translink29nw1

Metro Vancouver is facing a critical choice this spring. From March 16 to May 29, 2015 residents of the region will have the chance to decide on future investments in public transit with the Metro Vancouver Transportation and Transit Plebiscite.

The referendum is a direct result of changes in transportation governance. In June 2014, there were changes to regional transportation authority TransLink’s governance model. Two groups now govern TransLink: the Mayors’ Council and the TransLink Board of Directors.

  • The Mayors’ Council is made up of representatives from the 21 municipalities in the transit service region, Electoral Area A (UBC campus and Musqueam lands), and the Tsawwassen First Nation. The Council appoints the majority of members on the Board of Directors and approves long-term transportation strategies (≥ 30 years), 10-year transportation investment plans, first-time short-term fares and short-term fare increases, changes in customer satisfaction survey processes, changes in customer complaint processes, TransLink’s Executive Compensation Plan and director compensation levels, and oversees sale of major facilities and assets.
  • The Board of Directors includes nine members appointed by the Mayors’ Council and up to two members appointed by the Province, selected on their skills and expertise. The Board appoints the TransLink Chair, Vice Chair, and CEO, supervises the management of the affairs of TransLink, submits long-term transportation strategies and 10-year transportation investment plans to the Mayors’ Council for approval, approves TransLink’s annual operating budgets, proposes to Mayors’ Council changes to customer satisfaction survey processes and conducts surveys annually, proposes to Mayors’ Council changes to customer complaint processes and implements approved processes, publishes annual reports, holds public annual general meetings, and establishes subsidiaries and appoints their Board Chair and members.

The “new and improved” Mayors’ Council represents a fundamental shift in the way regional transportation planning decisions are made, returning a voice to the public through their elected representatives, who have a vested interest in building a collaborative vision and plan for transportation and transit (TransLink’s mandate includes roads, bridges, and public transit). In 2007, Minister of Transportation Kevin Falcon said that there was too much in-fighting among the municipalities and little agreement on regional goals. He introduced governance changes that weakened the ability of the Mayors’ Council to determine the regional transportation vision. But a 2013 governance review criticized the lack of accountability to local residents. The 2014 governance changes eliminated the Regional Commissioner of Transportation and the ability of the provincial government to set the regional transportation vision.

As many of my readers know, municipal/regional transportation authorities have an uneasy relationship with their provincial ministries at the best of times–the Province of BC’s decision to prioritize of the Canada Line over the Broadway Line and Falcon’s 2007 governance changes soon afterwards highlighted this power struggle. In Ontario I once overhead a longtime provincial policy analyst say that he “didn’t think the province would ever let go” of its legislative authority over municipalities. The governance issue relates back to the British North America Act, which granted authority to the federal and provincial governments, omitting municipal governments because Canada was largely a rural nation in 1867. Today municipalities, and local/regional bodies such as transit agencies, struggle to fund their services because they lack revenue streams that the upper levels of government have (e.g. the Goods and Services and Provincial Sales Taxes) in a country where over 8% of the population now lives in urban areas.

So it transpired that in February 2014, the BC Minister of Transportation and Infrastructure asked the Metro Vancouver Mayors’ Council to confirm its transportation vision and to clarify the costs, priorities and phasing for investments and actions. The Mayors’ Council established a Subcommittee on Transportation Investment, which worked with TransLink, Metro Vancouver and municipalities to define their vision, establish spending priorities, and recommend new funding mechanisms. For those of my readers in other cities and countries, this kind of collaboration towards a common vision is typical of the Vancouver region, where the first regional plan was articulated over forty years ago. Liberal Premier Christy Clark asked for a referendum on the Mayors’ Council plan.

