hospitals. Personal expenditures for drugs, dental
work, and other services amounted to one-quarter
of health costs, partially paid by personal or em-
ployer-provided private-enterprise insurance.
The 1984 Act In 1984, the federal government con-
solidated previous health legislation in the Canada
Health Act, setting out five principles that provinces
had to observe. Each plan had to (1) be run by a pub-
lic authority accountable to the provincial govern-
ment, (2) cover all necessary physician and hospital
services, (3) be open to all residents, (4) be porta-
ble, covering residents wherever they needed ser-
vices, and (5) be accessible regardless of income or
ability to pay.
In support of the fifth principle, the 1984 act
threatened to reduce federal grants dollar for dollar
if provinces permitted extra billing by doctors or
hospitals beyond approved insurance payments. On
June 12, 1986, the Ontario Medical Association re-
acted to legislation banning extra billing with a
strike, but negative public reaction and dissent from
within the association’s own ranks caused the associ-
ation to abandon the job action on July 6, after
twenty-five days.
Criticisms Physician associations opposed govern-
ment insurance from the beginning, staging a bitter
strike in Saskatchewan when the province started
its 1962 insurance plan and a brief work stoppage
in Quebec in 1970. Doctors resented having their
income limited by government fee schedules. Al-
though fees were negotiated by provincial medical
associations on behalf of doctors, Canadian physi-
cians’ incomes regularly ran about two-thirds those
of American physicians.
Some patients loudly protested excessive waiting
times for elective surgery. The longest waits were
for orthopedic or eye surgery, averaging nearly six
months—in Manitoba, the average wait for a hip-
replacement was over a year. Emergency heart sur-
gery was rarely delayed, but waiting lists for elective
coronary artery bypass surgery stretched to nearly a
year in the late 1980’s. Public anger led the prov-
inces to devote more resources to the procedure,
markedly reducing wait times. Pressured to hold
down costs, Canadian hospitals purchased few tech-
nologically advanced medical machines. When mag-
netic resonance imaging (MRI) machines became
available, wait times to access them greatly exceeded
wait times in the United States.
Economists criticized lengthy wait times as a form
of nonmonetary rationing and insisted that private
enterprise could more efficiently ration limited re-
sources by price. Proponents of Canada’s system
were more impressed with studies examining use of
open heart surgery in the United States and Canada:
In the United States, people from low-income neigh-
borhoods benefited from such procedures much
less often than those from high-income areas, but no
such disparity existed in Canada.
Impact By the 1980’s, Canadians had constructed
a health care system that, despite some criticisms by
economists and popular discontent with its unsatis-
factory aspects, won the overwhelming support of
the majority of its citizens. The plans were popular
with employers, who liked having government pro-
vide health care for their employees. Defenders of
the system recalled earlier times, when it was not
unusual for a private insurance company to can-
cel policies if an insured’s health worsened, and
boasted that such cancellations were no longer pos-
sible.
Critics correctly predicted costs would rise if med-
ical services were freely available to users. Whereas
total health expenditures represented 6.1 percent of
Canada’s gross domestic product (GDP) in 1970, by
1987 they reached 8.6 percent. However, U.S. ex-
penditures went from 6.0 percent to 11.2 percent of
that nation’s GDP in the same period. Canadians
were also pleased to learn that their system pro-
duced slightly better results in terms of life expec-
tancy than did private enterprise in the United States.
Canadian life expectancies in the mid-1980’s were
73.04 years for men and 79.73 years for women; in
the United States, they were 71.5 years for men and
78.4 years for women. A health care system that guar-
anteed universal access to medical services had the
proud support of the overwhelming majority of Ca-
nadian citizens.
Further Reading
Bennett, Arnold, and Orvill Adams.Looking North for
Health: What We Can Learn from Canada’s Health
Care System.San Francisco: Jossey-Bass, 1993. Writ-
ing in clear, simple language, the authors praise
the Canadian system.
Chernomas, Robert, and Ardeshir Sepehri, eds.How
to Choose? A Comparison of the U.S. and Canadian
Health Care Systems.Amityville, N.Y.: Baywood,- Collection of heavily statistical essays exam-
The Eighties in America Health care in Canada 447