Dr. Brian Day @DrBrianDay Twitter

  • Past President Canadian Medical Association
  • Past President Arthroscopy Association of North America
  • Honourary Associate Professor University of British Columbia
  • 2014 Doctors of BC Don Rix Leadership Award

11 Years Ago Today: Let's Be Radical Again

Jun 16, 2015

MD Canada

This was originally published 11 years ago today, in MD Canada magazine.

There have always been those whose natural inclination is to look ahead, to challenge the status quo, to propose action and change and progress. Show them a bad thing and they say, "Let's fix it". Show them a good thing and they say, let's see how far it will take us. Show them a new idea and they say, "Let's try it".

And there have always been those whose natural inclination is to keep things just the way they are, to repress dissent, to oppose action, change or radical notions of any kind. Show them a bad thing and they say, "That's the way it's always been". Show them a good thing and they say, "It's the best we can do". Show them a new idea and they say, "Oh, no, you mustn't be allowed to try that".

It used to be that the people who automatically opposed any change were the right-wingers, the reactionaries, the entrenched place-holders -- the establishment. And it was the left-wingers who were the radicals, the free thinkers and the troublemakers who weren't afraid to upset the apple cart.

Back in the 1960s, when medicare was born, the establishment was conservative, smug, comfortable and in control of church and state and school and pretty much all of the media.

It kept women in their place, made sure the minorities among us didn't get too uppity, saw to it that the right people got the big contracts and sent kids home from school for combing their hair forward like the Beatles.

Back then, it seemed like all the good ideas came from the left. Racial equality was a left-wing notion. Peace was fought for from the left. Women's liberation, academic freedom, labour rights, free speech -- it all lived on the left.

Back then, there were many Canadians who couldn't afford health care for themselves or their children and even more who lived in fear of the catastrophic illness that would bankrupt their entire families. The doers and the thinkers said, "Let's fix it".

Back then, universal health insurance was a radical notion. The left-wingers all said, "Let's try it".

And the establishment, medical and otherwise, put up a long hard fight -- against change as much as against medicare. They fought it for years in the legislatures and in Parliament. They went to court to stop it. There were strikes, demonstrations, threats and dire warnings of imminent doom.
The left won. The times they were a-changin'.

But then we got comfortable with it and the next time we looked, the world had turned upside down.

Now the ruling orthodoxy is all left-wing. Our governments and universities and media, with a few small exceptions, are basically owned by the left. The fact is, the raucous, radical, rebellious left of our youth has aged into an establishment as inflexible and unimaginative as the right-wingers of the 1960s ever were.
And medicare. What seemed like -- what was -- a good idea in 1966 has grown into the monster that all bureaucracies inevitably become. Somewhere along the line, universal health insurance designed to cover the basic and the catastrophic became a stifling government monopoly on 10% of our economy.
The earth has shifted under the 40-year-old assumptions that medicare was built on. Universal health care in 1966 cost $34 per person, per year. In 2003, it's about $2,685. After inflation, it's still a staggering 13.5 times as much in real dollars. If minimum wage had grown at the same rate, it would be $80 per hour today. An average family car would cost $270,000.

The point is that the logic, the compassion and the economics that gave us "basic and catastrophic" coverage in 1966 don't work when they are applied to "all conceivably necessary" care in an economy and a society that are both unrecognizably different and unimaginably bigger than they were 40 years ago.
But the radicals of 1966 have become the reactionaries of 2004. Faced with challenges from all sides -- long line-ups for service, shortages of doctors, support staff at the breaking point, political pressure to cut cost and the unstoppable tide of ever-increasing demand -- the radicals-turned-reactionaries are doing what reactionaries everywhere have always done.

They are digging in. They are resisting all possible change. They are tightening their control and attacking all possible solutions. Where a government monopoly was seen as a means to the end of providing universal care, the monopoly itself has now become the only goal.
What started as a noble undertaking has congealed into an ideology obsessed with retaining political control, preventing change, opposing progress and keeping everything just the way it is.

In short, the ideology that brought us universal medical care is now the biggest threat to its continued existence. But if we want to keep the promise, to move forward, to make things better and to try new things, the way forward is clear.

It's time to be radical again.

David Dehaas