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While mainstream discourse on the struggle for Medicare tends to credit the high-profile political leaders who fronted the movement, the struggle was in fact a collective one, won through popular grassroots support and the tireless work of countless community activists. These activists, whose combined voices were the real strength of the struggle, are however left out of the history books. They are systematically ignored in Saskatchewan’s Centennial Encyclopedia.
History is typically reconstructed by those currently in power, which serves to help stabilize the status quo. The idolization of Medicare’s political champions disregards the contributions of the popular grassroots movement to Medicare’s success across the country, which is disempowering and leaves us all more inclined to wait for the next Tommy Douglas to help us make history. In view of the imperative of tackling the climate crisis and moving towards sustainability we really can’t engage in such a waiting game. Remembering the grassroots history of Medicare is also a good first step toward reengaging to rejuvenate today’s deeply troubled healthcare system.
The text book history
The standard story of the origins of Medicare highlights the contributions of Saskatchewan premiers Tommy Douglas and Woodrow Lloyd, Minister of Public Health Bill Davies and high-profile opponents of Medicare such as Father Athol Murray and Saskatchewan Medical Association (SMA) president Dr. Staff Barootes. Douglas is most readily associated with Medicare, which is likely why he won CBC’s “greatest Canadian” poll a few years back. In 1944, on a radio announcement during his election campaign, he famously declared “We believe…we can ultimately give our people a completely socialized system of health services, irrespective of…individual ability to pay.” In 1947, as Minister of Health as well as Premier, he brought forward the Saskatchewan Hospitalization Act – the first public financing for hospitals in Canadian history. Then, in 1959, when the economy was stronger and federal government under John Diefenbaker more supportive Douglas announced his plan to proceed with Medicare.
This deeply aggravated the province’s doctors who at the time jealously guarded private enterprise medicine. The Saskatchewan College of Physicians and Surgeons vocally opposed the plan, and they were supported by “Keep Our Doctors” (KOD) committees, which were established among mothers who were erroneously told they would lose their personal doctors under Medicare. The only mothers who were threatened during the actual crisis were those who were expecting babies and whose pro-Medicare doctor was refused hospital privileges. One pregnant mother protested this by parking herself on the doorsteps of a hospital. The political forces whipped up recently in the U.S. to oppose Obama’s watered-down attempt to get a public option in healthcare insurance are reminiscent of the extremist rhetoric of the KOD campaign. Some people feared for Premier Lloyd’s safety. We also now know that in 1962 American medical and pharmaceutical organizations worked behind the scene to try to stop Saskatchewan from becoming a continental beachhead for Medicare.
In 1961 Douglas left Saskatchewan to head up the newly founded New Democratic Party (NDP). Premier Woodrow Lloyd picked up the gauntlet for universal health coverage, introducing and eventually passing the Saskatchewan Medical Care Insurance Bill, making Saskatchewan the first province to have free universal medical insurance. As Minister of Public Health, Davies helped the province to avert a potentially catastrophic doctor shortage during the Doctors’ Strike of the summer of 1962 by bringing in doctors from abroad. After the Doctor’s Strike ended, Allan Blakeney replaced Davies as Health Minister. Later Blakeney became NDP leader after Woodrow Lloyd was forced out of this position in 1970, after losing the 1964 election to Ross Thatcher and the provincial Liberals. Lloyd went on to briefly work in international development with my father Bill Harding in the United Nations Development Program (UNDP) until his untimely death in 1972. In 1979 Diana Lloyd published a compelling and politically revealing biography of her father, entitled “Woodrow”.
Soon after Medicare was established, Chief Justice Emmett Hall headed a federal Commission appointed by Diefenbaker that recommended that Medicare be expanded across Canada, and in 1966 the Lester Pearson Liberal government passed the Medical Care Act which guaranteed publicly funded universal health insurance for all Canadians. The heated struggle in Saskatchewan had laid the basis for a Canada-wide plan. In 1984, under the committed leadership of the federal Health Minister, Monique Begin from Quebec, the liberal government passed the Canada Health Act to set out conditions for federal transfer payments for provincially-controlled healthcare. Medicare however continued to be threatened by the expansion of for-profit medicine.
