They Said Medicare for All Wouldn’t Work in Canada, Too

The bitter mid-20th century struggle waged by Canada’s socialists to achieve single-payer health care holds lessons for Americans today: all the predictions of disaster we hear today were made back then — yet Canadian Medicare is now the country’s most widely cherished institution.

The CN Tower and the Skydome highlight the Toronto skyline in his undated file photo. Carlo Allegri / Getty

As Medicare For All has taken center stage in the American political debate, so too have bad arguments against it. Even as poll after poll demonstrates its remarkable staying power in public opinion, politicians in both parties have remained resoundingly hostile to the idea of a universal, single-payer health care model, raising familiar concerns about costs, tax increases, feasibility, and the supposed threat to individual “choice.”

Such arguments are a direct outgrowth of a concerted (and well-funded) industry effort that aims to suffocate Medicare For All in the court of public opinion before it ever has a realistic chance of passing through Congress as legislation.

But there’s another genre of opposition, coming primarily from liberals, that claims that unlike countries like Canada or France, the United States is uniquely ineligible to achieve a single-payer model because in this country it would face determined opposition from entrenched health care industry interests. In other words, that the chances of Medicare For All legislation ever passing are so low there’s simply no point in trying.

A real, if subtle implication here is that countries that do have universal public health insurance managed to secure it thanks to the absence — or, at any rate, dearth — of comparable political opposition.

This argument is nonsensical to anyone familiar with the history of Canada’s fight for Medicare, which reached a climax in the small prairie province of Saskatchewan some fifty-eight years ago. Despite Saskatchewan’s comparatively tiny size, strongly rural character, and nearly six decades of intervening time, virtually every dynamic of the current American health care debate was present in what became the decisive struggle in the effort to win health insurance for every Canadian citizen as a right. This naturally extended to the arguments against socialized medicine deployed by industry groups, hostile newspapers, and political opponents alike — all of whom worked overtime to portray it as a costly and mortally dangerous endeavor that would inevitably hurt patients, doctors, and taxpayers.

The ultimate outcome of this struggle is better remembered than the details of its history.

Staving off fierce resistance, Saskatchewan’s pioneering pursuit of universal public health insurance soon found an analogue in federal legislation in the form of the 1966 Medical Care Act: a bill that laid the foundation for Medicare as it exists today. The fight for a truly universal health care system, of course, remains unfinished. Having been created in the 1960s, Canadian health insurance does not extend to dental, drug, or psychiatric services, all of which are covered through a messy patchwork of publicly subsidized and private plans (if covered at all). Nonetheless, the political consensus around nationalized health insurance remains close to impregnable. Poll after poll has demonstrated Medicare’s enduring popular support over and against the expansion of private options and universal health care has become deeply interwoven with Canada’s civic identity as a whole. As doctor and medical historian Louis Horlick put it in 1999:

Medicare is considered to be the most valued social programme in Canada today. Canadians have rated it as their most important concern, ahead of programmes in employment and social welfare … [it] is an essential part of Canada’s national identity and part … of what it means to be Canadian.

At around 10 percent of GDP, Canada spends far less per capita on its universal system than the United States (where spending is nearly 18 percent of GDP) even though millions remain beset by high medical costs or even uninsured. In a particularly cosmic irony, public health care spending is actually lower than its US equivalent.

The existence and endurance of universal health care in Canada is a testament to the longevity of gains won through popular struggle. As Saskatchewan’s formative battle demonstrates, there was no “incremental” route to the same outcome or alternative path that would have precluded the inevitable bitter opposition. Seen in relation to America’s health care debate today, the major lesson it offers is both elegantly simple and glaringly obvious: as a socialist government voted into office by farmers and workers attempted to carry out its election promise of extending health insurance to every person in Saskatchewan, a well-funded coalition of private interests responded with an aggressive campaign of fear-mongering and disinformation.

Without exception, every objection it raised in relation to the plan — from its ostensibly punitive cost to its supposed destruction of personal choice — turned out to be untrue, and Medicare quickly became a cherished national institution.

Coming to power in a landslide 1944 victory that saw it capture forty-seven of fifty-two seats in the Saskatchewan legislature, the Cooperative Commonwealth Federation (CCF) represented the first socialist government elected anywhere in North America. Winning reelection some four more times, it would stake the bruising campaign of 1960 on one of its most transformative proposals to date: a universal, single-payer system of public health insurance. As CCF member and health minister Alan Blakeney would later reflect, the election largely became a one-issue fight and would represent the most bitter he would ever experience throughout a decades-long career in politics. In Blakeney’s words:

What made it so hotly contested was the intervention of the organized medical profession. Operating under the name of the College of Physicians and Surgeons, they spent more money on electronic and print media than any political party. Their campaign was aimed against the Co-operative Commonwealth Federation government of Saskatchewan.

The issue proved so contentious and the campaign against the government so fierce that popular former premier Tommy Douglas — who had recently entered national politics to lead the newly created New Democratic Party (NDP) — even lost his Regina City seat in the federal election of June 1962. The critical moment came when the government moved to extend existing hospital insurance to doctor visits in the form of the Saskatchewan Medical Care Insurance Act. As Sarah Kliff explains:

There was no comparable insurance scheme for doctor visits, which meant that patients could still end up with a significant bill from the doctor who saw them in the hospital. Some doctors did participate in smaller, publicly-run health plans that cities offered, but many found it more lucrative to accept private payments from wealthier clients.

It was a bridge too far for private interests. On July 1, 1962, Saskatchewan enacted the first universal public health insurance scheme in North America. Its doctors would strike the very same day. Both before and during the strike, the campaign against the government and its proposal was a rhetorical carbon copy of the one against Medicare For All today.

Some doctors warned of placing “control of medicine in the hands of the government and its appointees.” An emblematic pamphlet produced by the Canadian Medical Association labelled the plan “Political Medicine” and warned, among other things, of “red tape, bureaucratic control, high costs, and inferior medical care” charging that “The Provincial government through government employees, would make decision seriously affecting you the patient, and the doctor” and suggesting a voluntary insurance program as an alternative. “The government,” the pamphlet read, “proposes a permanent, inflexible, government scheme” funded by “direct compulsory taxation” on every family.

A 2012 retrospective on the struggle for Medicare aptly summed up the general ugliness of the campaign against universal public health insurance, which predictably devolved into hyperbole and red scare paranoia:

It was the most polarized Saskatchewan battle of the 20th century and it divided the population into warring camps which brought the province to the brink of a civil war. The campaign, which included most of the local media, was based on outrageous lies about the intent of Medicare, racial slurs, red-baiting, acts of violence and threats of blood in the streets. One of the most infamous statements was made by the right-wing priest Athol Murray to an anti-Medicare rally, broadcast by radio to thousands more: “This thing may break into violence and bloodshed any day now, and God help us if it doesn’t.”

The government ultimately refused to back down and the strike, despite its ferocity, lost momentum as the weeks wore on. A July 11 rally in front of the provincial legislature drew a mere 5,000 instead of the predicted 20,000 as public opinion began to turn. Twelve days later the Saskatchewan College of Physicians and Surgeons agreed to end the strike, winning only minor concessions in exchange. Against all odds, the CCF had prevailed.

From overall cost to ease of use and availability of care, the universal health care system made possible by North America’s first socialist government remains superior to the American model in every imaginable way. Despite decades of campaigning from right-wing think tanks and interest groups, its popularity has remained robust enough that any politician who embraced the rhetoric currently favored by mainstream Democrats in the United States would handily lose a federal election in Canada. Only a fool would try.