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If you think our fight for affordable universal health care with a public option is difficult, you should know something about what Canada went through. Or, more accurately, Saskatchewan, the first province to implement what has become known as the Canadian Health Care system. Or, as they call it, Medicare. For all.

In Saskatchewan, instead of having a large number of doctors in favor of such a plan, about 90% of the doctors actually went on strike in protest. A bitter strike that lasted from July 1, 1962 to July 23, 1962.

And in the end the plan started by Tommy Douglas and implemented by his successor Woodrow Lloyd, who faced tremendous pressure to withdraw the plan, was popularly adopted, with some provincial adpatations, over the whole of Canada within ten years.

And there lie a couple of things I think we can learn.

Canada went through a long gestational process in their eventual progress to a universal single payer system. It started with the Union Hospital Acto of 1916, took a giant step with Governor Tommy Douglas' Saskatchewan Hospitalization Insurance Plan (SHIP) in 1946, and made the big leap with the implementation of the-Premier Tommy Douglas' "Saskatchewan Medical Care Insurance Act" in 1962, and inevitably led to the current system of universal single payer, Medicare, by 1972. Since then there have been several rounds of finetuning. History source.

The initial implementation in Saskatchewan was a bitter fight, basically over money. Doctors wanted to maintain fee-for-practice, while the government wanted payment by salary. The public even got involved, similar to the way the Tea Baggers are now, organizing "Keep Our Doctors Committees":

In Regina, a group of mothers formed a committee to support their doctors. Similar committees were organized throughout the province, encouraged by doctors and joined by political opponents of the government. These KOD (Keep Our Doctors) Committees, with support from the media, launched a well-organized campaign against the government and the medicare plan. Rallies, petitions, panels and advertisements raised the emotional climate to a white heat.

On 1 July 1962, when the Act came into force, most doctors closed their offices, some took holidays or educational leave, while some staffed emergency centres. A few left the province for good. The Medical Care Insurance Commission brought doctors from Britain and encouraged others to come from the US and other parts of Canada to meet the emergency. Local citizens groups organized medical clinics and hired doctors to attend them.

By mid-July much of the KOD support had dissipated. Some doctors were returning to work; the force of the strike was spent. Lord Taylor, a physician who had been active in introducing Britain's health-care scheme, was brought to Saskatchewan by the government. He acted as mediator and the 2 sides signed an agreement in Saskatoon 23 July 1962. Source

At this point notice two key things: 1) the doctors were not in support of the plan, unlike the majority of doctors today, and 2) it was not universal, it was only implemented in one province and fully funded by that province.

Now keep in mind Senator Cantwells' amendment to allow a Medicare-type program with states option, where those states that want it can get it (with federal funding help) and those who don't want it have that choice.

My guess is that about 40 states will buy-in. And the rest will follow in the next few years.

OK--just got the call I've been waiting for and have to head to a meeting over my new office. Be back soon.

Originally posted to bewert on Mon Oct 05, 2009 at 11:43 AM PDT.


Your least acceptable public option

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Comment Preferences

  •  Tip Jar (18+ / 0-)

    "I have no special talents. I am only passionately curious." A. Einstein

    by bewert on Mon Oct 05, 2009 at 11:43:29 AM PDT

  •  What a lot of people don't quite understand.... (7+ / 0-)

    about the Canadian system is that although it is Federally administered, it is managed by the local provinces.  So each province has a certain amount of control in how the Federal money is spent.

    So some provinces have better systems than others.  There are differences in emphasis etc.

    It seems to work reasonably well.  It only makes sense that the provincial gov't would know how to spend the $'s in the province better than the federal gov't.

    In the US you already have the cancer of private insurance so you have quite a mess to work out with the cancer fighting back every inch of the way!

  •  The American Medical Association (4+ / 0-)
    Recommended by:
    bewert, Pris from LA, Lazar, smallgal

    ...supported the striking doctors, and had already spent many thousands fighting Medicare in Saskatchewan. It is said they would later spend $1 million fighting the spread of Medicare in Canada.

    Doctors in Saskatchewan at first backed the hospital scheme, but later soured on the notion of government involvement in what they saw as their turf. The biggest stumbling block to their acceptance was the long-standing concept of fee-for-service. The government conceded on this point, but control was something it couldn’t give up.

    Douglas called the doctors’ bluff by making medicare the key issue in the June 1960 election. "The people of this province will decide whether or not we want a medical care program," he said. In retaliation, the doctors raised a war chest of $100,000, much of it donated by the powerful American Medical Association, and launched a massive advertising campaign that claimed the CCF planned to put doctors on salary, that doctors would leave the province en masse and that the government would bring in "the garbage of Europe" to fill their shoes.

    Here we are now Entertain us I feel stupid and contagious

    by Scarce on Mon Oct 05, 2009 at 12:02:33 PM PDT

  •  thank you for the encouragement (3+ / 0-)
    Recommended by:
    bewert, Pris from LA, Lazar

    I hope other countries haven't forgotten how hard it was for them to get universal health care enacted. There's a lot of people fighting against reform, and it will take a lot more than one bill to do it right.

