Canada's publicly funded health care system is often described as a defining national institution. Less often acknowledged is how much of its existence is owed to the organised labour movement. Unions and labour councils lobbied, marched and bargained for universal health care for decades before it became federal law — and they have spent the decades since defending it against erosion and privatisation.

The Roots of the Demand

The campaign for publicly funded health insurance in Canada began in earnest in the 1930s, when the Great Depression made the cost of medical care ruinous for working families. The Co-operative Commonwealth Federation (CCF), the social-democratic party founded in 1932 with strong labour and farmer support, included health insurance in its founding Regina Manifesto. The Trades and Labour Congress and, later, the Canadian Congress of Labour endorsed the principle of universal health insurance and pressed governments to act.

The immediate postwar period brought new momentum. Returning veterans and their families were unlikely to accept a return to pre-Depression conditions, and the federal government, aware of the electoral threat from the CCF, established the Royal Commission on Dominion-Provincial Relations (the Rowell-Sirois Commission) to examine social policy. The case for health insurance was made at these hearings by labour representatives who presented detailed data on the cost of illness to working families and its effects on workplace participation.

Saskatchewan and the CCF Experiment

The breakthrough came at the provincial level. In 1947, the CCF government of Tommy Douglas in Saskatchewan introduced hospital insurance covering the full population of the province — the first such scheme in North America. Saskatchewan's hospital insurance was almost immediately successful: hospitalisation rates went up as people who had previously delayed treatment could afford care, and the province demonstrated that a public system could be financially and administratively viable.

Labour councils across Canada pointed to the Saskatchewan experience as evidence that universal coverage was practical, not merely aspirational. The Canadian Labour Congress, formed in 1956, made national hospital and medical insurance a central legislative priority. The CLC's submissions to federal committees and royal commissions provided the detailed costing and administrative analysis that gave proponents of public insurance credible answers to opponents who claimed it was unworkable.

The Hall Commission and the Path to Medicare

In 1960, Prime Minister John Diefenbaker appointed Justice Emmett Hall to lead a Royal Commission on Health Services. Hall's commission consulted widely, receiving submissions from unions, medical associations, provincial governments and community organisations. Labour's submissions were among the most detailed, presenting data on the health status of workers and their families, the cost burden of illness on low- and middle-income households, and the experience of hospital insurance in Saskatchewan and later other provinces.

Hall's final report, published in 1964, recommended universal comprehensive medical insurance — what became known as Medicare. The report was a major political event, and labour celebrated it. The CLC and affiliated labour councils lobbied hard for the Pearson government to act on the recommendations. The Medical Care Act was passed in 1966 and came into force in 1968, establishing federal cost-sharing with provinces that met the criteria for universal, comprehensive, publicly administered and portable coverage.

Labour's Ongoing Defence of Public Health Care

Winning Medicare was not the end of the campaign — it was the beginning of a permanent defence. Throughout the 1970s, 1980s and beyond, provincial governments facing budget pressures introduced extra billing by physicians, facility fees and service delisting that eroded the universality of the original commitment. The Canada Health Act of 1984 was passed in direct response to these erosions, partly as a result of sustained pressure from the labour movement, which documented the return of financial barriers to care and their effects on lower-income Canadians.

Periods of federal and provincial fiscal restraint in the 1990s produced cuts to health transfer payments that reduced hospital capacity and led to waiting lists that became a persistent public concern. Labour councils organised against these cuts, arguing that the health system was being deliberately underfunded to build public support for privatisation. Health care workers' unions — including the Canadian Union of Public Employees and the Ontario Nurses' Association — were at the forefront of these campaigns, combining their members' professional knowledge with the political capacity of the broader labour movement.

Health Care Workers and the Labour Movement

It is worth noting that health care workers themselves are among the most unionised workers in Canada. Nurses, paramedics, hospital support workers, personal support workers and long-term care staff are represented by unions that have bargained for working conditions that directly affect patient care: adequate staffing ratios, limits on mandatory overtime, protections against violence and harassment, and fair wages that reduce turnover.

The connection between worker conditions and patient outcomes has been documented in research on hospital staffing: settings with better nurse-to-patient ratios, lower turnover and stronger labour protections tend to produce better patient outcomes. Labour councils have used this research in their public advocacy, framing good working conditions in health care not as a narrow union interest but as a public health issue.

Looking Forward

The labour movement's commitment to universal public health care remains active. Campaigns for national pharmacare — a public drug insurance program that would extend the Medicare model to prescription medications — have been supported by the CLC and affiliated unions for decades. The federal government made a partial commitment to pharmacare in 2024; labour organisations are pressing for comprehensive coverage as the program is implemented.

Long-term care — the sector that experienced catastrophic mortality during the COVID-19 pandemic, particularly in privately operated facilities — has become a focus of intensive union organizing and legislative advocacy. The case labour is making is the same one made for Medicare seventy years ago: that essential health care should be publicly delivered, publicly funded and publicly accountable.

For more on health care campaigns, visit the Canadian Labour Congress and the Ontario Health Coalition.