The actual wording of the ballot is:

The Mayors’ Council has developed a transportation and transit plan called Regional Transportation Investments – A Vision for Metro Vancouver. The plan will:

  • add bus service and new B-Line rapid bus routes
  • increase service on SkyTrain, Canada Line, Seabus, and West Coast Express
  • maintain and upgrade the region’s major roads
  • build a new Patullo bridge
  • build rapid transit connecting Surrey Centre with Guildford, Newton, and Langley
  • build rapid transit along Broadway in Vancouver
  • extend the region’s cycling and pedestrian walkway networks.

A new Metro Vancouver Congestion tax would be applied as a 0.5% sales tax on the majority of goods and services that are subject to the Provincial Sales Tax and are sold or delivered in the region. Revenues would be dedicated to the Mayors’ Council transportation and transit plan. Revenues and expenditures would be subject to annual independent audits and public reporting.

Do you support a new 0.5% Metro Vancouver Congestion Improvement Tax, to be dedicated to the Mayors’ Council transportation and transit plan?

Screen Shot 2015-02-21 at 2.02.05 PM

You can get more details on the Mayors’ Council, and their plan, on their website (www.mayorscouncil.ca). If you live in Metro Vancouver, and are a registered voter, you can vote by mail between March 16 and May 29th. If you’re not registered, and you are 18 or over, a Canadian citizen, a resident of Metro Vancouver and a BC resident for at least 6 months, click here to go to Election BC’s website.

I’m also supporting Moving In a Livable Region, a consortium of businesses, organizations, local governments, and transportation leaders working together to create a long-term sustainable funding regime for transportation in the Metro Vancouver region, in their efforts to get information out to the public. Click here to read my guest post. Transportation referendums are exceedingly rare in Canada, so don’t miss your chance to have your say!

Funding shortfalls are common among cities, as this year’s municipal elections have shown. While many governments are turning to public-private partnerships to fund expensive projects, they also work with community organizations, social enterprises, and non-profit groups to implement projects and run programs such as affordable housing for seniors and job placement services for youth. Crowdfunding could represent another aspect of cost-sharing that municipalities could use to help pay for services and projects that have strong support of municipal staff and the public. I’ve written before about participatory budgeting in Vancouver, Calgary, Guelph, and Toronto and posted last month about a crowdfunded bus proposal originating in Toronto’s Liberty Village.

RaiseanArm.org is a civic crowdfunding website created by Abdullah Mayo and the Hamilton Stewardship Council to give the public more of a say in public spending. Building on crowdsourced models common among start-ups and entrepreneurs which allow innovative ideas to find funding from many small donors online, the website aims to allow citizens to suggest ideas for the city. Spacehive in the UK, the world’s first civic crowdfunding site, currently has 359 projects such as recreation facilities, public art, and building restoration projects–50 are now fully funded. Citizeninvestor in the US features projects from $2,500 bike rack installations or tree planting all the way up to $200,000 public parks.

RaiseanArm has worked with the City of Hamilton to investigate the feasibility and legalities of crowdfunding in Ontario. RaiseanArm staff will bring ideas to the City to find out if the project is feasible or already being done in the Hamilton. If the idea were approved by the City, the project would be posted in the website and citizens would be able to pledge financial support or volunteer their services to get the project completed. While Mayo is excited to begin with local projects, he would like to gather support from across Canada and eventually expand to projects across the country.

Tree canopy on a Marpole residential street. The neighbourhood has a variety of commercial, industrial and residential land uses.

This year the City of Vancouver will be starting community plans for three neighbourhoods: Marpole, the West End and Grandview-Woodlands. In addition to the usual open houses and community meetings, the City has been using its new Public Engagement Division (within its Communications Department) in innovative outreach. This past weekend the City, local residents and designers coordinated walking tours of the three neighbourhoods as part of Jane’s Walk. The Marpole walk was hosted by Margot Long, landscape architect and urban designer, and local resident Jo-Anne Pringle. Lil Ronalds, the City planner working on the Marpole plan, and City Councillors Heather Deal and George Affleck also attended. For more info, check out my article “Get with the plan (Marpole edition!)” for Spacing Vancouver; others will be writing upcoming articles about the West End and Grandview-Woodlands walks, so stay tuned!

