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Professor Gordon Guyatt, MD, MSc, FRCP, OC is a Distinguished University Professor in the Department of Health Research Methods, Evidence and Impact and Medicine at McMaster University. He is a Fellow of the Canadian Academy of Health Sciences.
Here we talk about the start of national healthcare coverage for Canadians.
The conversation went into the beginning of the national healthcare coverage in Canada. Dr. Gordon Guyatt described how the program was a national hospital insurance program and began in the late 1950s.
He stated the big change came from the bringing in of the physician services under the national program. We call this Medicare. The Premier of Saskatchewan in the early 1960s, Tommy Douglas, made the provincial program cover the physician services.
“The physicians were very unhappy. There was a physician strike. They had to bring in people from England to fill in the gaps, but, eventually, the physicians lost that battle. There was a Medicare program for physicians’ services in Saskatchewan,” Guyatt stated, “It is for this reason that some people see Douglas as the father of Canadian Medicare. A few years later, the Pearson government passed legislation that enabled the national Medicare program that we have. Now, medicine, medical services, in Canada are a provincial responsibility, so that the federal government could not bring in their own program.”
There was a need to persuade the other provinces of the need for the program. That the program meets the federal standards. The incentive was if the program met a minimum standard then 50% of the cost would be paid. It was a “very enticing” carrot for the provinces.
By the late 1960s, legislation was being passed and by 1971/72 the rest of the provinces bought into the deal. “Now, we have effectively national public insurance for physicians as well as hospital services. Canadians have been the beneficiaries,” Guyatt opines.
Healthcare may be less important to young people than to old people because young people tend to be healthier than old people. Young people develop illnesses with, at times and unfortunately, fatal or seriously injurious consequences.
“If you want a picture of the difference, you would only have to look south of the border. You come from a high-income family. Your parents in the States have probably purchased insurance from you, or can pay if you have problems,” Guyatt explained, “If you are low income or middle income, and not fully insured, which would be the case for a lot of young people who say, ‘Okay, I am low-risk. Why should I pay these very high insurance costs?’”
You are in big trouble. That is a worry and a burden that you are free of in Canada. It makes a big difference to our quality of life. The feeling, “If I fall into problems, then I have a system there. That will deal with me. That I will not be constrained from it because of cost.”
When I asked about younger Canadians feeling more precariousness in their sense of security around health without the Canadian national healthcare program, Guyatt said, “I think inevitably. If you had been in the United States, you would either have one of two choices. You pay insurance. There are varying levels of insurance. You pay the basic insurance. That you might be able to afford, but that means if you get sick then you have additional payments that you can’t afford.”
Some people may take the risk. Others may not take the risk. However, if they take the risk and become sick, then they will be in real trouble because underinsurance is the number one cause of United States citizen bankruptcy. It has to do with people getting sick.
“Most people who go bankrupt have some insurance,” Guyatt notes, “But they are underinsured. There is a whole level of insurance, where to be well-insured costs a lot of money. So, the choices facing young people in the United States who are not from very affluent families is not a cheerful one.”
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The British Medical Journal or BMJ had a list of 117 nominees in 2010 for the Lifetime Achievement Award. Guyatt was short-listed and came in second-place in the end. He earned the title of an Officer of the Order of Canada based on contributions from evidence-based medicine and its teaching.
He was elected a Fellow of the Royal Society of Canada in 2012 and a Member of the Canadian Medical Hall of Fame in 2015. He lectured on public vs. private healthcare funding in March of 2017, which seemed like a valuable conversation to publish in order to have this in the internet’s digital repository with one of Canada’s foremost academics.
For those with an interest in standardized metrics or academic rankings, he is the 14th most cited academic in the world in terms of H-Index at 222 and has a total citation count of more than 200,000. That is, he has the highest H-Index, likely, of any Canadian academic living or dead.
He talks here with Scott Douglas Jacobsen who founded In-Sight Publishing and In-Sight: Independent Interview-Based Journal. We conducted an extensive interview before: here, here, here, here, here, and here. We have other interviews in Canadian Atheist (here and here), Canadian Students for Sensible Drug Policy, Humanist Voices, and The Good Men Project (here and here).
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Photo credit: Getty Images