2006 John F. Roatch GLOBAL LECTURE SERIES on Social Policy and Practice Roatch Global Lecture2006 Series on Social Policy and Practice Health Care in Canada and the United States: Consumer Good, Social Service or Right of Citizenship? Presented by Gregory P. Marchildon, Ph.D. March 3, 2006 With gratitude Theto Mary present Roatch The John and Mary Roatch Endowment was created by gifts made to the university by John and Mary Roatch. The endowment provides support for the Global Lecture Series, which are organized through the office of the John F. Roatch Distinguished Professor at University College. John Roatch was born in Ellsworth, Wisconsin, on May 3, 1921 and died in Phoenix, Arizona, on July 2, 1997. Mary was born to missionary parents in Darjeeling, India and resides in Phoenix. The Roatches have four children, Virginia, Thomas, David, and Joseph. Both Mary and John met and graduated from Hamline University in St. Paul, Minnesota. John also received a master of social work from Washington University in St. Louis, Missouri. He practiced social work and was director of the social work department at the Clinical Center of the National Institute of Health in Bethesda Maryland from 1965 to 1972. John came to Phoenix as director of the social service department at the Indian Medical Center, where he retired in 1979 with the rank of Captain in the United States Public Health Service. John then became a part-time financial consultant and real estate investor. Mary Roatch was a teacher, a cottage-parent, and a tutor, but her real love was being a librarian and a consultant on libraries for persons with special needs. She worked at the Phoenix Public Library where she organized the first Special Needs Center in 1983. Mary is a very accomplished individual who has been an active speaker on issues affecting special needs programs in libraries. She was the recipient of the 1993 Francis Joseph Campbell Award from the American Library Association. We continue to be indebted to John and Mary for their vision and to all the family for their continued support of the Lecture Series. Emilia E. Martinez-Brawley John F. Roatch Distinguished Professor 2006 Celebrating John F. Roatch’s TheLegacy memory Dear Friends and Colleagues The John F. Roatch Global Lecture Series has always been at the forefront in covering timely topics. Each year, whether discussing language maintenance or human rights, the lecturers found an eager audience because the topics had entered center stage in Arizona public policy discussions. Nearly two years ago, when we began planning the 2006 lecture, issues of health care policy in Arizona were important. We anticipated they would remain at center stage in 2006, but serendipitously, our local paper featured articles on health care policies in Arizona in January and February 2006, and the Arizona legislature saw a health insurance proposal introduced by Rep. Phil Lopes. Gregory Marchildon’s careful analysis and examples of the Canadian and American situations will constitute a valuable addition to the dialogue in which all of us have recently become engaged. The contributions of our distinguished respondents, Dr. Len Kirschner and Susan Gerard, added locally based knowledge and information. We cannot doubt any longer that what is happening in the house of our neighbor to the north is important to us and can add to our experiences. An enthusiastic audience welcomed Prof. Marchildon and the respondents and engaged in a very meaningful discussion. We believe the conversation about health care in Arizona has been launched and will continue as we strive to solve a serious policy challenge. Our friend Monsignor Edward J. Ryle, recently deceased, whom we honored at this event through the message and reminescences of Rev. Buz Stevens, would be particularly proud that we addressed health care in Arizona. May we keep his commitment to the poor. With best wishes, Emilia E. Martinez-Brawley John F. Roatch Distinguished Professor 5 he perception of essential health care as an economic “Tcommodity rather than a public good is a barrier to fundamental change in health financing in the United States. Perhaps it goes too much against the grain of American political culture, with its strong sense of individualism and its inherent anti-statism, to expect that an overwhelming majority of Americans will suddenly view health care as a social service. But it is possible that this country could one day leapfrog that step by concluding, through a court decision, that certain essential health services are a right of citizenship and must be provided to everyone on the same basis.” Gregory P. Marchildon, Ph.D. Canada Research Chair and Professor GREGORY P. MARCHILDON holds a Canada Research Chair in Public Policy and Economic History and is Professor of Public Policy in the Graduate School of Public Policy at the University of Regina. He is also a Fellow of the School of Policy Studies at Queen’s University and a Trudeau Mentor with the Trudeau Foundation. From 2001-2002, he was Executive Director of the Commission on the