CUDAHY-DISSERTATION-2015.Pdf (1.179Mb)
Total Page：16
File Type：pdf, Size：1020Kb
HEALTH CARE POLICY MAKING IN CANADA AS RHETORICAL TRANSCENDENCE: 1944-2014 A Dissertation by CHRISTOPHER MICHAEL CUDAHY Submitted to the Office of Graduate and Professional Studies of Texas A&M University in partial fulfillment of the requirement for the degree of DOCTOR OF PHILOSOPHY Chair of Committee, Charles Conrad Committee Members, Joel Iverson Jennifer Mercieca James Burk Head of Department, Kevin Barge May 2015 Major Subject: Communication Copyright 2015 Christopher Michael Cudahy ABSTRACT Canada’s national program for health services was conceived in the late 1960’s after protracted advocacy on the provincial level – most notably from Tommy Douglas, premier of Saskatchewan. After insured services for both hospital and physician services had been secured in the province in 1961, the Government of Canada faced increasing pressure to nationalize universal health care. Largely in response to the advocacy of Mr. Justice Emmett Hall in his 1964 Commission Report, a national system was instituted into law in 1968 under Prime Minister Lester B. Pearson. Since that time, robust advocacy has waned and successive federal governments have instead focused on defending Medicare through the enactment of rigid legislation such as the Canada Health Act. This legislation and other advocacy has enshrined universal health care into the Canadian psyche making it highly resistant to change. I sought to assess the nature of the advocacy that has served to perpetuate the status quo at all costs and have suggested ways in which the rhetorical landscape could be altered to reinvigorate public discussion to keep Medicare up to date and to ultimately strengthen health care services in Canada. I employed rhetorical and communication theory as a lens for providing suggested pathways for clash and reform. The following findings were noted in the dissertation. First, rhetorically induced value principles associated with Medicare have devolved into an institutionalized system that has been reinforced through its strong connection with Canadian identity. Second, there has been a marked de-emphasis of rhetoric which has been supplanted by a focus ii on funding mechanisms and point of service delivery. Third, the more flexible argumentation associated with the legislative realm has been neglected and largely replaced by the more adversarial and rigid enforcement of perceived rights for health care through judicial review. Throughout the dissertation I argued for the need for rhetoric to be resurrected in Canada perhaps through the vehicle of egoistic charismatic political leaders. All in all, I envision a health care system that is more flexible, molded by rhetoric and allows for greater innovation while retaining core principles such as universality. iii DEDICATION To my Lord iv ACKNOWLEDGMENTS I would like to thank my gracious committee for their service. I would like to especially thank Dr. Charles Conrad for his patience, encouragement, expertise, mentorship, and friendship. I could not have completed this project without him. I would also like to thank my family for their patience and encouragement and for ‘keeping the faith’ in me. Particular thanks to my Mom for her listening ear as I brainstormed ideas and perspectives on a chapter-by-chapter basis. These brainstorming sessions were essential to my success. Andrew S. Marshall, Assistant Librarian at Crandall University was not only helpful with research, but also played a significant motivating role for the completion of this dissertation. Your listening ear and friendship were invaluable. Also, I would be remiss if I did not give special mention to an excellent colleague, Dr. Keith Bodner, for helping me to believe in myself again and to finally break through the inertia of procrastination. Dr. Christopher Levesque was also instrumental in this regard. Thanks finally to the Department of Communication at Texas A&M University for such a great educational experience. As a result, I definitely caught the Aggie spirit! Finally, I would like to thank Dr. Roy Joseph. You freely offered friendship, hospitality, conversation, encouragement, loyalty and the intellectual engagement of a life time. Without your influence, I may have never taken a Ph.D. and benefitted from the privilege of attending Texas A&M. You were a true friend and brother-in-Christ and I look forward to seeing you again someday. Rest in peace and joy with our Lord. v TABLE OF CONTENTS Page CHAPTER I INTRODUCTION AND LITERATURE REVIEW................................. 1 Proposed Critical Framework…………………………….. 5 Constitutional Influences on Canadian Health Care........... 8 The Canadian Cultural Philosophy………………………12 A Bird’s Eye View of Medicare........................................ 