Dr Michael Rachlis, who was born and raised in Winnipeg, delivered an address to the University of Manitoba Medical Graduates Convocation on Thursday May 13, on the occasion of his receiving the honourary degree of LLD ( Doctor of Laws) from the University of Manitoba.

Rachlis, who graduated from U of M's medical school in 1975, interned at McMaster University and then practiced family medicine for eight years. He completed training in Community Medicine at McMaster and was made a fellow of the Canadian Royal college of Physicians in 1988. He is the son of Harry and Ruth Rachlis.

A respected and vigorous champion of Canada's public health care system, Rachlis practices as a private consultant in health policy analysis. He has served as a consultant to the federal government, all ten provincial governments, and two royal commissions.
The following is an excerpt from his address to the medical graduates, reflecting on the successes and challenges facing Canada’s health care system:

“Now I would like to briefly address this year’s graduating class. You are some of the most privileged people on this planet. You are fortunate to live in a peaceful and prosperous country. You will be able to “do good” while “making good”.  With very few exceptions you will not have to worry about your patients’ financial circumstances as you plan their care.

“Before Tommy Douglas became Saskatchewan Premier in 1944, Canada had pretty much the same health system as the United States. With Douglas’s leadership and that of Justice Emmett Hall, Mike Pearson, Monique Begin and many others we have created a uniquely Canadian health care system at a time when our two countries have become more similar politically, economically, and culturally. And, Medicare has been good to Canada. Compared with the US we spend much less on health care yet get more services overall. And, everyone in Canada is covered while in the US 50 million have no insurance and tens of millions have such inadequate coverage that over one million Americans declare personal bankruptcy every year because they can’t afford to pay their medical bills. I see the inequity and inequality of the US system every time I visit my wife’s family.

“In head to head studies Canada’s health care quality is as good as or even better than that found south of the border. Medicare dramatically lowers the cost of doing business in Canada and is directly responsible for hundreds of thousands of our country’s best jobs being located here instead of another country.

“But Medicare does have its’ problems. We don’t wait for emergency care but too many Canadians wait too long for doctor appointments, diagnostic tests, and elective procedures. Some Canadians blame Medicare for these problems and suggest a system based on equity and funded by government is unsustainable. Some say Tommy Douglas might have meant well but he bequeathed us a system which doesn’t work. But these waits and delays and other quality problems have nothing to do with the solid values that underlie our system. In fact, Medicare’s problems result from our failure to fully implement Douglas’s vision.

‘In 1982, Douglas told a meeting in Montreal, “Removing the financial barriers between the provider of health care and the recipient is a minor matter, a matter of law, a matter of taxation. The real problem is how to reorganize the health delivery system. We have a health delivery system that is lamentably out of date.”

“In 1970, Douglas asserted in a meeting in Ottawa, “I am concerned about Medicare—not its fundamental principles—but with the problems we knew would arise. Those of us who talked about “Medicare back in the 1940’s, the 1950’s and the 1960’s kept reminding the public there were two phases to Medicare. The first was to remove the financial barrier between those who provide health care services and those who need them.

“He went on to say “The phase number two would be the much more difficult one and that was to alter our delivery system to reduce costs and put an emphasis on preventative medicine…Canadians can be proud of Medicare, but what we have to apply ourselves to now is that we have not yet grappled seriously with the second phase.”

“Douglas’s criticism is as modern as the quality revolution in health care. We could prevent 80% of cases of adult onset diabetes, heart disease, and chronic lung disease with healthier public policies—but we don’t. Once someone has diabetes we could prevent most complications—but we don’t.

“Once someone has heart failure we could prevent most hospital admissions—but we don’t. In Douglas’s vision for the Second State of Medicare we empower patients and families to be active participants in their own care. We purge ourselves of our professional prejudices which block our creative juices and prevent us from seeing the solutions to Medicare’s problems.

“Canadians deserve to see one of their regular primary health care providers the same day they call for an appointment. They deserve to get elective specialty care within one week and elective surgery within two months. And, they deserve to be treated the way you would want your parents treated.

“Tommy Douglas was born in Scotland, but grew up in Winnipeg. As a young boy he developed osteomyelitis, a serious bone infection in his leg and his doctors told him that he had to have his leg amputated. But, at the last moment, Dr. Robert Smith, a prominent Winnipeg surgeon, volunteered his expert services if Tommy agreed to be a teaching patient. These events left Douglas with the view that if he hadn’t been considered an “interesting case,” he would have lost his let. As he later said, “I felt that no boy should have to depend either for his leg or his life upon the ability of his parents to raise enough money to bring a first-class surgeon to his bedside.” He vowed that no Canadian family should ever have to choose between health care and impoverishment. Then he spent the rest of his life achieving this goal.

“My second suggestion is really an exhortation. Doug never did live to see the second stage of his beloved Medicare. Like Moses, he glimpsed the promised land but did not live to enter it. I encourage you, the class of 2010, to complete Tommy’s work and implement Medicare’s second state. Let us reaffirm his vision of social justice and let us finally re-organize the health care delivery system so it is easier for doctors and other caregivers to provide the excellent care all Canadians deserve.

“Thank you again to the faculty of medicine and the university for honoring me today. I am thrilled to have my work recognized by my Alma Mater. In closing let me offer the class of 2010 one more piece of advice from Tommy Douglas, paraphrasing Alfred Lord Tennyson:

“Tis not too late to make a better world.”

“ I wish the graduates every success in making our planet a healthier place for all.