Vincent Lam | Archive | Excerpt from Tommy Douglas featured in The National Post

Excerpt from Tommy Douglas featured in The National Post

The National Post
June 21, 2011

est known as Canada's "father of medicare," Tommy Douglas was many things to many people: a champion boxer, a Baptist minister, and a fiery politician. In an excerpt from Tommy Douglas, Vincent Lam's new book in Penguin Canada's "Extraordinary Canadians" series, the Giller-winning author explores Douglas's early fight for universal health care.

Following the [Co-operative Commonwealth Federation's] first election victory in 1944, Douglas brought Dr. Henry Sigerist, a professor of social and preventive medicine at Johns Hopkins University in Baltimore, to Saskatchewan to advise the province on reforming the health care system. By bringing to bear his usual mix of frugality and charm, Douglas persuaded Sigerist to come out of medical duty, without pay, and covered only his expenses.

Sigerist stayed for just a month -he was on his way to a public-health post in India -but in that month, he travelled widely to hear presentations and assess conditions in the province. He remarked to Douglas that given the state of the outhouses in rural Saskatchewan, he was surprised that the citizens of the province did not suffer from chronic constipation. Nonetheless, the recommendations he produced initiated the CCF's development of the health-care system, a process that was to continue over the next two decades. The CCF's infrastructure improvements and the arrival of flush toilets would also make the ceremonial burning of the outhouse a rural Saskatchewan ritual over the ensuing years.

Sigerist noted that the province was near bankruptcy and cautioned it to proceed gradually as finances allowed. He advised the government to begin to build the groundwork and facilities that would allow it to offer progressively more public services. Before full hospital insurance could be implemented, he observed, more hospitals had to be built first. At that time Saskatchewan had the fewest hospital beds per capita in Canada. The ultimate goal should be kept in mind, said Sigerist: "to provide complete medical services to all the people of the province, irrespective of their economic status, and irrespective of whether they live in town or country."

In 1944 the CCF started by addressing the needs of the most vulnerable groups of patients, instituting programs to fund all cancer, psychiatric, and venereal disease treatment. On Sigerist's advice, Douglas set up the Health Services Planning Commission to oversee new programs. A husband-and-wife team, Dr. Mindel Sheps and Dr. Cecil Sheps, came from Winnipeg to head the commission. Early in 1945 government-funded medical care was also extended to the elderly, the blind, recipients of mothers' allowances, and wards of the state. In Swift Current, "Health Region No. 1," a pilot project of full medicare, was established. It included then-innovative public-health measures such as water-safety testing and routine immunization. It worked well, proving on a small scale that such a program was doable, despite the Saskatchewan College of Physicians and Surgeons' attempts to dissuade the doctors of Swift Current from participating.

As the province's finances stabilized, the government renovated or built 33 hospitals. In the spring of 1946 Douglas promised that there would be province-wide hospital insurance running by Jan. 1, 1947. His own Planning Commission felt this was too rapid a pace, but he insisted on pushing ahead. On Sigerist's recommendation, Douglas hired Dr. Fred Mott, the deputy surgeon general of the United States, and Dr. Len Rosenfeld, another American expert in public health, to join the Planning Commission and assist with the implementation of the program. They came to Saskatchewan, assessed the situation, and agreed that it couldn't be done on the premier's timeline.

In most areas Douglas heeded his expert advisors when they recommended cautious, slow progress. In the field of health he sometimes insisted on moving forward despite advice to the contrary. Stubbornly, Douglas told the Planning Commission that they would either bring in the plan by Jan. 1 or be replaced by people who could. Meanwhile, murmurs of opposition by hospital administrators began to bubble up. In December the entire executive of the Saskatchewan Hospital Association arrived in Douglas's office to tell him that they would not co-operate with his plans. They pointed out that many of the hospitals had been built by church funds, charitable donations, and community money and could not simply be taken over.

Douglas explained that the province would not be taking over ownership or administration of the hospitals. It would just pay their bills. His legislation centralized financing, not administration. The advantage, in an era when between 30 and 60% of hospital bills went unpaid, was obvious. Despite all obstacles, the hospital plan began on time, and proved successful and popular. The hospitals became ardent supporters of the provincial plan, and within seven years Saskatchewan had the most hospital beds per capita in Canada.