This post was authored by Chris Simpson, MD, FACC, Ontario ACC Governor and president-elect designate of the Canadian Medical Association.

Canadian Medicare was born in Saskatchewan; its roots dating back to the Depression era. In 1949, Saskatchewan became the first political jurisdiction in North America to introduce public coverage for all hospital services. In 1959, Premier Tommy Douglas announced that the government intended to implement universal and comprehensive medical insurance. Saskatchewan doctors were apoplectic. Douglas won the 1960 election with a mandate to proceed, but the doctors went on strike.

Negotiation eventually led to an agreement. The doctors could still bill patients directly, but patients would just be reimbursed by government. Very shortly afterwards, doctors started billing government directly, having quickly realized that by doing this, payments always came promptly. Doctors’ incomes went up, and opposition to government “control” melted. Further advancing the rate of acceptance was that professional autonomy, if anything, was enhanced. No one told doctors what to do, whom they could see, or what tests they could order.

The Saskatchewan experiment was a success, and by 1972, all provinces and territories in Canada had provincial publicly funded health care. Then, in 1984, the Canada Health Act (CHA) was enacted into law, cementing the universal health care culture in the national political consciousness. The now iconic “Five Principles of Medicare” in the CHA are: public administration, comprehensiveness, universality, portability, and accessibility.

However, Tommy Douglas did not foresee that spending would grow faster than both government revenues and economic growth. In 2010, Canada’s spending on health care was $4,445 per capita (U.S. dollars); one of the highest in the OECD (not counting the U.S., which spends almost twice as much). Our health care spending as a percentage of GDP was 11.4 percent in 2010, fifth highest amongst 34 OECD countries (the U.S. was highest at 17.4 percent).

It is widely accepted that this growth is not sustainable at current tax rates. The question has now become: how do we both preserve the benefits of our system (high life expectancy, high levels of health equity, low infant mortality rates, etc.) and fix the weaknesses (long wait times for some elective treatments and overcrowded emergency rooms) in a fiscally sustainable way?

This is where doctors can help to lead. We can lead by helping our health care organizations find efficiencies. We can lead by helping to transform our health care culture from a hospital-centric (expensive) one to a community and patient-centered one. We can lead by proactively defining what constitutes medically appropriate diagnostic testing and treatment. We need to be on the right side of history.

In essence, we can protect our long-held professional autonomy and our ability to advocate for our patients by also embracing our civic professionalism – our duty to protect and enhance our country’s health economy. I passionately believe that Canada’s doctors can help lead the transformation of our health care system into one that is truly worthy of Canadians’ confidence and trust.

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