    In a democracy, everyone is a politician. ~ Ehren Watada

    by Lefty Mama on Mon Oct 05, 2009 at 12:05:17 PM PDT

  •  Reagan Speaks Out Against Socialized Medicine (3+ / 0-)
    Recommended by:
    bewert, Pris from LA, Lazar

    From the 1961 Operation Coffee Cup Campaign against Socialized Medicine as proposed by the Democrats, then a private citizen Ronald Reagan Speaks out against socialized medicine. There is no video because this was an LP sent out by the American Medical Association

    Thousands of these were sent up to Canada and given away to Doctors.

    Here we are now Entertain us I feel stupid and contagious

    by Scarce on Mon Oct 05, 2009 at 12:09:55 PM PDT

  •  Nice work, as always bewert. (2+ / 0-)
    Recommended by:
    bewert, Pris from LA

    I've been searching - forever - for a wonderful quote by a woman who, I believe, was one of the prime movers in the fight for the Medicare system. She noted how naive Americans were, simply expecting Congress to pass a law completely revamping the current set-up and brushing special interests aside; she noted how the Canadians had needed a grass-roots, long-term effort, replete with failures and successes, before they attained real reform.

    It was one of the most thoughtful cautionary notes I've seen on the problem. Would kill to find it. Ring a bell?

    Slap it. Shoot it. Kaboot it.

    by adios on Mon Oct 05, 2009 at 12:15:33 PM PDT

    •  No, but I do have a quote from a strike leader (1+ / 0-)
      Recommended by:
      Pris from LA

      This is from a fasinating interview with Dr. E. W. Barootes, who led the Doctors Strike with Dr. H. S. Dalgleish--Source:

      So, if we were to adopt a similar health care system here, what might Bob Dole and other vocal opponents to comprehensive health care reform be saying in the year 2025, thirty years after implementation of the plan?

      Dr. Barootes observes, "Today a politician in Saskatchewan or in Canada is more likely to get away with canceling Christmas than he is with canceling Canada's health insurance program."

      "Thirty years ago, when you were describing the Saskatchewan Medical Insurance Act as 'legislation reversing the civil rights and liberties of citizens,' did you ever think you would hear yourself saying that?"

      "At that time I'd rather have cut my arm off."

      This site also has an amazing amount of information. I was looking for it earlier but didn't have access to my bookmarks:

      Scans of old newspapers and actual documents written by the doctors leading the strike.

      I may try to flesh this subject out even more for a new diary tomorrow, as I think it brings an important perspective to our fight.

      PS Thanks for the kind words.

      "I have no special talents. I am only passionately curious." A. Einstein

      by bewert on Mon Oct 05, 2009 at 02:07:39 PM PDT

      [ Parent ]

  •  Maybe it was this guy's (2+ / 0-)
    Recommended by:
    bewert, Pris from LA


    Shirley Douglas?

    "you can lock up a mouse or a man but you can't lock up an idea"....Tommy Douglas

    by marigold on Mon Oct 05, 2009 at 01:39:21 PM PDT

  •  Good history, recommended. (2+ / 0-)
    Recommended by:
    bewert, Pris from LA

    I only take issue with your sentence that:

    My guess is that about 40 states will buy-in. And the rest will follow in the next few years.

    Problem is our states are too broke, too influenced by the insurance lobbies, and too many Republican states for that to happen. The result would be patchwork plans in different states, underfunded health care, and other shenanigans that won't cut the mustard and leave us all with poor access, unaffordable care, denied care, and other nonsense.

    •  I don't agree (1+ / 0-)
      Recommended by:
      Pris from LA

      I think done right, a system could be set up allowing whatever states that wanted to to opt-in (or even better, have to opt-out) to a system with significant seed funding from the federal government. Baucus has proposed a $6B seed fund for coops already. The program would be something like Medicare + 5%. It would be available via the exchanges. Whether to all, or just the uninsured/self-employed is a big question.

      The blue states, including California, New York, etc. would opt-in. By far the largest population areas heavily support a public option. States like Alabama and Georgia would not be affected, taking away one of their arguments against a public option. The large states opting in would give us a sufficiently large pool to make it workable. This is key.

      Premiums would be income based, and a mandate could be included, with the mandate penalty equal to the minimum premiums.

      "I have no special talents. I am only passionately curious." A. Einstein

      by bewert on Mon Oct 05, 2009 at 02:19:19 PM PDT

      [ Parent ]

  •  but canadians didn't have 1000 radio stations (1+ / 0-)
    Recommended by:
    Pris from LA

    blasting lobbyist talking points 24/7/365

    ignoring the talk radio monopoly continues to be the biggest political blunder in decades

    by certainot on Mon Oct 05, 2009 at 02:08:37 PM PDT

    •  They had pleny of media against it (1+ / 0-)
      Recommended by:
      Pris from LA

      Go here, it's fascinating:

      Medicare was a people’s issue. But was it also a violation of rights and freedoms? Would there even have been a Medicare Crisis without the press? From its roots to the crisis to its resolution, this intriguing chapter from our past is deserving of our historical attention.

      It's a series of pages, with a lot of historical docs, from the Saskatchewan Archives.

      "I have no special talents. I am only passionately curious." A. Einstein

      by bewert on Mon Oct 05, 2009 at 02:22:07 PM PDT

      [ Parent ]

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