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Swift Current experiment

In Canada, the gradual movement toward publicly insured medical care began in a small city in southwest Saskatchewan where, during the years following World War II, a Scottish-born Baptist minister who would eventually lead the country’s first socialist government kick-started the drive.

Tommy Douglas eventually become the province’s premier and is remembered for his relentless pursuit of universal health care. The town, dubbed Swift Current by its first inhabitants— after a creek that winds across a hundred miles of prairie — became the epicenter of Canada’s quest to implement government-run health services for all who lived within its borders.

During the early years of the Swift Current Health Region, as it is still called today, many crises occurred, including a polio outbreak that nearly derailed the experimental system. But persistence in support of a public health care system prevailed, and the number of doctors practicing in Swift Current rose from 19 in 1946 to 36 in 1948.

Ultimately, its success provided a functioning model to the Saskatchewan government for a provincial medicare system, which was introduced in 1962 as the first universal hospital and medical care program in North America — two years ahead of the British Health Service.

Six years later, in 1968 on Canada’s 101st birthday, Saskatchewan’s model of public health insurance was adopted throughout the country’s 10 provinces and three territories — although Ontario held out until 1971.

Several tweaks were made to the system over the years, but in 1984 the Canada Health Act cemented the country’s approach to nationalized health care. The act established a protocol for public health services, allowing each province to create “medically necessary” services that the government would pay for. The law also set a strict tone for public health care by penalizing provinces that permitted hospital or physician user charges — known in the United States as co-payments.

“The first stage of Medicare has been very good to Canadians,” said Dr. Michael Rachlis, a Toronto physician and author of four best-selling books on Canada’s health care system. “Up until the late 1950s, Canadians and Americans had similar health status and similar health care systems with similar costs. Now Canadians are healthier and spend much less on health care.”

Since the early 1980s, an estimated70 percent of Canada’s health care services have been paid for by the government. The remaining 30 percent, which include such medical services as dentistry, optometry, pediatrics and physical therapy, are administered in the private sector and are paid for out-of-pocket.

Winds of change

The Canadian provinces currently use various legal tools to discourage private insurance so that access is based on need, not a person’s ability to pay. Six provinces — British Columbia, Alberta, Manitoba, Ontario, Nova Scotia and Quebec — outlaw private insurance for medical services.

But as a result of theChaoulli decision, the health care debate turned in favor of private financing.

“The largest impact of the decision has been to change the consensus on whether or not the health care system is sustainable. It has changed the consensus on whether it’s even just,” said Brett Skinner, director of pharmaceutical-policy research at the Fraser Institute, an independent research organization in Canada.

“There’s an evolutionary change that’s under way that will be incremental, year over year — a slow expansion of private options, and the development of private insurance for those things,” said Mr. Skinner.

But despite a groundswell for more privatization in Canada, it remains illegal under federal law to pay for health care that is deemed medically necessary by a provincial government.

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