Medicare Didn’t Just Happen!

There were various forces in Canada that led to the introduction of universal health insurance (Medicare) in Canada – World War 2 veterans returning home with ongoing medical needs, political pressure from community groups, and generally, citizens unable to pay their hospital bills for their diagnostic services and inpatient stay.

At the start of the 20 th century few hospitals foresaw how scientific discoveries would bring clinical breakthroughs to centuries old medical mysteries and myths. By the 1950s medical knowledge had doubled and technological discoveries were revolutionizing how hospital services were provided across the country. Medicare was the answer to how we would pay for the new hospital-centric system; that is, a system designed to embrace a self-governing medical system under the stewardship of provincial governments.

By 1980 medical knowledge was doubling every seven years but cracks were appearing in the medicare model. Band aids, in the form of greater funding transfers to the provincial stewards was deemed a solution. As the provincial stewardship model grew, so too did its ecosystem. The gravitational pull that served the old hospital-centric forces stubbornly remained. The evolving ecosystem however could not ignore the broader society which was witnessing rapid scientific progress and technological discoveries of its own in all walks of life. With the new millennium came the realization that our closed health system was beginning to shake, rattle and roll. By 2023 the Globe and Mail’s respected health journalist André Picard was proclaiming that, “…we’re trying to deliver 21 st -century care with a 1950’s model of delivery and funding.”

It’s 2024 and our post pandemic medicare system is staggering in the late rounds. But how can that be when, as Dr. Angela Genge of the Montreal Neurological Institute notes, “Medical knowledge is doubling every seven months”. For a clue to the answer, I think we have to look to the writings of Professor Catherine Burns of the University of Waterloo. Dr. Burns, acutely aware of rural community hospitals’ vulnerabilities within the old ecosystem, provides a technological warning. “AI must be designed with a goal of promoting greater access and equity in health care. This means AI must be designed to support equity, be broadly inclusive and be designed to partner with our communities… Our next generation of AI designers will design their technologies for the problems we tell them are important. We need to define what those problems are and what success would mean.”