Health Insurance and Canadian Public Policy, 2nd edition

This second edition is introduced lucidly and insightfully by Allan Maslove, Carleton University, who summarizes the book and concludes with two excellent points about its relevance to today’s debate about health care. Everyone interested in health care, including those who teach and do research in that field, will find this book very useful. The general public should be interested in the reissued book as they will discover just what a precious public policy medicare is. But they may be left with a question: How could there be so much dissension and acrimony today over medicare when elected representatives a generation ago voted unanimously to support it? This book will enable readers to identify the culprits. Not only is there a wealth of valuable data in Health Insurance and Canadian Public Policy that is still relevant, but the way Taylor presents the struggle for prepaid health insurance is as fascinating as it is informative. Until one reads about the infighting, and the difficulties reformers faced in order to get what we call medicare, we have no idea of the miracle that has come to pass.

The author traces the process from 1919, when health insurance was a plank in the Liberal Party’s platform, through the developments in Saskatchewan, which pioneered the municipal doctor movement, followed by the first universal hospital insurance plan in North America in 1947 and medical insurance in 1962. Then there were the efforts of the federal government, during the Second World War years and shortly after, to produce a plan that the provinces might like (but didn’t), and the Royal Commission on Health Services, which reported in 1964, recommending national prepaid medical insurance—all of which set the stage for some of the most interesting drama that could have been conceived. Ego-driven provincial premiers and disagreements within the federal Cabinet threatened to scuttle the whole thing, but finally, in December 1966 the Medical Care Insurance Act was passed in the House of Commons, practically unanimously.

Taylor refers to the health charter that Emmett Hall, chairman of the Royal Commission on Health Services, had insisted on placing at the beginning of the report. The charter refers to the “enormous gap between our scientific knowledge and skills on the one hand, and our organizational and financial arrangements to apply them to the needs of men, on the other,” and recommended that the gap be closed

through the full cooperation of the general public, the health professions, voluntary agencies, all political parties and governments, federal, provincial and municipal, directed towards the most effective use of the nation’s health resources to attain the highest possible levels of physical and mental well-being.

(p. 343)

The reader will have noticed the word cooperation in the health charter. Hall, evidently, had no doubt that there would be cooperation, after he had talked to so many people and read a multiplicity of briefs during the three years that the report was in the making.

Dead wrong! Organized medicine and the insurance industry have been anything but cooperative, and that probably explains, as much as anything, why provincial governments across the country have had to take a bureaucratic, rather than a cooperative approach, to the dispensing of health services.

Taylor, who died in 1994, discusses the developments in medicare since his first edition (1978), including the second Royal Commission that Hall undertook in the early 1980s, in which he himself was involved. (Taylor left the Commission soon after it got started, presumably because of the completely unrealistic time frame to meet the terms of reference.) He does an excellent job of presenting that Commission’s findings, including the explosive response from organized medicine. The 1962 Saskatchewan strike seems benign, he says, compared to the length and bitterness of the 1986 Ontario doctors’ strike. Taylor’s assessment of the behaviour of organized medicine in all this is interesting.

Back in 1943, in what Taylor describes as organized medicine’s finest hour (p. 46...