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Saskatchewan's Medical Care Insurance Act

The public demand for compre-
hensive medical care has been spear-
headed by the trade union move-
ment, it was suggested, Vice-Presi-
‘dent MacKenzie said:

For years, the Canadian trade
union movement has advocated the
establishment of a national health
services plan .which would provide
every individual with adequate
health care, regardless of means. In
this province, the trade unions have
urged the enactment of legislation
similar to that now in force in
Saskatchewan. A national health
services plan was introduced in
Great Britain by a Labour Govern-
ment. It proved so advantageous to
the British people, that a Conserva-
tive Government, originally opposed
to the scheme, has not dared to re-

peal the measure or even dispute its
benefits.

B.C. Mandate
Ignored

Conclusive evidence, from doctors
and patients alike, regarding the
value of the British scheme has been
accepted by the Canadian trade
unions as pointing to the need of
such a scheme in our own country.
Indeed, Canada and the United
States are the only two large indus-
trialized nations in the Western
world without Health Insurance.

Popular demand has caused all
political parties to promise some
form of health insurance. The rea-
son is that the cost of any serious
illness is beyond the resources of the
average wage-earner, and too often
brings financial tragedy. The New
Democratic Party, which forms the
Saskatchewan Government, has been
the first political party to keep that
promise.

A plebiscite in British Columbia
some years ago gave a mandate for
Health Insurance. It was nullified by
reason of the doctors’ opposition.
Now the position taken by the con-
trolling political interests in the
medical profession in Saskatchewan
makes it very clear that they are
prepared to oppose any public medi-
cal care plan in defiance of demo-
cratic procedures as well as public
demand and need. They cannot hope
to turn back the march of social
progress forever.

Surely As Day
Follows Night

The spokesmen for the Saskatch-
ewan doctors have aroused the Ca-
nadian public to the need for com-
plete and public health insurance
which will come in this country as
surely as day follows night.

Before taking sides in this present
controversy, the first and most sens-
ible thing to do is to read the Sas-

Seldom Has A Public Document Been
More Grossly Misrepresented

katchewan Medical Care Insurance
Act. It is most unfortunate that
many of its most severe critics have
not even seen the Act. Any rational
person making a careful study of
the Act would find it impossible to
believe the distorted statements
which originate with Saskatchewan
doctors. Seldom has a public docu-
ment been more grossly misrepre-
sented,

We should also consider the back-
ground of this controversy. The
Medical Care Plan was first an-
nounced by Premier T. C, Douglas
of Saskatchewan in December, 1959.
It immediately received widespread
and expressed support from farm,
co-operative, community and labour
organizations. The election campaign
that followed was fought primarily
on this issue. The New Democratic
Party Government then elected was
given a clear-cut mandate from the
electors to implement the scheme.
Accordingly, at the first session of
the new Legislature, the present Act
was introduced and enacted.

Act Incorporates
All Principles

The present Act incorporates the
five principles for such legislation
which had been endorsed by the

people of Saskatchewan at the polls.
These were:

Prepayment: that all medical care
should be paid for on an insurance
basis.

Universal coverage: that every

_person in the province should be

assured of medical care—good risks
as well as bad risks.

High quality of service: that the
quality, distribution and availability
of medical care should be improved.

Public administration: that the
plan should be administered by a

representative body responsible to
the people.

Acceptability: that the plan should
be acceptable, both to those provid-
ing the service and to those receiving
it.

Before drafting the Act, the Gov-
ernment established a Planning
Committee on Medical Care. Three
doctors were nominated by the Col-
lege of Physicians and Surgeons to
this Committee, which was headed
by Dr. W. P. Thompson, a former

head of the University of Saskatch-
ewan.

This Committee examined briefs
from 49 organizations. It also ex-

amined health insurance plans in
other countries. Private meetings
were held with the College of Phy-
sicians and Surgeons. The Govern-
ment accepted the majority report,
which was approved by the three
doctors on the Committee. The ma-
jority report was given effect in the
subsequent legislation.

College Launched
Public Protest

At that point the spokesmen for
the College launched a public pro-

test, and made counter - proposals.
These were:

That medical care insurance be
made available to Saskatchewan
people through existing or new vol-
untary prepaid health care agencies.

That a Registration Board func-

tion as an approval body for these
insurance agencies.

That the Government should pay
the entire premium for persons
deemed to be indigent.

That the Government should pro-
vide stated subsidies for each con-
tract offered by approved agencies.

That each approved agency should
determine the amount of money re-
quired in addition to the subsidy
and charge this additional amount

as a premium to be paid by sub-
scribers.

That patients would pay their ac-
counts directly to their doctors and
obtain from the approved agency a

refund of a major portion of the
expenses involved.

The Premier met with the doctors’
spokesmen on numerous occasions
in an attempt to iron out differences
of opinion. Here it is interesting to
note the position of the Government

with regard to the doctors’ pro-
posals.

It was held by the Government
to be unjust that beneficiaries under
the scheme should be required, after
paying taxes and premiums, to pay
directly and completely the doctor’s
bill. Although they might receive a
refund, they might not receive a
total refund.

