Belgian doctors strike to block single-payer healthcare, 1964

During the 1950’s and 60’s, as many countries advanced and became more
industrialized, doctors in organized medicine tried to push back against
the post-World War II trend of increased state involvement in medical
care. The worry was that state involvement would, over time, reduce
doctors’ income and self-governance.  Belgium was a unitary state in the
1960’s and only became a constitutional federation in 1993. Belgium’s
social insurance system was private but also corporatist.  At the time,
the system consisted of five health insurance funds called mutualités.
The funds were organized by political ideologies, including: Liberal,
Socialist, and Christian funds.  Doctors argued with the government for
years throughout the 1950’s against these groupings, but they were not
heard, despite their status as members of the  social elite.

The public institution for these five funds was called l’Assurance
Maladie-Invalidité, or AMI.  This institution set a fixed fee for all
doctors, medical specialists and general practitioners. In 1959, Edmond
Leburton was appointed the new chair of the Socialist health insurance
fund.  He campaigned for a health service modeled after the British
system. He believed that growing deficits in salaries resulted from high
administrative costs due to the division into the five funds and the
inflationary manner in which the fee-for-service system worked.  By
1960, a huge recession hit Belgium, and in response the government
decided to cut spending. The Christian-Liberal coalition government
introduced a new law, Loi Unique, that kept the fee-for-service system.
In response, doctors protested in the streets along with civil servants.
Loi Unique applied stricter controls on the five funds, and created
harsher fixed fees. Article 52 specifically stated that doctors who did
not follow the maximum rates would face a fine, or at worst,
imprisonment. In response, the doctors banned together and started the
Contact Commission to consolidate their voices against the new law. The
government ignored them. During the 1961 elections, a new
Socialist-Christian government, including Leburton’s former partners,
was put in place, and it appointed  him Minister of Social Health Care. 
Health professionals were outraged since they had no choice in electing
Leburton.  Consequently, an even worse relationship between the
government and organized medicine followed.

In order to be heard, they needed a powerful political organization,
good communication among all doctors and supporters, public information,
and funding.  In 1964, doctors against the new law held their first
mass meeting in Brussels in order to show how many doctors were in favor
of change.  Combining with already existing doctor groups, including
FMB (Belgian Medical Federation), they joined together to create a new
national organization called the Association Générale des Médecins
Belges or AGMB.  Together, they published a public guide to help people
understand the problem, called a White Paper.  The paper criticized Loi
Unique and the recommendations of AMI. They issued their own AMI reform
proposal, and asked to be included in any and all future negotiations
over AMI.  With all the upheaval and the bad press, Leburton agreed to
negotiate with five members of AGMB. On 20 October 1961, these five
members came to an agreement with Leburton without involving the
majority of the other AGMB members.  The majority began to attack the
negotiations publically and show their discontent.  The negotiations
were not approved.

The older and younger doctors divided, since the older doctors preferred
to work out a compromise with the government, while the younger members
remained unwilling to compromise. The younger doctors began to hold
secret meetings, issued letters asking all doctors not to sign anything
from the AGMB, and most importantly, on 30 May 1962, created syndical
chambers of medicine.  The format of these chambers borrowed from
earlier Belgian resistance during WWII.  They divided the members, which
represented 94% of all doctors, into cells of ten, each one having a
representative, who relayed messages to and from the direction
committee.  They stressed equality and unity among the doctors, treating
all generalists and specialists equally, as well as distributing
communication in both French and Dutch.  Since they did not have an
office to manage finances and raise funds, they hired a staff of
lawyers, economists, and tax specialists.  They operated completely
underground without the knowledge of the government or AGMB. When AGMB
dissolved from little support or membership, the government assumed it
was due to disorganization. The chambers wanted  to affect conversation,
so they created a new public national emergency organization named the
National Committee for Common Action (NCAA), which represented all
medical associations, including their secret underground one.  

A new law, Loi Leburton, was finalized by August 1963, and the chambers
were still trying to delay its implementation.  On 19 October, 1963,
4,500 out of 12,665 doctors initiated a strike. In January of 1964, CNAC
abolished itself due to lack of involvement and agreement, and the
chambers came out of hiding.  By the end of March,  8,000 doctors took
to the streets, and the government chose to  delay the bill.  The strike
lasted 18 days.  The government held a meeting to negotiate on March
31st, but the doctors were not willing to negotiate.  They announced
their total and unlimited strike later that day.  A large media presence
further destabilized the government. Hospitals became overcrowded
within two days, and the government had to open the military hospitals.
Both sides invoked the need for Health Care to argue that their opponent
should back down.  

On 9 April, rectors of four Belgian universities offered to mediate
negotiations between the government and the doctors.  The original
negotiations were supposed to be held on 7 April, but after a snide
comment by the Prime Minister, the doctors refused.  The government, in
response, became nervous, and demanded that all doctors return to their
duties or face repercussions.  In response, the media and citizens alike
criticized the government, and the government gave in.  The
negotiations were rescheduled for 17 and 18 April, when they revisited
and changed their positions based on the demands of the doctors.  In the
end, the doctors received their fee-for-fee earnings, nonintervention
by the government on doctor’s judgement in specific cases, and state
neutrality in overseeing administration.