/cmc/exhibitions/hist/medicare/medic-5h24e.html Canadian Museum of History – Making Medicare:  The Next Stage of the Battle".]</ref> The proposed policy shift almost triggered MacEachen's resignation, and generated internal debates in the Liberal party.<ref name= Next/> As word of the split within the Liberals became public, the PC and Social Credit MPs began to put greater pressure on the government to stop the bill in the Commons. The bill eventually passed second and third readings with NDP support, after contentious debates.<ref name="Forman2009">{{cite book|first=Lillian E.|last=Forman|title=Health Care Reform|url=https://books.google.com/books?id=igthi21RZVgC&pg=PA2002|access-date=June 6, 2011|date=January 2009|publisher=ABDO|isbn=978-1-60453-532-7|page=2002}}</ref><ref name = Next/> The government agreed to defer implementation of the Act for one year, coming in force on July 1, 1968.

In 1984, the ''Canada Health Act'' was passed, amalgamating the 1966 ''Medical Care Act'' and the 1957 ''Hospital Insurance and Diagnostic Services Act''. The ''Canada Health Act'' affirmed and clarified five founding principles: (a) ''public administration'' on a non-profit basis by a public authority; (b) ''comprehensiveness'' – provincial health plans must insure all services that are medically necessary; (c) ''universality'' – a guarantee that all residents in Canada must have access to public healthcare and insured services on uniform terms and conditions; (d) ''portability'' – residents must be covered while temporarily absent from their province of residence or from Canada; and (e) ''accessibility'' – insured persons must have reasonable and uniform access to insured health services, free of financial or other barriers. These five conditions prevent provinces from radical innovation, but many small differences do exist between the provinces.<ref>{{cite web|title=Benefits Canada|url=http://www.benefitscanada.com/benefits/health-wellness/the-canada-health-act-then-now-and-in-2014-26218|access-date=May 16, 2014}}</ref>