19 Concluding Remarks......................................................... 32 CHAPTER II CONSTITUTIONAL PRECURSORS TO MEDICARE……………... 35 Constitutional History in Canada………………………. 37 The Dialectic of Constitutions………………………….. 44 Burke and The Canadian Constitution…………………. 50 The Textual Nature of The Canadian Constitution…….. 65 A System’s Approach to Rhetorical Criticism…………. 67 Implications…………………………………………….. 69 CHAPTER III TOMMY DOUGLAS—PRAGMATIC REFORM…………………...72 Biographical Insights…………………………………… 75 Baptist Preacher to Politician…………………………... 79 The Establishment of Medicare in Canada……………... 80 The Socio-Political Philosophy of Douglas……………..81 Historical Contextual Considerations…………………... 86 Emotional Rhetoric and Rhetorical History……………. 96 Rhetorical Assessment of Some Key Speeches………..101 Capitalism as Insidious................................................... 103 Implications…………………………………………… 122 ; CHAPTER IV THE APPROPRIATION OF CANADIAN IDENTITY…………… 124 Rhetorical Identification………………………………. 128 Connecting Federal Values to Provincial Systems……. 132 Canadian Identity in Its Current Context........................136 Innovation as Counteractive Ultimate Term.................. 148 Implications.................................................................... 153 vi CHAPTER V RHETORICAL INVERSIONS OF REALITY……………………….156 The Nature of Commissions in Canada........................... 157 Rhetorical Criticism and Close Textual Analysis............ 161 The 1964 Hall Commission Report................................. 167 The 1980 Hall Commission Report................................. 192 CHAPTER VI DE-EMPHASIZING RHETORIC…………………………………... 208 The Romanow Report………………………………….. 224 The Rhetoric of The Romanow Commission.................. 225 The Health of Canadians – The Federal Role………….. 248 Implications..................................................................... 259 CHAPTER VII JUDICIAL RHETORIC AND SOCIAL CHANGE………………... 262 Health Care Debate and Informal Argumentation........... 276 The Dissenting Perspective..............................................279 Implications..................................................................... 286 Medicare – from Chaoulli to Present............................... 291 Summary……………………………………………….. 302 CHAPTER VIII SUMMARY OF HEALTH CARE POLICY IN CANADA………. 303 Richard Weaver and Argument from Definition………. 307 Analysis………………………………………………... 314 Authority, Freedom and Liberal Judgment…………….. 328 Implications……………………………………………. 331 Future Directions for Research………………………… 333 REFERENCES………………………………………………………………………. 342 vii LIST OF TABLES TABLE Page 1 Summary of Protective Measures for Medicare in Canada.................................256 2 Summary of Federal Funding under Harper’s Conservatives………………… 295 viii CHAPTER I INTRODUCTION AND LITERATURE REVIEW “Afoot and light-hearted I take to the open road, Healthy, free, the world before me, The long brown path before me, leading wherever I choose” (Whitman, qtd. in Bellah et al., 2007, p. 34). “We must delight in each other, make others conditions our own, rejoyce together, mourn together, labor and suffer together, always having before our eyes our community as members of the same body” (Bellah et al., 2007, p. 28). The above two quotes are reflective of two philosophies that can conceivably have a bearing on the nature of debate concerning health care and the kind of health care that is ultimately implemented in a particular nation state. The first quote illustrates one possible benefit associated with good health and having access to quality health care. Good health increases the potential of an individual to pursue their own interests and goals in life. However, those who subscribe to a more ‘communitarian’ perspective to life might highlight some of the pit falls associated with being so individually focused. Individualists miss out on both the promises and perils involved with living in a community. The individual/community dialectic has certainly been an important factor in the inception, implementation, and continuation of Canada’s universal system of medical care. The Canadian debate concerning the implementation and maintenance of what the Hall Commission termed health services programmes has been both complex and important to Canadians. In recent years, however, the health care debate has slipped in priority and been partially supplanted by other issues such as the economy, the environment, and the war in Afghanistan. This despite the fact that Medicare is 1 increasingly coming under attack by such free market oriented organizations like the Fraser Institute. Medicare has also been subject to increasing criticism from a variety of interest groups ranging from the Canadian Medical Association, to patients and most recently