The last time the Canadian Medical Association’s general council convened in Nova Scotia, there was a high-stakes exchange over the role of physicians in reforming the national health system.
In a hot hockey arena in August of 1996, CMA delegates launched an historic dispute that they would still be discussing years later.
The country’s doctors were severely conflicted about whether to introduce and enhance privately-funded health insurance in the wake of federal and provincial government intentions to restrict public funding.
Over the next few years, observers would come to cite the debate in Sydney as the start of ongoing controversy centring on the defence of Canadian-style medicare.
In the end, words spoken that day would help stall development of a parallel private system, specific definition of core publicly-paid or “medically necessary” services and more intense efforts at utilization management.
But the tide in the council chamber that morning was clearly flowing toward approval of a motion requiring the CMA to lead national discussion about the “appropriate place of regulated private insurance for medical services.”
And another motion called on the CMA to propose models for parallel, nonpublicly-funded health care.
Support for a parallel system was fueled by delegates from so-called “have” provinces. Their “have-not” colleagues worked to squelch the trend arguing that CMA support for such treasonous activity would bring both the association and the profession scorn from any number of sectors.
That’s the way things were going until Dr. Jack Armstrong got to the podium and turned the tide almost singlehandedly.
The Winnipeg-based pediatrician, past-president of the Manitoba Medical Association (now Doctors Manitoba) and the CMA’s outgoing president at the time, was widely regarded as a compassionate, modest man and strong supporter of a public system as well as measures ensuring quality health care for aboriginal communities.
If Canadian physicians supported privately-funded care for essential services in any way, shape or form, it would let governments “entirely off the hook,” he feared.
The CMA would be “shot down in flames” if perceived as among the first calling for private funding, and it wouldn’t take long before medicare “became a hollow shell of its former self,” added Armstrong, an Order of Canada recipient who died after a lengthy illness during the CMA’s 2006 meeting.
While his views are commonplace now, back then they were radical and enough to get the attention of everyone in the room. When he was done, other delegates rose to defend him.
“It’s disingenuous to say that as you bring in the artillery that you are still for peace,” one said.
While supporters of private funding spent the early morning crowding around microphones, medicare’s defenders began using Armstrong’s words to bolster their own campaign.
Early on, both resolutions seemed to be on the fast track to easy approval, but his words spurred their ultimate defeat in close votes.
Armstrong’s impassioned, extemporaneous plea also set the tone for a session that ended with decisive defeats of other motions backing a two-tiered system.
However, he couldn’t get delegates to reject a motion calling on the CMA to lead the national debate on regulated private insurance, something the CMA has been in the vanguard of doing ever since.
Pundits remind us never to doubt that a small group of thoughtful and committed citizens – or even one – can change the world. Such was the power on display in Sydney that day.
Matt Borsellino is the former national correspondent for The Medical Post