Health Care Policy Making in Canada as Rhetorical Transcendence: 1944-2014

Abstract

Canada’s national program for health services was conceived in the late 1960’s after protracted advocacy on the provincial level – most notably from Tommy Douglas, premier of Saskatchewan. After insured services for both hospital and physician services had been secured in the province in 1961, the Government of Canada faced increasing pressure to nationalize universal health care. Largely in response to the advocacy of Mr. Justice Emmett Hall in his 1964 Commission Report, a national system was instituted into law in 1968 under Prime Minister Lester B. Pearson. Since that time, robust advocacy has waned and successive federal governments have instead focused on defending Medicare through the enactment of rigid legislation such as the Canada Health Act. This legislation and other advocacy has enshrined universal health care into the Canadian psyche making it highly resistant to change. I sought to assess the nature of the advocacy that has served to perpetuate the status quo at all costs and have suggested ways in which the rhetorical landscape could be altered to reinvigorate public discussion to keep Medicare up to date and to ultimately strengthen health care services in Canada. I employed rhetorical and communication theory as a lens for providing suggested pathways for clash and reform.

The following findings were noted in the dissertation. First, rhetorically induced value principles associated with Medicare have devolved into an institutionalized system that has been reinforced through its strong connection with Canadian identity. Second, there has been a marked de-emphasis of rhetoric which has been supplanted by a focus on funding mechanisms and point of service delivery. Third, the more flexible argumentation associated with the legislative realm has been neglected and largely replaced by the more adversarial and rigid enforcement of perceived rights for health care through judicial review. Throughout the dissertation I argued for the need for rhetoric to be resurrected in Canada perhaps through the vehicle of egoistic charismatic political leaders. All in all, I envision a health care system that is more flexible, molded by rhetoric and allows for greater innovation while retaining core principles such as universality.