NEWS

Single Payer Health Care – A Canadian Nursing Perspective
By Vera Chernecki

As nurses, we know that the health of individuals depends on much more than health care. It depends on factors such as income, education, environment, employment, where we live, genetics and personal habits such as the food we eat, whether we smoke, as well as our level of activity. However, we also know that accessibility to health care services is of paramount importance to an individual’s health status.

I believe the single most important benefit of the single payer system is not having to turn a patient away from receiving health care. In a single payer system, there are no restrictions based on ability to pay, no restrictions regarding pre-existing conditions and no limits because of the type of coverage your plan provides. Nurses are free to nurse.

There are five basic principles of the Canadian, publicly-funded health care system. Under the Canadian system, the 10 provinces have responsibility for administration of public health. However, in order to receive funding from the federal government, all provinces have to abide by the following principles:

• Universality – All Canadians are covered under the Canada Health Act.

• Accessibility – No one is prohibited from receiving health care due to lack of finances.

• Comprehensiveness – All necessary physician and hospital services are covered.

• Portability – Residents of one province are covered in all Canadian provinces (and outside Canada with qualifiers).

• Public Administration – Health care is administered on a non-profit basis by a public authority.

Since 1966, the Canadian health care system has allowed all Canadians, regardless of their ability to pay, to receive medically necessary services from hospitals and physicians. In addition, over the years, varying degrees of coverage have evolved for people in nursing homes and home care services. There is currently an effort being made by various groups and organizations, as well as a promotion by the federal Department of Health, to have home care completely covered by provincial health care systems.

Nurses’ role in single payer system

Having nursed in the system pre-Medicare and since Medicare was introduced, I can most definitely speak in favor of a single payer system. In the late 1960s, before my province (Manitoba) participated in the federal program, I worked as a nurse in a physician group practice. Time and time again, I saw patients wait too long before seeking medical attention for their children or for themselves. Although the physicians I worked for were charitable and assessed a lower fee or did not charge the people they knew were unable to pay, many patients did not want to impose on the physician’s kindness because of their own feelings of pride and the desire not to accept charity.

One incident (although there were many) particularly stands out in my mind. A mom finally bringing in her 1-year old son who had been suffering from a bout of vomiting and diarrhea. The child was severely dehydrated with an excoriated bottom which caused him to scream with pain when touched. The mom indicated that her husband was unemployed, there were three other children at home and they had very little money. My heart ached for her and her family! This was an easily treatable condition, but it had been left far too long. Accessibility was a barrier for this family and so a child had suffered when he could easily have been treated. Of course, the doctor did not charge her and sent her home with free medication but I could see how demeaning it was for her to accept charity as she thanked the doctor. 

It’s now been 30 years since Medicare was introduced in Canada. Since then, the health status of Canadians has improved immensely and our life expectancy is among the highest in the world. In 1997, we ranked second only to Japan (and tied with Iceland). Canadian life expectancy at birth was 79 years, up from 59 years in the early 1920s and 69 years in the 1950s. This puts us more than two years ahead of the United States (who ranked 25th). (Source: 1999 Human Development Report, United Nations Development Program).

Is it a perfect system?

Of course it’s not perfect. However, nurses across Canada feel that although our health care system is one of the best in the world, there is much more that can and should be done. 

First, the focus for treatment needs to change from illness care to preventative care. Either through our unions or registering associations, we have lobbied for more focus on preventative health care and for alternative entry points of access to the health care system. Traditionally, doctors have been the gatekeepers of access. We have advocated for more community health centers where all health care practitioners including doctors, nurses, occupational and physical therapists, social workers and nutritionists work together in offering a wide range of services, accessible to patients as required (the concept of one-stop shopping for health care).

Second, we have also lobbied for an increase in the range of services covered. In the ‘90s, cost containment measures resulted in deinsuring of some services. As mentioned earlier, all home care services need to be upgraded and covered in all provinces. We need 24-hour a day, 7-day a week programs to keep people in their own homes. We know that this is more beneficial to an individual’s health and more cost effective for the health care system.

Right now, the biggest threat that nurses see to our single payer system is the introduction of legislation in one of the western provinces that allows a private, for-profit hospital to perform surgeries that are currently performed in our public hospitals. Nurses see this as a move toward a two-tiered system of health care (one for those who can afford, and another for those who cannot), which if allowed to expand across Canada, would see the demise of our publicly funded and administered system. It appears the battle has just begun on this issue as groups and organizations are holding rallies and marches to demonstrate against this move. The issue is clear – Canadians are proud of our Medicare system and are willing to stand up and fight to defend it. 

It has now been 30 years since Medicare was introduced and many Canadians do not have the pre-Medicare experience. However, because of American produced programs such as “ER” and “Chicago Hope,” Canadians see the effects of a private system on patient choice and accessibility. Our experience in Canada is different. When Canadians need health care, they go to the physician of their choice. They do not pay directly for hospital and physician services. They are not required to fill out forms. There are no deductibles, co-payments or dollar limits on coverage. When their children are sick, Canadians do not need to consider whether they can afford to seek medical attention, or whether it will be covered. I did work in a private system prior to Medicare, and fully value the current system. I will continue to defend and support our single payer system so that no Canadian, no matter how minor or major the condition, will ever be turned away from receiving health care. 

Vera Chernecki is a registered nurse who has worked in Canada both before and after the single payer health care system was introduced. Her experience also includes 17 years as the full-time president of the Manitoba Nurses Union (MNU). She has recently retired from that position.