The Inclusion Agenda: Why does the disability community not embrace Medicare?

Fourth in a series submitted by Dr. William Cowie, Every Canadian Counts Coalition; https://everycanadiancounts.com,

Why does the disability community not embrace Medicare? The answer is both complex and simple. But one thing is clear, if the health advocacy community of the 1950’s and 1960’s had the culture, organization, and activist pre-occupations of the culture of the disability community in Canada today, we would never have had Medicare. Yet Canadians cherish their Medicare. Despite decades of assault on it, from attempts at privatization, to recent Supreme Court Rights challenges, this publicly funded universal, non means tested health care model enjoys the unequivocal support of the bulk of Canadians.

So why, when you mention Medicare as something that may be desirable for persons with disabilities, is there a shudder, a ‘oh we don’t want that’ response. It seems to boil down to a fear often expressed of being ‘medicalized’.  

What is meant by that? A complex notion in itself, I believe it has to do at its heart with the medical approach seeing its patients/clients, as being the object of interventions, as objects to be ‘fixed’ (made better) – an objective that runs counter to the narrative, which I have addressed elsewhere, that ‘people don’t need fixing, society does’.  Without getting too much into the different aspects of the term ‘medicalization’ the overall objection to Medicare coming from this vantage point is in the way Medicare interventions are offered to people.  In short, the objections to Medicare for advocates for persons with disabilities is in the way Medicare is delivered.

But there is a fundamental problem.  Medicare was not conceived as a delivery system. That system was already in place when it was created.  Rather, Medicare was conceived as a funding system, a way of paying for medical services. It was an insurance-based model of funding. How did it work?  In the words of Tommy Douglas, the founder of Medicare in Saskatchewan, “You go to your Doctor (or hospital), and instead of the bill going to you it goes to the government.”  It is paid for out of public funds where the premiums for the insurance are generated through the national tax system. This was universally accepted because everyone would benefit and because everyone’s basic health needs would be paid for.  That is Medicare.

Every Canadian Counts has been advocating for an insurance-based funding system for persons with disabilities along very much the same lines a s Medicare. It is in recognition that in the delivery of such funded services will have the distinct mark and character and priorities (values) the embody the disability support system today. As with Medicare’s creation in the 1950’s and 60’s the fusing will not only gee to support the current system, but also work to improve it because the resources and oversight will be available to produce quality outcomes while generating considerable efficiencies. 

Disability activists in the decades that embrace de-institutionalization have tackled all sorts of problems related to persons with dyabilities: housing, employment, education, inclusion, and they have done it from their small corners. In a culture of competitive fragmentation, they have not come together to address the problem that faces them all – chronic underfunding. They all face this, and in the meantime for all of them but above all for the persons that need the supports.