After weeks of predicting a tight race in Alberta’s provincial election, pollsters are scratching their heads. Articles such as “Wildrose on track for majority with a week to go in Alberta” (The Globe and Mail, April 18th) were widespread just a few days ago. Yet somehow, Premier Alison Redford led her Progressive Conservative party to its 12th consecutive majority government with 62 seats, while Danielle Smith’s upstart Wildrose Party has become the Official Opposition party with 17 seats. The popular vote was closer: Redford captured 44% of the popular vote and Smith 34.5%. So what happened in the battle of conservatives?

Premier Alison Redford. Photo: John Lehmann, The Globe and Mail

Some sources report that strategic voting played a major role: those who may have voted Liberal or NDP may have voted PC to keep Wildrose from power. Albertans seem to have shown a healthy skepticism for the Wildrose party, particularly issues of gay rights and racism raised by two Wildrose candidates (Allan Hunsperger and Ron Leech, neither of whom was elected). Other centrist and left voters may have disapproved of the party’s stance on the fundamental right to refuse a medical service–such as abortion–based on religious objections, and their refutation of climate change. But another interesting factor has emerged: the polls weren’t really that accurate. Only a few polls, such as that by Leger Marketing, asked voters whether they were undecided: they found that up to one-fifth of voters were undecided in the final week of the campaign. Despite technological advances, polling has not become more precise, and the margins of error are significant: lest we forget, not a single poll predicted Stephen Harper’s majority government in last year’s federal election.

Wildrose also had poor support in Alberta’s cities. PC support was strong in Edmonton and Calgary: the province’s two largest cities hold half of its seats, 44 in total. In Calgary, the Wildrose party took only 3 of 25 ridings while in Edmonton Wildrose failed to win a single one. Lethbridge, Red Deer, and Fort McMurray were also overwhelmingly PC. It seems that urban Albertans preferred Redford’s Joe Clark-style conservatism, while many rural residents considered the PCs too centrist. But many journalists are saying that the values, views and opinions of Alberta voters may have been too complex to capture using polls.

Alberta’s election pitting Redford and Smith against each other would have had a historic result no matter who won. Only nine women in Canadian history have ever served as provincial/territorial premier: five were elected leader of their party while it was in power, and four were elected premier in a general election. Redford became premier in October when she was elected leader of the party, and this win makes her the first female premier elected in Alberta. BC’s Christy Clark is in a similar position: she became premier after Gordon Campbell resigned in 2010 and narrowly won his seat in a by-election. If she were to win the general election next May, she would become the province’s first elected female premier (Rita Johnson briefly held the position of premier in 1991 after Bill Vander Zalm resigned and she was elected leader of the Social Credit Party, but she was defeated in the 1991 BC election). With this win, Redford also marks a second milestone: the PCs will become the longest-standing provincial government in Canadian history by the end of this term.

In my previous post, I wrote that many Canadians don’t know much about municipal planning processes, the implications of the legal division of powers in Canada, and what this means for service provision in our cities. In this vein, readers might be interested in some examples of municipal efforts at citizen engagement that go beyond the often-uninspired public meeting.

Participatory budgeting originated in Porto Alegre, Brazil in 1989. It’s driven by core principles such as democracy, equity, community, education, and transparency. Thousands of citizens assemble in Porto Alegre each year to elect delegates to represent each city district, prioritize demands, serve on the Municipal Council of the Budget, and produce a binding municipal budget. Proponents of participatory budgeting say that because people with the greatest needs play a larger role in the decision-making process, spending decisions tend to redistribute resources to communities in need. In Porto Alegre, for example, there has been a marked increase in funding for badly-needed sanitary sewer projects and schools. Participatory budgeting is used in about 140 municipalities in Brazil as well as towns and cities in France, Italy, Germany, Spain, the United Kingdom, India and Africa. It is used for municipal school, university, and public housing budgets.

