Free Health Care?


What happens if you break your arm in Canada? You head to emergency. If you have a sore throat, you visit a doctor.

For minor treatments to major surgeries, Canadians enjoy a universal health-care system that is rivalled by few other nations.

Some people say Canadians enjoy free health care, but the truth is your tax dollars mostly pay for the system. It wasn’t always this way. The road to universal health care in Canada was a winding, and sometimes, bumpy one and our ability to ensure that all Canadians receive similar levels of care is being squeezed by rising demand and by the challenge of paying for it all.

Long before Europeans arrived in North America Indigenous peoples used medicines created from plants to treat ailments. Unfortunately, Indigenous peoples were devastated by many diseases imported in the 1600s by the European newcomers, including smallpox and typhoid.

By the 1700s, settlers in New France and in the British colonies could visit surgeons, doctors, apothecaries, and healers. Hospitals were built and operated by religious orders.

The first hospital in North America — Hotel Dieu — was established in Quebec City in 1639. However, people’s lives were short compared to today, and epidemics were always a threat. Sometimes medical treatments were as dangerous as the ailments themselves.

Over the following centuries, medical science unraveled the mysteries of the human body. In the 1820s, the first medical schools were in Canada. The first classes took place at the Montreal Medical Institute in 1824.

By the 1850s, students were being trained in anatomy, surgery, midwifery, and other disciplines. Meanwhile medical colleges were formed to regulate the practice of medicine.

The British North America Act of 1867 made health care delivery a provincial responsibility, but the federal government has long sought a role in ensuring national standards of care. There is also the issue of who is responsible for providing health-care services to Indigenous communities.

In 1876, the federal government signed Treaty 6 which included a medicine chest clause which states that “a medicine chest shall be kept at the house of each Indian agent for the use and benefit of the Indians at the direction of such agent.”

First Nations interpret that clause as a promise by the Crown to provide a full range of government-funded medical care — from doctors visits, and dental services, to prescription drug coverage and eye care, including glasses and contact lenses. However, many health care services for Indigenous peoples have been reduced or cut completely, like drug prescriptions covering only generic brands, or not covering some drugs at all.

In 1919 after the influenza pandemic that followed the First World War, the federal government created a National Department of Health. This department tackled a host of concerns, from helping the country recover from the pandemic, to supporting wounded veterans, to reducing child mortality. At that time, the health-care system was run on a private model where citizens paid for most medical services.

But in 1947, the government of Saskatchewan introduced a law that guaranteed hospital care without fees. Supported by the federal government, public hospital insurance gradually expanded to all provinces.

In 1962, Saskatchewan went even further. It introduced a universal medical insurance plan that provided doctor services to all residents. Not everyone backed the plan. Some people feared the quality of care would decline. Some doctors feared they would make less money in a publicly-funded system. But in 1966, the federal government promised to pay for half the costs of doctors appointments outside of hospitals under the Medical Care Act.

By the early 1970s, all provinces and territories had universal health-care plans similar to Saskatchewan’s. The age of universal health care in Canada had arrived. In 1984, the federal government passed the Canada Health Act which set out five guiding principles for provinces to receive federal health-care funding.

Some critics of the public system have pushed for an increase in privatized health care. They argue Canadians should be able to pay to access care more quickly. This in turn might reduce the wait times for surgeries and other treatments in the public system.

But others say this approach would result in a two-tiered health-care system, one for the rich, and another for the poor.

What’s clear is that the push and pull between federal and provincial governments over health-care funding will continue and as the country’s population ages health care will be a top-of-mind concern for most Canadians into the future.