Health care in Canada

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As the health care debate continues in the United States, Canada has been struggling to implement its own universal health care system. We talk with Roy Romanow, who was Premier of Saskatchewan from 1991 to 2001.

• Health Canada
• Foreign lessons in hospital efficiency

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JEB SHARP: I’m Jeb Sharp and this is The World.  This was a Canadian Broadcasting Corporation television broadcast from July, 1962.

NOLTON NASH:  Good evening, I’m Nolton Nash and this is another special report on the Saskatchewan Medicare fight.  A fight that has torn Saskatchewan apart in almost unbelievable bitterness and anger.

SHARP:  That summer, doctors in the Canadian prairie province of Saskatchewan, went on strike.  Their grievance?  A new government healthcare program.  It was the beginning of what was a long uphill battle to implement universal health care in Canada. Roy Romanow was Premier of Saskatchewan from 1991 to 2001.  He joins us from Saskatoon, Saskatchewan.  Roy Romanow, you Canadians have been through this uproar already.  Give us a sense of what the rhetoric was like back in Saskatchewan at the beginning.

ROY ROMANOW:  When we listened to the rhetoric going on in parts of the United States, that’s exactly the rhetoric that you heard in Saskatchewan, with the exception thankfully of any reference to violence, physical violence.  But the usual rhetoric, this was Socialism; this was introducing a plan whereby a government bureaucrat would be between you and your healthcare provider.  Freedom, you couldn’t afford it, the quality of healthcare descending and all of those things that are coming across in the United States of America.

SHARP:  Why were the doctors striking specifically?

ROMANOW:  The doctors felt very strongly that the program made them “employees” of a government plan and initially, the idea was to put them on a salaried basis as opposed to a fee for service basis and they argued that once you’re salaried, then by definition you’re an employee of the state.  In fact, the eventual solution came about as a result of the intervention of Lord Taylor from the UK House of Lords, who was brought in as a mediator and they negotiated an agreement whereby the provision on salary was removed but the battle raged on for a number of years after that.

SHARP:  I was going to say.  I mean, was the doctors’ argument about being salaried employees the main argument or was there a much stronger main thrust that was simply anti-government?

ROMANOW:  It was a stronger anti-government thrust, just the notion that a government would be the somehow arbitrator of the delivery of healthcare to people in Saskatchewan.  I attended several rallies and our rallies here were very large by Saskatchewan standards, eight, nine, ten thousand people, so it was a combination but mainly a combination of mainly the argument of politics and ideology and some flaming rhetoric attached to issues of healthcare and the quality of healthcare. The argument which tried to focus on the quality of healthcare was really the weakest and the least pronounced.  The most pronounced was essentially the scare tactics and of course the largest scare tactic was when all the doctors, with the exception I think of three or four, went on a province wide strike so we had no doctors and then we had to bring in UK doctors who rallied to the cause in a humanitarian way and very quickly were processed by the UK government and the Canadian government, in fairness to the Canadian federal government, to come to Saskatchewan to help break the strike.

SHARP:  I do want to help Americans understand what happened in Canada by talking a little bit about the man who drove the change in Canada to a universal healthcare system.  His name was Tommy Douglas.  Douglas was the Premier of Saskatchewan and he launched a campaign in the late nineteen forties to create what became Canadian Medicare. Here’s Tommy Douglas in an interview with the CBC in 1962, explaining why this new healthcare system was needed.

TOMMY DOUGLAS:  Most of these plans, in order to stay solvent, have to eliminate a great many groups of people because of age, because of chronic conditions, because of congenital illnesses, past medical histories and so on and these are precisely the people who need some kind of protection.

SHARP:  That was former Saskatchewan Premier Tommy Douglas speaking in 1962 so again there, you know, we’ve heard these arguments before but what’s it like to hear that old tape and think about what it means now, especially with regards to the United States as opposed to Saskatchewan?

ROMANOW:  Well, before I get to the United States, very briefly, hearing Tommy’s voice, I knew him, I was much younger of course.  Those of us who actually saw that debate and heard the oratory of Douglas and his successor, Woodrow Lloyd, this brings goose bumps because it was a very difficult period, bordering on civil disorder a bit in Saskatchewan but essentially, Douglas’ analysis then is dead right now.  I think Obama is going to be forced to adopt reforms limiting the insurance companies’ capacities to limit or to delist those kinds of people that Douglas identified as having illnesses which do not permit coverage.  That’s what I think the legislation will be aimed at, trying to rectify.  I don’t think it’ll work because there will still be a market system which will be involved in the process and there will be ways and means to get around it.  But this again speaks to the values.  If America could ever adopt an approach that healthcare is a social good, that there’s a communitarian value to this, then of course they would see the elimination, if not complete, largely those categories of people who have been denied, had been denied before Medicare in Saskatchewan and are being denied in the United States of America.

SHARP:  Roy Romanow, are you finding it quite excruciating to watch the debate unfold here from up north?

ROMANOW:  Well I am, actually.  I’ll give you one small anecdotal story.  I was in Ottawa, our capital city, oh four or five weeks ago at a congressional, joint congressional and Canadian conference on healthcare and primarily the American healthcare system.  And we had two representatives from Congress, both Republican and Democrats who were there and I, excruciating may not be the word but I certainly find it very befuddling to hear some of the language that is kicked around.

SHARP:  But why since you, you all went through very much the same thing up there.

ROMANOW:  Yes, I would have thought that you know, history’s a bit of a teacher, that we learn from other countries, the good things and avoid the bad things.  And we can adjust some of the good things to fit our own societies.

SHARP:  In 2004 there was a CBC poll to find the greatest Canadian and the winner was actually this Premier from Saskatchewan, Tommy Douglas, who championed healthcare.  Do you think he’s a hero?

ROMANOW:  He is a hero.  He really struck a nerve, implemented a great program.  He remains a Canadian hero.  Leadership is very important.  Douglas and Lloyd went through fire to implement the Medicare plan.  They were prepared to sacrifice their government and they had the authority of the parliamentary system to do so.  Obama needs to exhibit leadership and a determination to go through fire to have a reformed healthcare Medicare system in the United States.

SHARP:  Roy Romanow, great to have your perspective, thank you.

ROMANOW:  Thank you for inviting me.

SHARP:  Roy Romanow is the former Premier of Saskatchewan.  He’s now the chair of the Institute of Well Being Advisory Board.

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