The process has also been used in several Canadian municipalities: Toronto Community Housing Corporation (TCHC) allows its tenants to participate in decision-making on local, neighbourhood and city-wide spending priorities. TCHC’s participatory budgeting process first took place in 2001, when tenants were asked to help decide how to spend $9 million per year (13.5% of TCHC’s budget); 237 local capital projects were funded. In Guelph, residents allocate a small portion of the City’s budget through the Guelph Neighbourhood Support Coalition. Since 1999, neighbourhood groups have been sharing and redistributing resources for local community projects, including recreation programs, youth centres, and physical improvements to community facilities. In 2005 some 10,000 people participated in the process and 460 events and programs were funded.

In a review of participatory budgeting efforts in Canadian cities, Josh Lerner and Estair Van Wagner outline several challenges for participatory budgeting in Canada: the fact that Canadians are extremely diverse in language and culture, the small scale of these efforts so far, the limited power of citizens in the process, the fact that none of them have fundamentally changed their cities’ political systems or created a more progressive social agenda, and the potential for the process to become co-opted by politicians.

City of Calgary "Our City. Our Budget. Our Future."

Other efforts at participatory processes in budget planning have included the Cities of Toronto, Calgary and Vancouver. In each case municipal officials encouraged citizens to get involved in the City’s budget planning. For the 2004 City of Toronto budget, Mayor David Miller initiated the Listening to Toronto consultations. A City Budget Community Workbook was posted on the website and seven public sessions were held. This wasn’t participatory budgeting (participants didn’t help formulate priorities that were then adopted); in a process similar to integrating feedback from public meetings, participants’ ideas were used to guide City Council during the drafting of the budget.

In February 2011, Calgary Mayor Naheed Nehshi opened up the budget planning process to the public through a citywide engagement process. In “Our City. Our Budget. Our Future.” the City aimed to help people feel like they were part of the process, make the budgetary process clearer by simplifying communication from city staff, and gather ideas on the budget. Their online budgeting tool allowed users to see how much each department currently spent, and what an increase or decrease in areas like transportation or safety would look like. The City heard from 24,000 people during this process. Again, citizens’ ideas were considered in drafting the budget, which was adopted in November 2011. The new three-year budget resulted in property tax rate increases of 6.0% in 2012, 5.7% in 2013 and 6.1% in 2014 and included (among other things) additional funding of $1 million for Calgary Transit, a reserve fund of $3.5 million for snow clearing in 2013 and 2014, a $225,000 increase to the Calgary Arts Development Authority.

“We used to do things like open houses and town halls when we had those discussions. And what we learned this time around is that the open houses and the town halls are the most expensive and least successful part of the process.”– Calgary Mayor Naheed Nenshi

A screen shot from the City of Vancouver Budget Allocator

The City of Vancouver followed suit this year, encouraging citizens to get involved in the 2012 budget process. In addition to attending public meetings and completing an online survey on budget priorities, a section of the City’s website lets users to download a primer explaining how the budget works (how the city raises funds, what percentage of taxes goes to pay for utilities, fire and police services, etc.). The interactive tool lets them “be Councillor for a day, see what it costs to run a city.” This simple tool gives you options to remain at the current level of funding or to increase or decrease funding levels in each area. When you’ve finished making your budget, the Budget Allocator tells you whether you have a surplus or a deficit, and how much you would have to raise taxes to cover the increased costs. You can submit your budget, along with the reasons for your choices, directly to city staff: if you’re a local, go to www.talkvancouver.com/Budget 2012 before February 10th to have your say.

