By now, just about everyone in Canada knows the story. When he was a young boy, Tommy Douglas fell and hurt his leg. Faced with amputation, as a result of his family not being able to afford the operation that would save his leg, the future premier of Saskatchewan was spared having to wear a prosthetic limb for the rest of his life when a renowned surgeon, Dr. R.J. Smith, offered to operate for free, so long as his medical students could watch. While grateful for Dr. Smith’s timely intervention, Douglas made it clear years later that as far as he was concerned no child should ever have to depend upon the ability of his or her parents to raise the necessary funds to engage the services of a first-class surgeon, saying that had he been a rich man’s son, he’d have had no problems getting the treatment he needed in a timely manner instead of having to depend upon chance for a cure.
Thus, the seed of medicare was planted.
Thomas “Tommy” Clement Douglas was born in Falkirk, Scotland. He immigrated to Canada with his family for a second time in 1918, having originally come over in 1910 before returning to Glasgow, Scotland, for a brief period following the outbreak of the First World War. An amateur boxer, a Baptist minister, and a politician, it seemed there was nothing the scrappy Douglas couldn’t do, no challenge he wasn’t willing to take on.
After being elected the first Co-operative Commonwealth Federation (CCF) premier of Saskatchewan in 1944, winning forty-seven of fifty-three seats, and forming the very first democratically elected socialist government in North America, Tommy Douglas rolled up his sleeves and got to work. During that first term, the new government created Saskatchewan’s first publicly owned power company, which enabled the province to begin extending electrical services to remote farms and small towns and villages. The Douglas government also introduced Canada’s first publicly owned auto insurance plan, as well as a program that offered free hospital care to all residents of the province — a first in North America. Before his inaugural term in office was over, Premier Douglas proudly ushered in the Saskatchewan Bill of Rights, and introduced legislation allowing the public service to unionize. Remarkably, the CCF would win four more majorities in Saskatchewan, making for a total of five in all. It was at last swept out of office in 1964, after Douglas had stepped down as premier in 1961 to become leader of the federal New Democratic Party.
Before leaving Saskatchewan for Ottawa, however, Tommy Douglas had one more trick up his sleeve — the introduction of universal health care coverage in Saskatchewan. Thanks to a booming economy and prudent fiscal stewardship, the Douglas government had managed to pay off the large public debt that had been left them by the previous Liberal government, resulting in a modest surplus for the province. This, coupled with a promise from the Diefenbaker government in Ottawa to give more money for medical care — fifty cents on the dollar — to any province that introduced a hospital plan, opened the door for the introduction of medicare in Saskatchewan.
The Saskatchewan Medical Care Insurance Act received royal assent in November of 1961, but implementation was delayed until July 1, 1962, by Douglas’s successor, Woodrow Lloyd, to allow for a cooling-off period in the long and very public quarrel with the province’s doctors, who were vehemently opposed to the plan. In spite of this delay, 90 percent of Saskatchewan’s doctors went on strike on July 1, shutting down the health care system in the province for the next twenty-three days. The doctors had a number of concerns. Chief among them was a fear the medical profession would suffer significant losses of both income and autonomy. They were particularly worried that the government would interfere with the way doctors practised medicine, coming between them and their patients, or might even deny patients the right to choose their own doctor. Eventually, a truce was reached and the strike came to an end, thus ending the dispute — though the tension between doctors and their political masters would continue to percolate just below the surface for many years.
Ironically, it was this resistance by organized medicine that ensured the success of medicare in Saskatchewan, and ultimately paved the way for a similar program to be rolled out by the federal government all across Canada over the next decade. I believe I can explain why this was so. As someone who has worked with doctors for many years now, I’ve come to understand how physicians think and why they’re often their own worst enemies. The answer is quite simple, really. Doctors, as a result of their training, know a great deal about a very limited field. They, even general and family practitioners, are society’s ultimate specialists. Unfortunately, doctors tend to think they know a great deal about everything. They’re convinced they are great negotiators. Or gifted public relations gurus. This is why when governments choose to act and make changes to something as complex and complicated as our health care system — as they are known to do every now and then — doctors will typically open their mouths in order to insert both feet without stopping to think about what they’re saying and what the ramifications of their words might be.
This is precisely what happened in Saskatchewan in the early 1960s. One can’t help but cringe at some of the tactics the medical profession used to try to make their case. They suggested, for instance, that the government would bring over the “garbage of Europe” to replace Canadian doctors. They burned Tommy Douglas in effigy and distributed pamphlets and posters portraying the CCF as a bunch of commies. Many shuttered their offices, and deliberately understaffed emergency departments, which may well have contributed to the tragic death of nine-month-old Carl Derhousoff on the first day of the strike. No wonder the public turned against doctors. Physicians made it easy for them to do so.
