Achieving Public Medicare & the Canada Health Act

The printable version of the fact sheet (linked below) presents the following events in a timeline.

1947: The first public hospital insurance plan in Canada was introduced by the Saskatchewan government led by Tommy Douglas.

1957: The federal government, with Paul Martin Sr. as Health & Welfare Minister, introduced the Hospital Insurance and Diagnostic Services Act (1957) that brought in public hospital insurance across the country. The funding arrangement was that the federal govt shared half the cost of provincial/territorial hospital insurance plans. It faced strong opposition from pro-privatization forces wanting to bill patients directly (doctors, insurance companies, and large corporations).

1959: Ontario created a public provincial hospital insurance plan.

1961:

• All provinces and territories had implemented a public hospital insurance plan.

• In 1961, Saskatchewan passed legislation to expand their Medicare program to cover physician care outside of hospitals(e.g. doctors’ offices), prompting a three-week strike by doctors who wanted control and wanted to be able to extra-bill patients. The government held strong and brought in Public Medicare but with amendments allowing doctors to opt out of the plan. By 1965, once it was in operation, the majority of doctors supported the plan.

1964: The federal Diefenbaker government’s Royal Commission on Health Services led by Justice Emmett Hall called for national Public Medicare.

1966: The Medical Care Act (1966) was passed so that doctors and medical care would be covered for all Canadians (not just in hospital). The federal govt would share half of the cost with the provinces/territories.

1972: Each province and territory had implemented Public Medicare plans for hospital and physician services.

1984: In response to doctors extra-billing patients (charging patients extra user fees on top of OHIP/the provincial public health plan), the Canada Health Act was passed, establishing five principles for our health care system and banning extra-billing and user fees.

5 Principles of the Canada Health Act:

• • Portability: Health coverage must not end or stop when a person travels or moves between provinces/territories in Canada.
  • Accessibility: All insured individuals must have reasonable access to health care without barriers, such as financial or physical limitations.
  • Universality: All Canadians must be covered by Public Medicare on equal terms and conditions.
  • Comprehensiveness: All medically necessary hospital and physician services must be covered, even when the services are provided by another designed health professional.
  • Public Administration: Provinces and territories must operate their health insurance plans on a non-profit basis. They must also be administered and operated by a public authority.

1995: The federal Chrétien government with Paul Martin (Jr.) as Finance Minister, brought in major cuts in the federal budget. The Canada Health and Social Transfer (CHST) combined funding for health, education and social services into one block fund and they cut federal health transfers by 40%. These cuts, combined with provincial cuts, led to the expansion of private clinics.

2002: The Romanow Report called for the creation of the Canada Health Transfer (CHT) that would separate out health funding from other federal transfers and an escalator clause in the CHT to match inflation.

2004:

• Ontario’s Commitment to the Future of Medicare Act was passed to uphold the Canada Health Act. It bans extra-billing, user fees, queue jumping, and restricting access to insured services through block or annual fees. It sets out fines and jail terms for offenders who accept payment for an OHIP-covered service and requires the Ministry of Health to reimburse patients for unlawful extra-billing and user fees.

• The 2004 Health Accord introduced a 6% escalator for the CHT to offset the huge cuts made in the 1990s – although privatization had already gained a foothold. It also increased the federal share of health funding, not back to the historic 50-50 split with the provinces, but back to the 20% range (varying among provinces).

2006: The election of the Harper government halted progress as they sought to remove themselves from health care policy and refused to attend First Ministers’ meetings.

2011: The Harper government announced cuts to the funding formula that governed CHT increases by tying them to changes in GDP with a floor of 3% starting in 2017, eliminating the 6% escalator agreed upon in the 2004 Accord. The impact was estimated by the provinces to be a reduction in federal public health care funding by $36 billion over ten years compared to what provinces would have received under the 6% escalator.

2016: During the 2016-17 Health Accord negotiations, the Trudeau govt only minimally modified Harper’s cut to the funding formula. After the provinces and territories rejected their proposal, the Trudeau govt left the negotiating table. They then went province-by-province pushing through 10-year bilateral deals (that means different deals between the federal government and each province) to pressure all the provinces and territories into adopting the proposal.

2022: Legislation to implement a national dental care insurance plan was passed. However, the federal govt contracted a private insurance corporation (Sun Life) to administer the plan.

2024: The Pharmacare Act was passed in October 2024 to create a national pharmaceutical insurance plan, starting with coverage for contraceptives and diabetes medications.