In short, there are varying levels of participation in budget processes, from consultation to surveys to participatory budgeting. In addition to various levels of power for the participants, the educational aspects differ as well: one could argue that while Toronto, Calgary and Vancouver have made strides in educating the public on the budgetary process, they stop short of allowing residents to learn how to prioritize spending objectives and vote on them. Nevertheless, Canadians in other municipalities might want to find out how their budget works, when their budget is up for adoption and what the process is for citizen involvement. With so many online and interactive ways to get involved, there seem to be many opportunities to inform and involve communities that may not participate otherwise: young adults, immigrant groups, seniors living in facilities, etc. High school teachers, college and university professor could use the online budgeting tools in civics, planning, political science, or urban studies courses. Immigrant groups could organize online participation at a community event. Residents and health care support workers could help seniors participate. If your municipality doesn’t currently encourage participation in the city budget process, ask your councillor to suggest the idea.

Update: check out the latest national issue of Spacing magazine for integrated approaches to public engagement in Saskatoon, Vancouver, and Halifax (“Speaking with Your City” by Rachel Caroline Derrah).

Talk about timing. A few weeks ago, in time for provincial elections in Ontario, Manitoba, PEI, and Newfoundland and Labrador, the Federation of Canadian Municipalities released a report urging the federal government to support public transit and affordable housing in cities. This in itself is nothing new: FCM has long advocated stable funding for public transit and affordable housing in municipalities, who have been struggling to pay for new infrastructure and operating costs. The twist: FCM maintains that better transit and affordable housing can actually help immigrants integrate, and that municipalities should offer them along with services such as English language training (download their report: Starting on Solid Ground: The Municipal Role in Immigrant Integration). This echoes the findings of my Ph.D. dissertation, which found that flexible approaches to housing and transportation increased community resiliency.

This week, FCM and the Canadian Urban Transit Association met with members of the Standing Committee on Transport, Infrastructure and Communities to discuss the idea of a National Public Transit Strategy. They argued that fast and efficient transportation connections through public transit are crucial to strengthening the economy. MP Olivia Chow, NDP critic for transport and infrastructure, introduced a private member’s bill on September 30th (Bill C-615, An Act to Create a National Public Transit Strategy) calling for the federal government to work with municipalities in the creation of a national transit strategy and create a stable source of funding for municipalities. She noted the economic benefits and the disadvantages of long commute times: Canada’s big city mayors have been pushing for a national strategy since 2007. In the CBC’s unofficial poll on this topic, 88% of readers agreed that Canada needs a national transit strategy. I needn’t go into this issue here in Vancouver: this week, an Angus Reid poll of 504 Vancouver residents showed that 85% want improvements to transit service and 75% felt those improvements should be funded by the provincial government. As I wrote in my last post, the Mayors’ Council on Regional Transportation votes today on the adoption of the Moving Forward strategic plan, which includes a 2% hike in property taxes and the beginnings of a new provincial-municipal funding agreement to help pay for transit improvements.

It looks like public transit is becoming a hot issue among cities of all sizes. The Regional Municipal of Waterloo is in the process of constructing an LRT line (currently in the planning process) funded by the provincial and federal governments. A strong motivation for the Region, which includes the municipalities of Kitchener, Cambridge and Waterloo, was increased immigration to the area, a point they raised at this year’s Metropolis Conference on Immigration and Migration in Vancouver. It’s very humbling to see the recommendations I made in my Ph.D. dissertation being echoed at the municipal, regional and federal levels. Considering the numbers of immigrants settling in Canadian cities every year (approximately 250,000 Permanent Residents and 200,000 Temporary Workers), governments need to do a better job of helping them integrate, and that includes more housing and transportation options. Maybe after decades of research and policy innovation in municipalities, we’re finally reaching the tipping point: let’s keep a close watch on Bill C-615 and Bill C-400, the bill creating a national affordable housing strategy (Bill C-304, the former private member’s bill of the same title and wording, was scrapped after the May 2011 election).

