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Health-care promises born of war need to be fulfilled

Posted on November 13, 2012

Globe and Mail / Andre Picard / November 12, 2012 —

As the poppies move from lapel to dresser, let’s not forget that the contributions of veterans extend well beyond the battlefield. From the first state-run hospitals built to care for returning First World War soldiers to the creation of a federal Department of Health and the first attempt at national insurance, the genesis of publicly funded health care in Canada can be found in the response to war. But in an extended period of peacetime, our health-care system has largely been frozen in time.

The conditions in which the First World War was fought were gruesome. During the conflict, more than 60,000 Canadian soldiers died and another 160,000 were gravely wounded, many suffering amputations and disfiguring wounds.

During the war, the federal government temporarily took over 11 hospitals for the care of returning soldiers. And it built the first state-run hospital – the Ste-Anne veterans hospital in suburban Montreal – one of what would become a network of military hospitals, rehabilitation centres and nursing homes.

At the time, health care was paid out of pocket or provided as a charitable act by religious orders. There was no insurance, private or public. As such, the ongoing care of veterans was a volatile political issue.

When the Conservative government introduced conscription in 1917, it sought the support of the opposition Liberals. They backed the measure with two key conditions: the assurance that veterans would get free medical care and the creation of a federal Department of Health.

The first act of the Department of Health was to fund programs to tackle tuberculosis and venereal diseases, two of the biggest public-health challenges of the time. But soon it would be overwhelmed by the challenge of Spanish flu, a global epidemic that would eventually kill more than 50 million people, including more than 50,000 in Canada.

At the end of the First World War, the government also instituted the first-ever income tax to pay off debts incurred in the war effort. (Yes, it was supposed to be temporary.) Despite our whining about taxes, we should not forget that redistributing income – as a progressive income-tax system allows – has a greater impact on population health than any medical intervention.

In 1919, in response to the war (and the fact that Canada’s child-mortality rate hovered around 20 per cent), the first “national sickness plan” – a public insurance program – was proposed.

That debate dragged on for decades but, in the meantime, a number of provinces, notably Saskatchewan, Alberta and British Columbia, adopted various public insurance programs and subsidized health care, particularly for children, that would eventually morph into what we now call medicare.

Fast-forward to the Second World War. During that drawn-out conflict, there were dramatic advances in battlefield medicine, notably the development of freeze-dried plasma, which would change surgery forever. And it is in those years that the concept of universal health care took hold in virtually all Western democracies.

In Canada, the notion that returning soldiers would get health-care services was a given, but the debate soon expanded. Ian MacKenzie, the minister of pensions and national health, argued that all Canadians – not just soldiers – deserved something special in return for the sacrifices they made to support the war effort. He became one of the first to push for national – not provincial – health insurance.

In 1942, prime minister William Lyon Mackenzie King signed the Atlantic Charter, a document that called for a postwar world free of hunger, disease, unemployment and war. It was a utopian vision, but upon his return from the signing ceremony, the PM created an advisory committee on health insurance. Months later, in Great Britain, Sir William Beveridge published his landmark report advocating the creation of a national health service, one that had a lot of resonance in former colonies such as Canada.

In 1943, Mackenzie King was presented with a draft health-insurance plan and made the provinces an astounding offer: Ottawa would pay all medical (hospital and physician), dental, pharmaceutical and home-nursing costs if, in return, they would agree to a national health-insurance plan and surrender their taxation powers.

The provinces balked, largely on constitutional grounds. So, to this day, the postwar dream of creating a truly universal health-insurance program that covers more than just physician and hospital care remains unfulfilled, and the structure of our health system has failed to keep pace with the needs of the population.

Yet the need to do more, to do better, is all the more evident with each passing year, particularly with the aging of the population, notably the baby boomers born in the period of postwar euphoria.

On Remembrance Day, you could see that need in the lines etched in the faces of the veterans who paraded proudly in cities and towns across Canada.

It is a shame that we seem to have forgotten that their contributions extended well beyond the battlefield, into shaping public policy. And doubly shameful that we have left promises made to their generation unfulfilled, notably the promise of a medicare system worthy of the sacrifices at the root of its creation.