Second-Stage of Medicare

One of the most important challenges facing the progressive health community is how to frame the debate about health care in ways that will win public support and shift the ways in which health reform is understood.

While there is solid support for the values of universal access and Medicare in Canada, there are also widespread worries about waiting lists, finding family doctors, long-term sustainability of the system, etc.

If the health care system is seen to be in crisis -- if the issue can be defined as unreasonable waiting lists or bureaucratic ineptitude, as conservative proponents attempt to do – then this can open the way for simplistic privatization arguments. Seen this way, the option to allow some people to get their hip replacements done at private clinics can seem entirely reasonable, if it would ease the burden on the over-stretched public system.

In fact, there is solid and consistent evidence that private funding and provision of health care services is far more costly, and results in inequitable access and reduced quality of health care services.

It is important to build arguments that don't ignore current health system short-comings, and build on what we know is working:

• Medicare cannot be defended simply as some kind of defining Canadian icon or immutable value;
• the existing system has great strengths – especially universal access – and the inequitable impact of privatization needs to be highlighted;
• there are significant problems in access and delivery that must be fixed;
• acknowledging these problems and the need to find creative solutions is critical, especially because it is on access bottlenecks and related problems that privatization supporters make their pitch.

We need to couple a vigorous defence of universal access and the basic values of Medicare with a plan to address the health system’s current problems and mobilize around a positive vision of the future.

Tremendous work in fleshing out this vision of the future is being done by the Association of Ontario Health Centres, the Canadian Alliance of Community Health Centre Associations and others in advocating for completing the second stage of Medicare. They remind us that Tommy Douglas and the original founders of Medicare always saw the crucial goals of universal health insurance and access to hospital and medical care as just the vital first steps to a system that would keep people well and not just treat them when sick.

The Second Stage would:

• increase the emphasis on preventing illness and promoting good health;
• develop cross-sectoral approaches to addressing the underlying social determinants of health;
• prioritize reducing health disparities;
• reorganize services to provide them in more flexible and integrated ways such as multi-disciplinary teams, comprehensive clinics, better local and regional coordination, etc.;
• through such delivery changes – and through more democratic governance of health care planning -- ensure more timely, equitable and effective care.

For a discussion paper and other material see the AOHC website [1]. 

[2]