Health care is a polarizing issue; it always has been. Because it is a service that is offered privately in some places and publicly in others, there is an ongoing debate about its ethics, its efficiency, and its reliability. The ethical debate is simple: in countries with private health care, the rich receive much better treatment than the poor. The efficiency debate is more complex: most argue a publicly-funded system is more efficient, saves costs, and treats all patients equally, while others argue the private system is superior. Reliability is a characteristic that is frequently brought up in health care discussions: wait times, availability of general practitioners, availability of equipment. But it often is difficult to get behind the political double-speak to the reality of health care provision.

Health care is a crucial factor in planning more socially equitable cities and regions because anyone can be affected by health problems or accidents, and public health care protects the middle and lower classes from bankruptcy and homelessness. Before the US mortgage crisis, medical bills were the leading cause of bankruptcy in the country, affecting 2 million people annually (this 2005 Harvard study showed that three quarters of these had health insurance at one time, 56% were middle class and over half had attended college). A 2009 study published in the American Journal of Medicine reported that 62% of bankruptcies in the US were due to medical bills and 80% of these people had health insurance. A 2008 study in Health Matrix: American Journal of Law-Medicine showed that for 49% of homeowners going through foreclosure, the foreclosure was caused by illness, unmanageable medical bills, lost work due to a medical problem, or caring for sick family members.

The biggest debates at the moment are happening in the US, the only industrialized country that does not have public health care. US President Barack Obama has been getting a lot of flack for his proposed health care reforms, which would introduce a government-run insurance program to make health care more affordable. Obama’s approval ratings have fallen nine percent since July 2009, to 52 percent, which critics say shows waning support for a national health care program. Because of our proximity, the US and Canadian systems are constantly being compared. The scary thing is that while many Americans are terrified of the Canadian system, pro-economy Canadian politicians want our system to be more like the Americans’, with private clinics offering services such as MRIs in Quebec. American politicians will cite long wait times for surgeries and MRIs, inability to find a general practitioner, and rumoured higher costs as evidence that public health care doesn’t work. However, these comparisons are faulty for several reasons.

The myths demystified

First, the long wait times have only existed since 1996, when the Liberal government, faced with a budget shortfall due to a prolonged economic recession, cut overall spending levels and merged health care transfer payments to the provinces with transfers for other social programs. Serious cuts were also made to federal housing programs and education, resulting in an erosion of the social welfare state. These cuts, in addition to an aging population and high inflation rates in health costs, have caused problems with the system such as fewer available beds, shorter recovery time for surgeries, and increased workload for doctors and nurses. Fees have also been introduced for certain services such as travelling to a hospital by ambulance, eye exams, and physiotherapy. In BC and Ontario, each resident now pays a health premium annually. But the government has made significant strides in reducing these wait times: in 2004 a $5.5 billion Wait Time Reduction Fund was established and most provinces now have websites that allow us to check on wait times for specific services in our areas. Long wait lists are not a form of government rationing, as some Americans believe, but an unfortunate side effect of decreased government spending on health care. The wait lists, rather than prioritizing wealthier patients, ensure that all patients have equal access to scarce and high-demand services. Most health statistics in Canada are at or above the OECD average, including life expectancy, infant mortality, perinatal mortality, and percentage of health care costs paid by government. On the contrary, health care in the US is consistently ranked the lowest in the developed world by organizations as venerable as the World Health Organization.

Second, there are many studies showing private health care is much more expensive. Malcolm Gladwell, in a 2005 New Yorker article, wrote that “One of the great mysteries of political life in the United States is why Americans are so devoted to their health-care system.” He writes that efforts have been made to introduce universal health care six times: during the First World War, the Depression, the Truman and Johnson Administrations, the Senate in the 1970s, and the Clinton years. Americans spend $5,267 per capita on health care every year, almost two and half times the industrialized world’s median of $2,193; the US spends more than a thousand dollars per capita per year—close to four hundred billion dollars—on health-care-related paperwork and administration, whereas Canada spends only about three hundred dollars per capita.

