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History: 1968-1978 CONFLICT AND COMPROMISE: CREATING THE MEDICAL CARE AC, 1958–1968 FROM COST CONTROL TO HEALTH PROMOTION: IMPLEMENTING MEDICARE, 1968–1978 SAVING THE SYSTEM: THE CANADA HEALTH ACT, THE OTTAWA CHARTER AND ACHIEVING HEALTH FOR ALL, 1978–1988



Quebec and Medicare

Through the 1960s, as Quebec modernized its social, political and economic systems, it demanded control over areas of exclusive provincial jurisdiction, including health services. In 1965, Premier Jean Lesage made it clear that Quebec would not accept the federal proposal and began to discuss creating the province’s own health insurance program. The defeat of the Liberals in June 1966 and their replacement by a reinvigorated and highly nationalistic Union Nationale under, first, Daniel Johnson (1966–1968) and then Jean Jacques Bertrand (1968–1970) did not alter the push for made-in-Quebec solutions. In August 1967, the release of the first volume of the Castonguay-Nepveu Report echoed findings from the report of the 1964–1965 Royal Commission on Health Services (the Hall Commission) and confirmed that the Québécois did not generally have the same level of medical services coverage or access to the same number of general practitioners and specialists as their fellow Canadians. Not surprisingly, many Québécois, especially members of various unions, the teachers’ federation and the farmers’ association, strongly supported the national plan. Indeed, a January 1968 opinion poll asking Canadians to indicate whether or not they would support increased taxes in order to bring medicare into effect on July 1 informed politicians that 64 per cent of Québécois would support such an increase, compared to 49 per cent of Ontarians and 55 per cent of Westerners. The national average was 55 per cent in support, so citizens were clearly telling their government their views.

Having opted out of the hospital insurance program, the Bertrand government attempted to obtain the same arrangements from the Trudeau administration. But the Pearson–Trudeau transition had marked a change in federal policy. As a result, on March 10, 1970 the Bertrand government introduced a Health Insurance Act that conformed to the federal “principles” and responded to some of the concerns raised in the Castonguay Report. But the Union Nationale was defeated by Robert Bourassa and the Liberals in April 1970, and Claude Castonguay, who had resigned from the Commission of Inquiry on Health and Social Welfare to run for election as a member of the Legislative Assembly, was appointed as the Minister of Health, Family and Social Welfare. The legislation that the Liberals presented to the Assembly on June 25 was based on the previous legislation, but it also contained a provision allowing a maximum of 3 per cent of specialists in any region of the province to opt out of the plan, and indicated that their patients would be reimbursed 75 per cent of the established fees.

Photo: Enter the Guinea Pig
Enter the Guinea Pig

John Collins’ cartoon shows the trepidation felt by the ordinary citizen, “UNO WHO” (You Know Who), as Quebec embarked on its own course towards medicare.
© Library and Archives Canada, Acc. No. 1986-9-574, e008440958. Artist: John Collins.

Transcription:
Medicare
As practised in the rest of the country ...
We’re going to be — different

In Quebec, specialists, who dominated hospital services, medical education and the Quebec College of Physicians and Surgeons, were vehemently opposed to medical services programs. This was true of both Anglophone (Quebec division of the Canadian Medical Association [CMA]) and Francophone (Fédération des médecins specialistes du Québec) groups. In contrast, general practitioners had formed a separate organization, the Fédération des médecins omnipracticiens du Québec, and were willing to negotiate with the province to create a system that would enable them to have access to hospitals and to be paid fees equivalent to those that specialists received for similar services. The situation quickly polarized, as trade union members, teachers and farmers criticized the government’s legislation for leaving too much power in the hands of specialists, while specialists were outraged that their control over the profession was threatened by the dispute resolution mechanism and the proposal to eliminate the fee differential. As citizens enrolled with the Quebec Health Insurance Board (QHIB) in large numbers during June 1970, the tension between the government and specialists grew.

On July 10, 1970, when the Assembly passed the legislation with the opting-out clause removed, specialists concluded that they had no option but to take their case to the public through meetings at hospitals, and by way of pamphlets and books. As had happened in Saskatchewan in 1962, they argued that the government was engaged in a “socialist-communist” attempt to dictate medical practice. As in 1962, such claims were criticized by the press. In La Presse on August 11, 1970, Jean Pellerin commented: “The specialists have a right to get angry but not to scare the people with strike threats.” At a rally at Montréal’s Maurice Richard Arena on August 27, which attracted 4,500 people, including the president of the CMA and one of the vice-presidents of the American Medical Association, 98.5 per cent of the specialists present voted in favour of strike action. Such a contestation had succeeded for radiologists in 1967 but, by 1970, specialists had become isolated from other potential supporters, and when they began their strike on October 1, the public was less interested in specialists’ self-preservation and more interested in the government’s new classification system for doctors and the fate of the continuing negotiations. The new system allowed for three categories: les engagés, who were full participants; les désengagés, who did not join but agreed to charge no more than QHIB fees and whose patients would be fully reimbursed; and les non-participants, who did not join, set their own fees and whose patients would receive no reimbursement from the QHIB.

As the number of specialists refusing to provide services grew, the province was plunged into the October Crisis. The kidnappings and murder carried out by the Front de Libération du Québec occurred as the Bourassa government was attempting to find a solution to its conflict with specialists. On Thursday, October 15, a marathon 12-hour session of the Legislative Assembly finalized the implementation of medicare, set November 1 as the date of introduction and legislated specialists back to work. This episode illustrated the clash between professionals’ perceptions of their role and the government’s responsibility to legislate for the benefit of all citizens.



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    Date Created: March 31, 2010 | Last Updated: April 21, 2010