Chat with Distinguished Professor Gordon Guyatt on national healthcare and young people
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.
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.
Here we talk about national healthcare, I intend this as a gratitude piece as a young person who has been served well by the public healthcare system.
Scott Douglas Jacobsen: When it comes to having national healthcare coverage in Canada, when did it start? How did it develop? What would it be like if young people did not have national healthcare?
Professor Gordon Guyatt: There was a national hospital insurance program. That started in the late 1950s. The subsequent big change was bringing in physician services under a national program. That we now call Medicare. Tommy Douglas, when Premier of Saskatchewan in the early 1960s, brought in a provincial program to cover 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.
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.
They had to persuade the provinces to bring in the program that met federal standards. The way they did that was to say, “If you bring in a program that meets our standards, then we will pay 50% of the cost.” That was a carrot that was very enticing to the provinces.
Legislation was passed in the late 60s. By 1971 or 1972, all of the provinces have bought in. Now, we have effectively national public insurance for physicians as well as hospital services. Canadians have been the beneficiaries.
It is perhaps less important to young people than to older people because young folks are healthier. But, periodically, even young folks, they develop serious illnesses: sometimes catastrophic and sometimes accidents.
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. 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.”
Jacobsen: Would younger Canadians who did not have our national healthcare program be feeling a more precarious sense of their security of health?
Guyatt: 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.
Or, you say, “I am going to risk it. Then if you get sick, then you will be in real trouble.” In terms of underinsurance, the number one cause of bankruptcy in the United States in health cost, associated with getting sick. Most people who go bankrupt have some insurance.
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.
Jacobsen: Thank you for the opportunity and your time, Professor Guyatt.