The role of community clinics
Community clinics played a critical but often ignored role in the struggle for Medicare. While the Lloyd government was weakening, after the KOD rallied 5,000 people to the legislature on July 11, 1962 to oppose Medicare, grass-roots meetings were being held across the province to raise money to buy buildings and start community clinics that could hire doctors who supported Medicare. Thousands of people were mobilized. Doctors like Sam Wolfe and Orville Hjertaas helped establish clinics in Saskatoon and Prince Albert. British doctors were hired in Regina and elsewhere. Sam Wolfe went on to co-author the still definitive 1967 book, Doctor’s Strike: Medical Care and Conflict in Saskatchewan.
Woodrow Lloyd consistently praised the role of the community clinics in consolidating support for Medicare. Jack Kinzel, the first Secretary of the Medical Care Insurance Commission (MCIC), called the birth of the community clinics “a very important aspect of putting Medicare in place.” According to him, the “the activities of the clinics – the opening of the clinics in key centres in the province, small and large – did frighten the doctors and did make them uncertain about their ability to bring off what they were trying to do.” Speaking to Regina Community Clinic’s 1987 AGM, past Premier Allan Blakeney said that “Community clinics were on the very front line in the Medicare battle in 1962. They made Medicare possible”.
Stan Rands, who became the executive secretary of the Community Health Services Association (CHSA), is one of the unsung heroes in the development of community clinics and the launching of Medicare. Rands quit his 11-year job in Psychiatric Services, most recently as Assistant to the Director, to take on the new position in the midst of the heated conflict between doctors and government. In the Introduction to Rands book, Privilege and Policy: A History of Community Clinics in Saskatchewan, published post-humously, retired theology professor Ben Smillie wrote, “Rands, who calmly stood with [his wife] Doris in the eye of the storm, is one of the true heroes of Saskatchewan Medicare, and therefore a national hero of Canada.”
Stan worked closely with the CHSA’s founding President, Bill Harding, who had just returned from his first assignment with the UNDP to later become Provincial Secretary of the NDP and was Chairman of the Regina clinic board from 1962-65. These two men worked to the edge of exhaustion to establish clinic groups in 35 locations throughout the province. Stan and Bill also worked closely with Ed Mahood, renowned professor of Educational Foundations at the University of Saskatchewan, who was the first chair of the board of the Saskatoon clinic, which pioneered interdisciplinary community medicine in the province; and with Roy Atkinson, known most for being president of the National Farmers Union, who was founding Vice-President of the CHSA and followed Harding as its president There were hundreds of others putting their heart and soul into this work, but Stan Rands, Bill Harding, Ed Mahood and Roy Atkinson were the peaceful “generals” in the grassroots struggle for Medicare. They kept their cool in the face of provocation that tried to polarize and escalate the conflict and derail the Medicare legislation, and put organizational voice to the broad-based grass-roots support for Medicare.
Several other citizens groups sprung up in support of Medicare. Citizens for a Free Press, founded by long-time community activists Ben and Adele Smillie, lobbied the Saskatoon Star Phoenix newspaper to stop rejecting pro-Medicare letters to the editor. Saskatoon’s Citizens in Defense of Medicare also rallied people to show their support for Medicare.
Though Medicare is certainly the highest profile event in Saskatchewan’s first hundred years, none of the major community clinic activists are mentioned in Saskatchewan’s Centennial Encyclopedia. (A tiny piece by Denis Gruending, who in 1973 authored The First Ten Years, Saskatoon Community Clinic, mentions only the doctors involved with the birth of the clinics.) Contrast this with high-profile opponents of Medicare. One of the most vocal anti-Medicare spokespersons was Father Athol Murray who regularly made incendiary speeches on behalf of the KOD, once saying “We must get off the fence and make our views known”, continuing, “This thing may break out into violence and bloodshed any day now, and God help us if it doesn’t.” He is profiled in the Centennial Encyclopedia as the founder of Notre Dame College at Wilcox, home of the Hounds hockey team, and being in the Saskatchewan Sports Hall of Fame, but his provocative, outrageous opposition to Medicare isn’t mentioned. Another high-profile, staunch opponent of Medicare profiled in the Encyclopedia is Dr. E.W. (Staff) Barootes, who was the SMA President in 1962, went on to be appointed to the Senate by the Mulroney government, and like Father Murray, was appointed to the Order of Canada.
