REFLECTIONS ON TWO NATIONS -- TWO HOLIDAYS ( JULY 1 and JULY 4)

There are a lot of people, on both sides of our common border, who think Americans and Canadians are pretty much the same. That is true, superficially. When given more consideration, the hypothesis begins to fall apart.

That doesn't mean that Canadians are good and Americans are bad. Or vice versa. It is just that we are different. We see things differently; we value things differently.

The starting place, I suppose, is our own respective institutions. Americans are in search of "life, liberty and the pursuit of happiness," according to the Declaration of Independence (traditionally thought to be signed on July 4, 1776). In the British North America Act (July 1, 1867), Canada's first constitution, a key phrase refers to "peace, order, and good government." Those phrases represent two very different approaches to life. So one should hardly be surprising that our thinking is different.

Though I'm being a bit "broad brush" here, I think it is fair to say that Americans are more individual-oriented, while Canadians are more community-oriented (though much less now that in the past).

Nowhere is this more obvious that in our approaches to health care. Canada has, in effect, a single-payer system. Each province (state) has its own health care program, and pays for hospital and physician services in its province. (Constitutionally, health care is a provincial responsibility.) There is a federal act which co-ordinates inter-provincial collaboration, and provides federal money to the provinces, so similar services can be maintained nation-wide, regardless of the relative wealth of the various provinces.

This did not come quickly or easily. It evolved over a 20 year period, from the end of World War Two until the mid-1960s. Saskatchewan (where I now live) was the first province to take action. In 1946, the Saskatchewan Hospitalization Act was passed, giving free hospital care to virtually everyone in the province. The provincial government wanted to do more at that time, but didn't have the money. By 1957, the Federal government passed the Hospital Insurance and Diagnostic Services Act, which extended the Saskatchewan model to all provinces through permanent Federal-Provincial shared-cost funding. With the federal money in place for hospitals, Saskatchewan again took the lead in providing coverage for physicians services in 1962. By 1966, there was another Federal act, which provided shared-cost funding for physicians services. And while there has been some fine-tuning of the system over the subsequent years, the principles are still much the same.

I knew some of the pioneers of the Saskatchewan acts. The acts came about because of citizen pressure on government. There were lengthy public discussions -- in Church basements, Community Halls, and School classrooms. Rural people, particularly, saw neighbours loosing their farms -- both their homes and business -- in order to pay their hospital and doctor's bills. They agreed that sort of thing shouldn't be happening in a country like Canada. (That's not "peace, order and good government.") The leading party in Saskatchewan, the Co-operative Commonwealth Federation, was both instigator and responder to the citizens demands. And citizen demand is what ultimately led to the development of what is referred to as "medicare" in Canada.

So today, every person's hospital care, and doctor's care, is covered. A couple of provinces charge premiums for individuals or families, but these are relatively small, certainly not at the levels of US insurers. (To get Canadian-level care in the US, people would have to pay over $1,000 per month).

Ironically, the challenge which led to Canadian medicare is still a huge problem in the United States. Almost 50 million Americans (just under 20 per cent of the population) have no health care coverage, because they cannot afford it. Many more have inadequate coverage. Unpaid medical bills are the leading cause of bankruptcy in the US; of those who go bankrupt, 75% have some, but not enough, health insurance.

The proposed solution is a single payer. It's called HR676, and is slowly gaining support. A recent poll I saw indicated about 60 per cent of health care professionals, particularly doctors, support some form of this plan. This plan appears to go well beyond the bounds of Canadian legislation, in that it covers a lot more than Canadian medicare.

What will happen next is not clear, for either country. Some Canadian physicians are pushing for a return to more private health care (meaning more money to doctors, at patients' expense). Some Americans are pushing for better care through better insurance, even if that is provided by government (with or without some premium paid by the insured).

Interesting times await.