The publication in 2018 of Monique Bégin’s autobiography came at a useful time in Canadian politics. Entitled Ladies, Upstairs!: My Life in Politics and After, the part of the book that raises an interesting question about the current minority Parliament has to do with her account of how the Canada Health Act finally came into being in the spring of 1984. I say “finally” because, as she fulsomely reports, it was not a foregone conclusion that the Liberal government of the day would act to deal decisively with the problem that a proliferation of extra-billing by physicians and user fees were posing to medicare only in its second decade.
Bégin has dealt in more detail with the prelude to the Canada Health Act in a previous book, Medicare: Canada’s Right to Health, devoted exclusively to the issue of health care in Canada. In that book she credits the NDP, and the NDP health critic at the time, yours truly, with playing an important role in the House of Commons in keeping up the pressure on her and her Liberal colleagues to act. The newer account explains more comprehensively the nature and extent of the resistance within the Liberal cabinet and caucus to the idea of the Canada Health Act.
Part of the resistance was owed to perhaps an understandable desire to avoid the risk of opening up another front with the provinces over medicare, in a political term that was already characterized by federal-provincial tensions over the patriation of the constitution, the National Energy Program and other issues as well. Part of the problem was simply getting the prime minister’s attention in those four years that came as Pierre Trudeau’s second chance, following the election 40 years ago that returned him to power after he had already decided to leave following his 1979 defeat.
In this sense, the Canada Health Act is like everything else, including the Canadian Charter of Rights and Freedoms, that was accomplished between 1980 and 1984, which is to say that it might not have happened at all had it not been for the unusual circumstances pertaining to the defeat of Joe Clark’s Progressive Conservative government in December 1979. Another fortuitous circumstance was the re-appointment of Monique Bégin as minister of health and welfare, a re-appointment that enabled her to continue to work to save medicare, something she had been concerned about as the health minister before 1979 and during her brief tenure as opposition health critic.
The Tory minister of health in 1979, David Crombie, had set the stage for the Canada Health Act by commissioning Justice Emmett Hall to produce a second report on medicare, one in which he recommended penalties for those provinces who continued to permit extra-billing by physicians and user fees. It would take four years, and would almost have slipped away if some Liberals had had their way and left it as something to be promised going into the 1984 election. Bégin, wanting to get out of politics in any case, and convinced that the Liberals would lose the next election, pressed to have her legacy enacted rather than transferred to the promise bin.
It was widely believed at the time that Bégin wanted to act, but was having difficulty making it happen. I remember one time receiving a note from her after question period encouraging me to keep up the pressure because she needed it to succeed in the internal battle that she was waging.
We are at another crossroad in the future of health care in Canada as the case for a national pharmacare program becomes more and more persuasive. Promises have been made. Promises have been qualified, even weakened. Yet there is great hope that this minority Parliament might produce such a program. The NDP is strongly in favour of such an outcome, and using what leverage it might have to make it happen.
But who on the Liberal side wants to make it happen? Where is the present-day Monique Bégin, working to get her Liberal colleagues on board to do more than the covering-the-gaps limited vision that Finance Minister Bill Morneau has talked about? It’s not obvious who the pharmacare advocate is, and until it is, we may have to unfortunately content ourselves with the observation that they don’t make health ministers like they used to.
Bill Blaikie, former MP and MLA, writes on Canadian politics, political parties and Parliament.