Critical look at medicare reflects 100-year-old and contemporary Canadian conversations

Medicare, the publicly funded social program for which Canada is arguably best known, is entering its second half-century, and its cracks are showing. Medicare works differently in the country’s diverse communities, with social inequities and inadequacies becoming clear, particularly during the COVID-19 pandemic.

In Medicare’s Histories: Origins, Omissions, and Opportunities in Canada, leading social and health historians explore medicare’s roots, development, and current state, including missed opportunities, while also telling stories of specific needs for reform and the essential roles of those who are advocating for these reforms.

“Medicare’s past and present is rich, contested, complex, and in part problematic. Its origins were more diverse than we often imagine (it wasn’t just Tommy Douglas), and its initial incarnation privileged treatment over prevention. Even that was powerfully shaped by hierarchies of race, gender, and ability, among others,” say the editors, Esyllt Jones, James Hanley, and Delia Gavrus, who responded collectively to interview questions.

Medicare’s Histories is the first edited collection on the history of Canadian medicare written entirely by historians. The editors are all history professors specializing in health care: Jones at the University of Manitoba, and Hanley and Gavrus at the University of Winnipeg. Sixteen other scholars from across Canada were enlisted to cover critical aspects of health care and how medicare policy has shaped that care.

While this book is by no means comprehensive, it does present critical perspectives not widely considered before. “The collection as a whole tells a dynamic new story about professional and public engagement in medicare history. It’s not a celebration – it’s a critical look, but it also speaks to the depth of the conversation Canadians have had about medicare for nearly a hundred years,” say the editors.

While medicare historically failed to include critical components such as dental coverage and pharmacare, excluded Indigenous people, and did not foreground public and preventive health, its failures have served as a catalyst for further action. The editors say, “Medicare has been a powerful instrument of social welfare, and its limitations and exclusions led to ongoing social movements to advocate for a more equitable vision of physical and mental well-being.”

These social actions include popular and grassroots advocacy, Indigenous court cases, and broader civil rights and social justice movements in Canada. “Several of the chapters highlight the power and importance of these popular mobilizations,” the editors note.

Contributors to the book also explore the role that professional organizations (of doctors, nurses, dentists, allied health-care professionals) have played in shaping this history. “Nurses, for example, have been at the heart of policy debates about medicare,” the editors say.

Medicare is, as the editors write in the introduction, “a flawed project – one that needs more work,” and with various provincial moves towards privatization and underfunding, people need to demand improvements.

“Continued public and professional engagement in health care is as urgently required today as yesterday,” the editors say about the book’s overall message.

“The coronavirus pandemic has powerfully illustrated some of the strengths and weaknesses of Canada’s health-care system, and we hope that a better medicare can be a result.”