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About the CTF The Patient, The Condition, The Treatment A CTF Research and Position Paper on Health Care September 2001 Prepared by: Walter Robinson CTF Federal Director Suite 512-130 Albert St. Ottawa Ontario K1P 5G4 Web: www.taxpayer.com News Release Executive Summary About the CTF The Canadian Taxpayers Federation (CTF) is a federally incorporated, non-profit, non- partisan, education and advocacy organization founded in Saskatchewan in 1990. It has grown to become Canada’s foremost taxpayer advocacy organization with more than 83,000 supporters nation-wide. The CTF’s three-fold mission statement is: • To act as a watchdog on government spending and to inform taxpayers of governments’ impact on their economic well-being; • To promote responsible fiscal and democratic reforms, and to advocate the common interests of taxpayers; and • To mobilize taxpayers to exercise their democratic rights and responsibilities. The CTF maintains a federal and Ontario office in Ottawa and offices in the four provincial capitals of B.C., Alberta, Saskatchewan, and Manitoba. Provincial offices conduct research and advocacy activities specific to their provinces in addition to acting as regional organizers of Canada-wide initiatives. The CTF’s official publication, The Taxpayer magazine, is published six times a year. CTF offices also send out weekly Let’s Talk Taxes commentaries to over 800 media outlets as well as providing media comment on current events. CTF staff and Board members are prohibited from holding memberships in any political party. The CTF is funded by free will, non-receiptable contributions. The CTF does not receive government funding. The CTF’s award winning web site can be found at: www.taxpayer.com Acknowledgments This paper represents the culmination of 18 months of reading and research, and two months of writing and revisions. Special thanks are due to Dr. David Gratzer (1999/2000 Donner Prize winner and author of Code Blue) for his edits and advice and Dr. William Orovan, past president of the Ontario Medical Association (OMA) for his suggestions and his team at the OMA, for their April 2000 presentation in Regina. Thanks are also due to Dr. Keith Martin, MP, for his support and friendship and the leadership team at the British Columbia Medical Association for advice and materials provided this past July. The report’s principal author, CTF federal director Walter Robinson, accepts full responsibility for any omissions or errors this report. The Patient, The Condition, The Treatment1 September 2001 Table of Contents 1.0 Introduction.............................................................................................................7 1.1 Rationale: Why Health Care? .................................................................................7 1.2 Layout of the Report ...............................................................................................9 1.3 List of Acronyms ...................................................................................................10 1.4 Seven Core Beliefs: Before We Can Move Forward.............................................11 Belief #1: Health care is in crisis.................................................................................11 Belief #2: Canadians are ahead of their politicians.....................................................12 Belief #3: Health care IS a shared jurisdiction ............................................................13 Belief #4: The Canada Health Act is not the Bible......................................................13 Belief #5: It is impossible to measure health systems by numbers alone ...................14 Belief #6: The debate is too continental; it must become global.................................14 Belief #7: The concepts of quality and excellence must enter the debate ..................15 1.5 Scope and Purpose ..............................................................................................17 2.0 The History of Health Care in Canada .................................................................18 1867 – British North America Act................................................................................18 1883 – German Health Insurance...............................................................................19 1911 – National Health Insurance (Great Britain).......................................................19 1916 – Rural Municipality Act in Saskatchewan .........................................................19 1919 – Liberal Commitment........................................................................................19 1915 to the 1940s – Prepayment Plans......................................................................20 1933 – Winnipeg Doctor’s Strike ................................................................................20 1934 – CMA Releases Medical Economics Report ....................................................20 1940 – Royal Commission on Dominion-Provincial Relations (Rowell-Sirois)............20 1944 – Saskatchewan Health Insurance Bill...............................................................21 1945 – Green Book Proposals....................................................................................21 1947 – Saskatchewan Provincial Health Insurance....................................................21 1948 – Federal Health Grants Program......................................................................21 1948 – National Health Insurance System (Great Britain) ..........................................22 1957 – Hospital Insurance and Diagnostic Services Act ............................................22 1961 – Hall Royal Commission Announced ...............................................................22 1962 – Saskatchewan Expansion...............................................................................23 1964 – Royal Commission on Health Services...........................................................23 1966 – Medical Care Act ............................................................................................24 1966 – Canada Assistance Plan (CAP)......................................................................24 1969 – Action on Generic Drugs.................................................................................24 The Late 60s, Early 70s..............................................................................................25 1974 – A New Perspective on the Health of Canadians .............................................25 The Patient, The Condition, The Treatment2 September 2001 1977 – Established Programs Financing Act..............................................................25 The Late 70s, Early 80s – User Fees and Reprivatization..........................................26 1980 – Health Services Review by Justice Hall..........................................................26 1984 – Canada Health Act .........................................................................................26 1986 – Population Health Returns..............................................................................27 1983-84 to 1995 – The Slow Federal Retreat.............................................................27 1994 – The National Forum on Health........................................................................27 1995 – The CHST Budget ..........................................................................................28 1997 – National Forum on Health Report ...................................................................28 1999 – The Health Budget .........................................................................................28 2000 – Pre- Election Health Accord............................................................................29 2001 – Commission on the Future of Medicare..........................................................29 3.0 The Canada Health Act ........................................................................................30 3.1 The Five Principles ...............................................................................................30 3.2 The CHA: Diminished, Vague and Rigid...............................................................31 3.3 The “Principles” in Practice...................................................................................33 3.4 The CHA vs. Public Opinion .................................................................................34 3.5 The Bottom Line ...................................................................................................36 3.6 Modernize the Canada Health Act with New Principles........................................38 Public Governance .....................................................................................................39 Universality.................................................................................................................40 Quality ........................................................................................................................40 Accountability .............................................................................................................41 Choice ........................................................................................................................41 Sustainability ..............................................................................................................42 4.0 Health Care in Canada .........................................................................................43
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