And yet, for a while there, it looked like the doctors were going to win the day with their anti-medicare campaign. Importing tactics first road-tested by the American Medical Association and the private insurance industry that had proved successful in the United States, the College of Physicians and Surgeons of Saskatchewan, together with the Canadian Medical Association, launched its first offensive during the 1960 provincial election. While the opposition parties, sensing the popularity of “free” health care, chose not to come out against Tommy Douglas’s plan, those with money and the media made it clear where they stood — with the doctors. More than $100,000 was raised for a public relations campaign — in today’s world, the equivalent of nearly $1 million — which was more than any individual party could spend during the election period. Every home in the province received printed material decrying the horrors of socialized medicine. Radio and newspaper ads were also important parts of the propaganda campaign. In addition to this media bombardment, local chambers of commerce and boards of trade got involved, holding public meetings, which featured presentations by leading physicians and others in the community. Doctors who defied their colleagues and came out in favour of medicare were ridiculed and shunned by the rest of the medical profession.
The campaign was ugly, crude, and effective … at first. People were told, among other things, that the government could institute a policy whereby the mentally infirm would be forced to have abortions or be sterilized. After all, hadn’t Tommy Douglas come out in favour of this very thing when he wrote his master’s thesis on eugenics in 1933 while at McMaster University in Hamilton, Ontario? And what if the government legislated that civil servants — instead of physicians — would be the ones making decisions on who should or shouldn’t be committed to a mental hospital? As scare tactics go, these were pretty good — even if they were more than a little over the top. However, voters in Saskatchewan weren’t nearly as naive and easily conned as Americans. When the smoke had cleared and the election results were announced on June 8, 1960, the CCF had taken thirty-seven of the fifty-four seats in the legislature, receiving 42 percent of the vote in a four-way race. Not surprisingly, Tommy Douglas and his cabinet interpreted those results as giving their government a strong mandate to move forward and implement the plan.
And then a funny thing happened.
Tommy Douglas lost his focus for a moment, just long enough to have his arm twisted by his federal cousins up in Ottawa. The brand spanking new New Democratic Party needed a leader, and in the autumn of 1961 Douglas, to the surprise of just about no one, took on the challenge. Now, it’s easy to play the “What if?” game. “What if such and such had (or hadn’t) happened?” But in this case, Douglas’s decision really did change the course of history, having a huge and significant influence on how we ended up with our modern health care system. Had he turned down the offer, Premier Douglas likely would have stayed on as leader of the CCF and ensured a less bumpy ride for his government’s pro-medicare legislation. Instead, Douglas handed over the reins of power to Woodrow Lloyd, who then proceeded to very nearly drive the medicare bus over the cliff.
Sensing an opening, the leaders of organized medicine in Saskatchewan redoubled their efforts. If they couldn’t stop socialized medicine from being introduced in the province, so went the thinking, perhaps they could put up enough resistance that the new premier would opt for a watered-down version of medicare. One where, instead of setting up a publicly funded system, the government would limit its involvement to simply subsidizing existing medical insurance programs — programs that had been established by and were being run by doctors.
With the help of the Saskatchewan Liberal Party, who had lost five elections in a row and who must have felt the 1964 election would be theirs for the taking now that the popular Douglas was out of the way, Saskatchewan’s doctors started preparing for round two. Determined not to lose this time out, the doctors recruited as many community leaders as they could. One such anti-medicare advocate, Athol Murray, a priest, commenting on the doctors’ strike, proclaimed on a radio program broadcast province-wide, “This thing may break into violence and bloodshed any day now, and God help us if it doesn’t.” (Italics mine. The quotation is correct. Murray actually said this.) Things got so bad that the Catholic Church stepped in and ordered the priest to make himself scarce until the battle was over. But Athol Murray had nothing on the right-wing movement known as the Keep Our Doctors (KOD) Committee. Like the Tea Party in the United States, which would turn American politics on its head forty years later, the KOD movement attracted the ill-informed and undereducated. The movement’s organizers made it crystal clear they were not only against socialized medicine but wanted to rid the province of all forms of socialism.