In 2005, Dr. Quentin Young, national coordinator of Physicians for a National Health Program said that “The paradox is that the costliest health system in the world performs so poorly. We waste one-third of every health care dollar on insurance bureaucracy and profits while two million people go bankrupt annually and we leave 45 million uninsured. With national health insurance (‘Medicare for All’), we could provide comprehensive, lifelong coverage to all Americans for the same amount we are spending now and end the cruelty of ruining families financially when they get sick.” This year, the World Health Organization showed that the US spends 12.7% of its GDP on health expenditures, well above the worldwide average of 8.7% and 3.4% in South-East Asia. Canada spent 10.5% of its GDP on health expenditures in 2007. A 2007 report from the Coalition for Health Care said that national health expenditures were expected to outpace the growth of the GDP. The higher costs get in the US, the more people are uninsured.

Third, because we have the world’s most inflated health care costs just across the border, many of our more profit-hungry doctors are lured south. This means fewer doctors for Canadians, particularly general practioners. This, in addition to rampant health care cuts by successive neoliberal governments, is the reason for our doctor shortages.

I may as well put to rest other myths of universal health care voiced by the American public and mocked in Michael Moore’s Sicko: yes, we can choose our own doctors. No, the government will not force euthanasia on you. No, we’re not communists. And no, the economy will not collapse if universal health care is introduced.

As Gladwell writes, “moral hazard”, the idea that insurance can change the behaviour of the person insured, has become entrenched in American economic thought, policy and legislation. If Americans had universal health care, the idea goes, they would “waste” it; making them pay for it ensures it’s only used when it’s really necessary. But this only works if we treat health care like a consumer product, which it plainly is not: we only go to the doctor when we’re sick, and even then, we don’t really want to go. And there’s no way of knowing when a visit to the doctor could make sound economic sense: in the case of having moles checked for skin cancer, or having regular Pap smears. Early detection could save the health care system a good deal of money. Many insurance companies have moved to the “actuarial model” which charges more to insured people with serious health conditions, and their employers, basically guaranteeing that, in many states, these people cannot get health insurance. Under the social-insurance model, which Canada, Germany, the UK, Japan, and all other industrialized nations follow, everyone pays equally into health care, and everyone benefits equally.

The long fight for universal health care: Tommy Douglas

The reality is that health care has always been a political issue, and not just in the US. Tommy Douglas, the “father of health care” in Canada, fought long and hard to achieve universal health care in 1961. Douglas was leader of the Co-operative Commonwealth Federation (CCF) from 1942 and premier of Saskatchewan from 1944-1961. The fact that Douglas led the first socialist government in North America was intrinsically tied to his bold introduction of universal health care. There was also a personal connection: Douglas injured his leg at age 10 and developed osteomyelitis. He would have lost the leg to amputation had a local doctor not seen the condition as a good subject for his students, agreeing to treat Douglas for free. Unable to volunteer for service during WWII due to the old leg injury, Douglas set his sights on health care reform.

Douglas attended Brandon College to prepare for his future as a Baptist preacher. He was attracted to the social gospel movement, which fused Christian principles with social reform. While in his religious capacities at Calvary Baptist Church in Weyburn, Saskatchewan during the Great Depression, Douglas became a social activist and joined the CCF. He was elected to the Canadian House of Commons in 1935. He led the CCF to provincial victory on June 14, 1944, winning 47 of 53 seats in the Legislative Assembly of Saskatchewan. They won five straight victories until 1960, and were responsible for the creation of the publicly-owned Saskatchewan Power Corporation; Canada’s first publicly-owned car insurance service; a large number of Crown Corporations; legislation that allowed unionization of the public service; a significant passage of the Saskatchewan Bill of Rights that preceded the adoption the UN’s Bill of Rights by 18 months; and the first program in Canada to offer free hospital care to all citizens. Thanks to the postwar boom, the Douglas government also paid off the huge public debt left by the previous Liberal government and achieved a government surplus.