The important role of the labour movement in creating Medicare is indirectly acknowledged in mainstream history. Public Health Minister Davies, who helped bring pro-Medicare doctors to Saskatchewan, came from labour into politics, as did Walter Smishek, Minister of Health under Blakeney, who the Centennial Encyclopedia notes stood alone in opposing user and deterrent fees when he sat on the Advisory Planning Committee prior to Medicare. The Encyclopedia also notes that long-time labour activist Clarence Lyons was the “first president of the Saskatoon Community Clinic.”
Women have been mostly left out of the discourse around the origins of Medicare. During the Doctors’ Strike, when the overwhelming majority of doctors closed their doors, it was female doctors like Saskatoon’s Marg Mahood and Joan Whitney-Moore that kept their doors open to provide medical services. And the community clinics wouldn’t have gotten off the ground without women’s unpaid domestic labour – organizing fund-raising events, physically setting up and decorating the new clinics, and doing some volunteer office work. My mother, Bea, worked many long nights to sew curtains for all the Regina clinic office windows.
An unfortunate compromise
Desperate to end the Doctors’ Strike, the Lloyd government agreed to a compromise with the SMA. On July 23, 1962 the two parties signed the Saskatoon Agreement, which saw government acquiesce to doctors’ demands to keep fee-for-service as the sole form of payment. Those working at the grassroots to build community clinics tried to get the provincial cabinet to hold out for more popular support, but the government buckled under the political panic created by the strike. It agreed to alter the legislation to allow doctors to practice outside Medicare, to pay doctors under the plan 85% of the College of Physicians fee schedule, and to increase the power of the doctor’s business association, the SMA, within the MCIC. In his official centennial history, Saskatchewan: A New History, Professor Bill Waiser oversimplifies this by saying this was “removing sections…that implied government control of doctors.” This was the SMA’s clarion call but not what the conflict was about; it was primarily about defending for-profit , fee-for-service medicine or replacing this with a public system, like our educational system.
This rolling back of public policy was devastating to the community clinics. As Bob Reid notes in his 1988 popular history, More Than Medicine, the Regina clinic went through years of internal power struggles over community versus medical control of staffing and policy. Still having a monopoly on the clinic’s earning power, some doctors wanted to keep organizational power, and a clinic so divided could not build the needed team-work. The introduction of global budgets in the 1970s helped by providing some resources for interdisciplinary and preventative program development, but by then the momentum for community (“socialized”) medicine had waned. The hopeful province, which had seen 25 community clinics spring up from the grass-roots in less than a year, ended up by the mid-1990s with only 5 struggling clinics.
The history we create today
Despite passionate and hopeful beginnings, public healthcare in Canada is now in relapse. In 2001, with the growth of for-profit clinics threatening to expand two-tiered medicine, past Saskatchewan Premier Roy Romanow was appointed to head the federal Commission on the Future of Healthcare. One main recommendation was about the need for primary healthcare reform. As Romanow said in 2002 “no other initiative holds as much potential for improving health and sustaining our healthcare system.” This will require full-service community health clinics, such as were envisaged during Saskatchewan’s struggle for Medicare. It was telling and a little ironic that Romanow had to go outside Saskatchewan, to a community clinic in Sault Ste. Marie, Ontario, to find what he called “the best kept secret in the country”. Today, only four community clinics survive in Saskatchewan.
Rather than Medicare leading to community-based access to progressive medical practice, much of the province’s and country’s population is dependent on impersonal, for-profit, walk in clinics. Provincial health care systems are a hodge-podge of private and public services, with important preventive services in Saskatchewan like massage and chiropractics now totally un-funded, while there is escalating public expenditure for many unnecessary, ineffective, risky but profitable pharmaceutics. Pharmacare user-fees discriminate against the disadvantaged and disabled, homecare for the bulging senior population is severely under-resourced, and dental insurance is far from universal and remains in private hands.
Evidence-based medicine makes only slow progress in an environment where private interests dominate and could have flourished much better in a thoroughly public Medicare. Meanwhile, many families are without continuity of care from family doctors. During the visionary days of the struggle for Medicare no one imagined the widespread indignity to come. Learning a balanced history of the struggle that acknowledges Medicare’s grass-root pioneers is the first step to creating new momentum to realize the vision of Medicare. Better knowing this popular history can also inspire us for making other vital social changes, such as the shift to a public, democratic renewable energy system.
Aug. 5, 2010