Edited by Esyllt W. Jones, James Hanley and Delia Gavrus
UNIVERSITY OF MANITOBA PRESS
2022/$31.95/392 pp.
Healthcare coverage in Canada has never been universal or comprehensive, and our health system’s connection to the causes and cures for ill health is limited. That’s the message of this informative, if unintegrated, set of essays about the history of Canadian medicare.
In “Medicare Unfinished,” Catherine Carstairs notes that 33 per cent of Canadians either never visit dentists or fail, for financial reasons, to get full required treatment. Not coincidentally, 32 per cent of Canadians lack dental insurance. Access to pharmaceuticals is also far from universal. These exclusions partially explain why Indigenous people, who allege treaty promises for full health coverage, have fought continuously for separate, federally provided coverage rather than inclusion under porous provincial programs that often offer negligible service to remote communities such as reserves.
Much of what medicare does cover is gobbled up by physicians’ earnings. A scathing piece by hematologist and medical historian Jacalyn Duffin takes aim at “noisy” groups like the right-wing Coalition of Ontario Doctors, who she says are “not advocates, except for themselves.” Refusing to reveal their incomes, they demand a return to privatization and inequality. By contrast, as other essays suggest, less powerful, female-dominated groups within healthcare, including nurses and speech therapists, have faced pushback from doctors in attempts to make the system accommodate needs they have discovered from their greater hands-on experience with patients. In terms of the creation of medicare, however, Kathryn McPherson, a historian of nurses, sidesteps the past refusal of the nursing profession to call for a universal public system, something social workers and the trade union movement demanded publicly. Today nurses are prominent advocates for equality, but their long-time struggle for greater recognition, while important in feminist terms, does not negate that they once believed their position too precarious to demand equal access to medical services for all Canadians.
Calls for more expansive understanding of the components of healthcare, beyond the physician care and hospitalization embedded in current medicare programs, are many. That system, until recently dominated by male physicians, removed midwives from the birthing process. In rural, remote and northern communities, disproportionately Indigenous, that meant local and in-home services became rare. Whitney Wood documents struggles by Indigenous women to regain community control over births. Other essays underline the discrimination that people with disabilities requiring assistive devices and the elderly requiring home care have endured in a system built around hospitals and doctors’ offices. Unfortunately the piece on home care by Megan Davies zeroes in on British Columbia’s haphazard system and ignores Manitoba’s excellent universal public system, from which my late parents benefited.
Focusing on social determinants of health, Esyllt Jones and Aaron Goss recount feminist and social democratic efforts of the 1930s to 1950s to create a version of socialized medicine in Saskatchewan in which patient voices would balance those of medical professionals. Despite their democratic principles, such groups generally harboured colonialist views of Indigenous people and understated the role of social class in determining health outcomes. Strangely, the authors seem unaware that the Saskatchewan doctors’ strike of 1962 was in good part an effort to prevent community health clinics from becoming the model for medicare. Finally, Erika Dyck’s incisive analysis of medicare’s underplaying of mental health issues and their social underpinnings poignantly challenges a short-sighted healthcare emphasis solely on physical ailments and physician knowledge.
Alvin Finkel is the author of 13 books, including Compassion: A Global History of Social Policy (2019).