Future of Health Care in Canada also known as the Romanow Commission. The Commission’s Report, Building on Values: The Future of Health Care in Canada, was delivered to the Canadian Parliament in November, 2002. From 1997 until 2000, Dr. Marchildon was Cabinet Secretary and Deputy Minister to the Premier of Saskatchewan. From 1994 until 1996, he was the Deputy Minister of Intergovernmental Affairs in the Saskatchewan government. From 1989 until 1994, he was a professor of Canadian studies and economic history at Johns Hopkins University’s School of Advanced International Studies in Washington, DC. He has a doctorate in economic history from the London School of Economics as well as degrees in history, economics and law. He has written extensively on subjects ranging from public policy, including health policy, to public administration and economic history. His first book, Profits and Politics, was published by the University of Toronto Press in 1996. He has just completed a profile of Canada’s health system for the World Health Organization’s Regional Office for Europe and the University of Toronto Press. He has also edited or co-edited a number of books, including: The Heavy Hand of History (2005), The Fiscal Sustainability of Health Care in Canada (2004); Changing Health Care in Canada (2004); The Governance of Health Care in Canada (2004); Canadian Agriculture at the Border (2000); The NAFTA Puzzle (1994); Canadian Multinationals and International Finance (1992); and Mergers and Acquisitions (1991). Scenes from the Lecture 7 Health Care in Canada and the United States: Consumer Good, I want to explore the extent to which Social Service or health care is treated as a consumer good, Right of Citizenship? a public social benefit or service, or a right of citizenship in both Canada and the United States. March 3, 2006 It is a great honor to give this year’s John Roatch lecture, named in memory of a public servant who dedicated his life to improving the plight of the poor and marginalized in this country. Born in 1921, Mr. Roatch came of age during the Great Depression. He saw first hand the human devastation caused by the collapse of commodity prices and the impact this had on the farm belt. In much the same way that drought-stricken farm states suffered the most in the United States, the province of Saskatchewan was at the epicenter of the same calamity in Canada. It is no accident that the people and government of that province were the first to introduce national health insurance in North America and that the political leaders and public servants of that province played such a critical role in building the postwar welfare state in Canada itself. Just as John Roatch dedicated his life to improving the community, working through government—the community writ large—so, too, did this generation of prairie progressives dedicate their lives. Their names are now legendary. They include Tommy Douglas, the Premier of Saskatchewan during the 1940s and 1950s, a reformer whose stature has only grown with time. In fact, last year, during a popular television poll designed to pick the greatest Canadian of all time, Tommy Douglas was chosen instead of more visibly prominent individuals, including our first prime minister, Sir John A. Macdonald, and our famously charismatic prime minister, Pierre Elliott Trudeau. Why? In large part, it was because Tommy Douglas is known throughout the country as the father of Canadian-style Medicare. It was his small and rather impoverished provincial government that implemented the first working system of universal health care in North America. As I interpret the recent spate of articles in your local paper, the Arizona Republic, universal health care is a goal shared by many here as well. Indeed, the newspaper’s own poll suggests that just over 80 percent of registered voters in the state of Arizona say it is time that the state or the federal government “step in and create a health care system that ensures everyone has access to the medical care they need” (Crawford 2006). Great! The only problem is that everyone also disagrees on how this should be accomplished. Today, I want to explore the extent to which health care is treated as a consumer good, a public social benefit or service, or a right of citizenship in both Canada and the United States. I want to ask if these current conceptions of health care are helping or impeding us in our collective efforts to improve our respective health systems. 8 Whatever happens, we know one thing for sure. In other words, public attitudes towards health care in Politicians, policy experts, professionals, and the public Canada run along a spectrum from right of citizenship, in both countries will be pointing to the experience through social service or benefit, to consumer good of the other country to draw lessons, and no doubt some depending on the position the good or service occupies will continue to demonize the system across the border on a public-private continuum of governance, funding, in an effort to buttress their respective cases.