In 1958, newly elected Prime Minister John Diefenbaker, also from Saskatchewan, promised that any province seeking to introduce a hospital plan would receive fifty cents on the dollar from the federal government: this promise was renewed in 1959. The Saskatchewan Medical Care Insurance Bill was introduced in October 1961 and given Royal Assent in November, while Douglas went on to lead the newly formed New Democratic Party. Woodrow Lloyd became his successor as premier of Saskatchewan.

On May 1st, 1962, the Saskatchewan Medical Care Insurance Act was to be adopted, but the province’s doctors went on strike and 90% closed their offices, forcing Lloyd to delay adoption of the act. The government brought in doctors from Britain, the United States and other provinces in order to staff community clinics set-up to meet demand for health services. The Act was passed July 1st, 1962. By mid-July some of the striking doctors returned to work. Lord Taylor, a British physician who had helped implement the National Health Service in the United Kingdom, was brought in as a mediator and the “Saskatoon Agreement” ending the strike was signed on July 23, 1962. As a result of the agreement, amendments to the Act were introduced allowing doctors to opt-out of Medicare and raising fee payments to doctors under the plan, as well as increasing the number of physicians sitting on the Medical Care Insurance Commission. By 1965, most doctors favoured the continuation of Medicare. The strike was a significant test for Medicare. Its failure allowed the program to continue and the Saskatchewan model was adopted throughout Canada within a decade. The political divisions within the province aggravated by the strike contributed to the Lloyd’s government defeat in the 1964 provincial election. However, even though the Saskatchewan Liberal Party of Ross Thatcher had opposed the plan, Medicare was so popular that Thatcher’s government left it in place.

The program’s success led Diefenbaker to appoint Justice Emmett Hall, a noted jurist who also hailed from Saskatchewan, to chair a Royal Commission on Health Services in 1962. In 1964, Hall recommended the nationwide adoption of Saskatchwan’s model of public insurance. The program was created in 1966 under Lester B. Pearson’s minority government, with the NDP, who held the balance of seats, putting significant pressure on the Liberals. The federal government was to pay 50% and the provinces the rest. In 1984, the Canada Health Act was passed, prohibiting user fees and extra billing by doctors.

The moral dilemma

As Gladwell writes, the universal health care question is really quite simple: “Do you think that redistribution of risk is a good idea? Do you think that people whose genes predispose them to depression or cancer, or whose poverty complicates asthma or diabetes, or who get hit by a drunk driver, or who have to keep their mouths closed because their teeth are rotting ought to bear a greater share of the costs of their health care than those of us who are lucky enough to escape such misfortunes?”

As a Canadian whose parents (both registered nurses) immigrated to the country the year universal health care was introduced, I’m proud to say that we do not feel this way. Canadians, including Shirley Douglas, daughter of Tommy Douglas, have rallied to save our publicly-funded health care system throughout recessions and political changes. A 2009 poll by Nanos Research found 86.2% of Canadians surveyed supported or strongly supported “public solutions to make our public health care stronger.” A 2009 Harris/Decima poll found 82% of Canadians preferred their healthcare system to the one in the United States, more than ten times as many as the 8% stating a preference for a US-style health care system for Canada. A Strategic Counsel survey in 2008 found 91% of Canadians preferring their healthcare system to that of the US. In the same poll, when asked “overall the Canadian health care system was performing very well, fairly well, not very well or not at all?” 70% of Canadians rated their system as working either “well” or “very well”. Since the passage of the 1984 Canada Health Act, the Canadian Medical Association has been a strong advocate of a publicly-funded health care system, including lobbying the federal government to increase funding, and being a founding member of (and active participant in) the Health Action Lobby (HEAL), although some provincial medical associations would like to see a larger private role. Tommy Douglas was inducted into the Canadian Medical Hall of Fame in 1998 and voted “Greatest Canadian” in a nationwide Canada Broadcasting Corporation (CBC) contest in 2004.

No one should die because they cannot afford health care, and no one should go bankrupt or lose their home because they get sick. Period.