Not Universal
Under Docifors

Under the doctors’ proposals,
medical care would not be universal.
The Government plan provided for
participation by all, thus ensuring

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medical care at low cost, a feature
which was held to be necessary.

It seemed unwise to have a number
of agencies competing for the public
health dollar thus adding to admini-
strative costs.

It was also repugnant that persons
without means for necessary medical
care should be required to pass a
means test to be identified as indi-
gent persons.

It was also held to be contrary
to sound principles of parliamentary
responsibility that millions of dollars
of the taxpayers’ money should be
turned over to private agencies for
administration, without responsibility
to the people.

Doctors Claim
Veto Rights

The Government declared its will-
ingness to refashion the Act in order
to assure the doctors on the follow-
ing points:

There would be no interference
with professional standards and pro-
fessional independence.

The doctors’ remuneration would
be arrived at in a fair and equitable
manner, With the right of appeal.

Procedures would be provided for
the settlement of differences of

opinion respecting the administration
of the Act.

Regional bodies would be estab-

lished to review matters which might
be disputed.

A member of the medical profes-
sion would be appointed to overview

matters affecting individual physic-
jams...

Additional members of the medi-
cal profession would be appointed to
the Medical Care Insurance Com-

mission, after consultation with the
College.

All these points were placed in
the form of a memorandum submit-
ted to the doctors’ spokesmen and

rejected as “wholly unacceptable”.
The Doctors actually claimed the

right to veto an Act of the Legis-
lature.

Now let us examine the plan itself
from the standpoint of the average

family requiring medical care insur-
ance.

The plan is administered by a
Medical Care Insurance Commission
of which two members are doctors,
two are experienced in health region
and municipal administration, one
is a Jawyer and the Chairman is an
experienced administrator. The Dep-
uty Minister of Health is a non-vot-
ing member.

Everyone who has been resident
in the province for three months is
eligible for the benefits of the plan.

$24 A Year
Premium

These benefits provide free medical,
surgical, maternity, and diagnostic
services, including specialist services.

Every self-supporting person and
family is registered, with stated ex-
emptions. Families pay a premium
of $24 a year, and single persons
$12 a year. On this point we invite
comparison with the premiums paid
here in British Columbia to private
agencies. No premiums are to be
collected for 1962.

Each person is free to request
services from any doctor licenced to

practice in Saskatchewan.
The plan is financed from the fol-
lowing sources:

28% from the personal premiums
already mentioned;

50% from the 14% sales tax;

22% from income and corpora-
tion tax revenues.

Funds Solely
For Plan

Collections from tax sources are
placed in the Medical Care Insur-
ance Fund and used solely for medi-
cal care,

Private and municipal plans will
continue coverage in the interim
period. Benefits under the Medical
Care Plan are more extensive than
under the existing plans.

Statement
Not True

Now let us examine some of the
doctors’ objections, They say that
the private prepaid plans are more
economical. Compare the premiums
paid in this province with those
under the Saskatchewan Medical
Care Plan. Many of us are familiar
with the administration of the Medi-
cal Services Association, and its costs
of operation. We say that the state-
ment of the doctors is not true. It
is not true because when the costs
of operation are spread over all the
people in the province, the costs per
person are automatically lowered.

It is also not true that private
plans provide universal coverage.
We know that over twenty-five per
cent of our population is excluded
from private prepaid plans for the
simple reason that they cannot pay
the premiums. Our own industry is
paying for up to six months lay-off
medical coverage.

Employed workers, with families,
pay ten or eleven dollars a month
in many instances. We know what
happens when they are forced into
longer periods of unemployment.
How many can pay the premiums
levied for the alternative MSI

scheme, or those charged by insur-
ance companies?

Free To Choose
Own Doctor

It is quite untrue to state that the
Saskatchewan Act interferes with
the doctor - patient relationship.
Every person is free to choose his
own doctor. The doctor is free to
treat the patient according to his
professional standards without in-
terference. The only difference is
that the doctor's bill is paid by the
Commission instead of the patient.

A great deal has been said about
the rights of the medical profession.
We grant that these rights should be
protected, and we submit that in
the repeated efforts of Premier
Lloyd to reach an agreement with
the profession, these rights have
been assured,

Taxpayers
Have Rights

We must also consider the rights
and proper expectations of the
people of Saskatchewan. The Goy-
ernment was elected to place such
a plan in operation. The legislation
was enacted after a long period of
public consideration. All matters re-
lating to medical judgment will be
placed in the hands of the highly-
skilled members of the medical pro-
fession.

The position of the Government
is simply that the consumers of
medical services, and the taxpayers,
have the right to say how they shall
pay their medical bills.

The law concerns itself solely
with the economics and administra-
tion of public finance. Medical sery-
ice is not an optional commodity—
it is a necessity. When medical sery-
ices are needed they should not, in
the interests of each of us, or of all
of us, be denied by any of us,

Trade unionists naturally specu-
late on what would be said across
this country if any trade union at-
tempted to intimidate and defy pub.
lic authority in the irresponsible
manner displayed by Saskatchewan
doctors, and placed the health of

the community in jeopardy, You
know the answer to this question,