As often happens with these public campaigns, though, the anti-medicare side overplayed its hand and badly misread public sentiment. Dedicated groups of CCF supporters, trade unionists, health care advocates, and even a few doctors who dared defy their colleagues at great personal expense formed a loose coalition of their own. Suddenly, community clinics began springing up all around the province — clinics that were determined to enter into contracts with those doctors who’d refused to go on strike. Eventually, it was thought, these clinics, by providing the public with an alternative to the fee-for-service brand of medicine most of Saskatchewan’s doctors were fighting so hard to preserve, might prove to be so popular with the public they would become the wave of the future. Those responsible for building and staffing these community clinics would soon form groups such as Citizens in Defence of Medicare and Citizens for a Free Press as a way of countering the other side’s propaganda campaign.
Public opinion eventually swung in favour of the government, and the College of Physicians and Surgeons called off the strike in exchange for a few minor tweaks, which led to the signing of an accord with Premier Lloyd and his government that would ensure medical insurance would be controlled by the Government of Saskatchewan, compulsory, universal, and as comprehensive as reasonably possible. A victory for the people of the province and for Woodrow Lloyd — or so it appeared at the time. But in the strange way things often happen, Ross Thatcher, leader of the Saskatchewan Liberal Party, managed to skillfully lay the blame for the 1962 doctors’ strike at the feet of the premier and, with the help of the right-wing forces who’d fought so hard against the implementation of medicare in the province, defeated the Lloyd government in the provincial election of 1964. Thatcher then turned around and stunned his supporters by promising to make no changes to medicare when he took over as premier, proving once again that politics is nothing if not unpredictable.
So, what’s to be learned from the Saskatchewan experiment more than half a century later? Not much, apparently. While Tommy Douglas has been canonized by the pro-medicare forces — the ones who’d have us believe our health care system, as it is currently constituted, is in fact sustainable and that the status quo is just fine, thank you very much — I can’t help thinking poor Tommy must be rolling in his grave. Because the pro-medicare bunch are wrong. And if he were still alive, the first person who’d point out that they’re wrong would be, ironically enough, the former premier of Saskatchewan. For, you see, Tommy Douglas, despite the mountain of propaganda others have built up around him over the past six decades, was not a man stuck in the past — an inflexible, unmovable, and thoroughly stubborn man, whose vision of health care was blurred by misguided and thoroughly useless principles.
Truth be told, the version of medicare Tommy Douglas introduced in Saskatchewan back in the early 1960s was not a finished product — not by a long shot. It was a work in progress. Reorganizing how health care was funded in the province was only the first step. Douglas knew that the only way his plan would work was if all of those involved in the delivery of care embraced the concept of illness prevention and health promotion, as well as the extension of care out into the community. In other words, in order for the new system to succeed, the premier needed buy-in, not just from doctors, nurses, pharmacists, and other health care professionals, but also from the public.
And despite what the pro-medicare forces would have you believe, Tommy Douglas wasn’t against Canadians paying out of their own pockets to help fund medicare. As a matter of fact, he felt it was important the public make some kind of contribution to the cost of their own health care. “I think that there is value in having every family, and every individual, make some individual contribution,” he said. “I think it has a psychological value. I think it keeps the public aware of the cost and gives people a sense of personal responsibility. Even if we could finance [medicare] without a per capita tax, I personally would advise against it.” Tommy Douglas, the prairie pragmatist, knew what he was talking about. The “if it’s free, it’s for me” mentality that has grown up around medicare since it was introduced proves that. Without paying their fair share, people will naturally shrug their shoulders and ignore the true cost of trying to sustain Canada’s health care system.
Here’s something else you probably didn’t know about the form of medicare Tommy Douglas delivered to the people of Saskatchewan. The legislation allowed for a parallel private health care system to exist right alongside the one run by the government. People and doctors could choose to “opt out” of the provincial one if they so desired. In addition to this, Saskatchewan’s doctors were allowed to determine their own prices, a practice known as “balance billing.” The mind-numbing government monopoly that’s currently holding us back and stifling innovation didn’t exist until the passing of the Canada Health Act in 1984. What Tommy Douglas was in favour of was a guaranteed, affordable health care system that everyone in his province could access. He felt no one should lose their home or have to declare bankruptcy, as often happens in the United States, just because they got sick. However, the premier had no problem letting people pay a little extra if the public system wasn’t meeting their needs. In fact, Douglas himself hired private nurses to care for his daughter Shirley so she could stay at home when she came down with the measles, instead of having to be confined to a public hospital.
Proof that sometimes truth is stranger than fiction.
Stephen Skyvington’s book, This May Hurt A Bit: Reinventing Canada’s Health Care System, was published February 2019 by Dundurn Press. Follow him on Twitter @SSkyvington.