Setting the Record Straight: A Doctor's Memoir Of The 1962 Medicare Crisis

By Noel Doig

Most people know that in 1962 Saskatchewan became the "birthplace of Medicare" and that the rest of Canada soon followed. But few people today remember the political fight that the people of the province and its doctors waged in opposition to their government's Plan. In Setting the Record Straight, the events of that year are recalled vividly by one who not only witnessed it, but was also an active participant in it.

• Language: English
• Publisher: BookBaby
• Release date: Jul 1, 2012
• ISBN: 9780987810540

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How did a young English doctor, totally uninterested in politics, come to play an active role alongside the leaders of Saskatchewan’s medical profession in their now legendary struggle with Premier T. C. Tommy Douglas and his party—a struggle that culminated in the so-called doctors’ strike of 1962? Soon after arriving from Britain in March of 1958, I drove to Saskatoon to register with the medical licensing authority, the College of Physicians and Surgeons of Saskatchewan. Dr. George Peacock, the College’s Registrar, was keenly interested in hearing about my experiences under the British National Health Service (NHS). He spent three hours with me that day, an interview that should have lasted thirty minutes at the most. At the time, both of us were pipe smokers, and we puffed our way through a considerable quantity of George’s tobacco stock before we’d finished. Later, George introduced me to other members of the College’s Council, its elected executive body, and I soon found myself a junior ally and assistant in opposing Douglas’s plans for a provincial health service, apparently modeled on the lines of the British NHS. At this time, of course, the College and the Saskatchewan Division of the Canadian Medical Association (CMA) were a single body. They remained so until 1967, when the Saskatchewan Medical Association (SMA) was established as the provincial division of the CMA.

My own youth at the time, and the deaths of these far older friends, have left me in a sense as the surviving memory of the profession during those hectic days. Since then, supporters of Medicare seem to have succeeded in rewriting history, showing Douglas as more of a crusader rescuing patients from their own doctors than as the consummate politician he actually was. The time has come, before my own time runs out, to set the record straight. A recent article by the distinguished historian, Margaret MacMillan, in the periodical Oxford Today, has reinforced my purpose.¹ Commenting on an ignorant misunderstanding of the history of what happened at Pearl Harbor in 1941, she writes:

Does it matter that they got it so wrong? I would argue that it does, that a citizenry that has so little knowledge of the past cannot begin to put the present into context, can too easily be fed stories by those who claim to speak with the knowledge of history and its lessons. History is called in … to strengthen group solidarity, often at the expense of the individual, to justify treating others badly, and to bolster arguments for particular policies and courses of action. (16)

That method of strengthening group solidarity by rewriting history has been particularly necessary for the CCF/NDP in Saskatchewan. Although the party attained its aim of introducing Medicare into the province on July 1st, 1962, under its new Premier Woodrow Lloyd, an unforgiving electorate had already chased away Tommy Douglas when he ran for a seat in Regina in the federal election of June 18th, 1962, as leader of the Cooperative Commonwealth Federation (CCF)’s national party, newly renamed the New Democratic Party (NDP). Not only Douglas, but every federal NDP candidate in Saskatchewan, the party’s home province, was defeated in that election and in 1964 the Saskatchewan electorate trounced the party provincially, putting the Liberals in power for several years.

Nonetheless, from 1962 onwards, writers and speakers who support the NDP have made great efforts to strengthen party solidarity and to bolster arguments for Douglas’s ideology on medical affairs, with the result that a national media poll recently voted him the Greatest Canadian. Similarly, supporters of state-controlled medicine have praised Canada’s Medicare system, though most other countries, by avoiding complete state control, have achieved superior medical insurance schemes at less cost. The success of such political propagandists exactly illustrates MacMillan’s thesis. I hope this account will persuade readers to take a different perspective and to accord my old friends and leaders the respect they deserve for their efforts to battle state medicine and to establish genuine and affordable medical insurance in Saskatchewan.

My experience as a physician in England led me to give unstinting support to the leaders of the College, and, through them, to all my colleagues in the profession. In 1957, at the age of 30, I’d become thoroughly disillusioned with working as a general practitioner under the British NHS, and I had reluctantly concluded that I could maintain my skills as a physician and surgeon and practice good medicine only by leaving England. During my compulsory medical service in the Royal Army Military Corps, my wife Joan, our small daughter Anne, and I had lived in the beautiful Surrey countryside. We’d always been ardent nature lovers, so naturally I looked for an opening in a rural general practice. After only one interview, I arranged to train for a year with a middle-aged man who, apart from his wartime service as a medical officer in the Royal Navy, had spent his entire career as a single-handed family doctor in a small coastal town in Essex. Cliff Johnson and I had quickly become good friends. He was the best type of GP—a skilled physician who was devoted to his patients. Sadly, his practice had been drastically altered under the NHS, whose planners had reinforced a rigid classification of physicians as hospital doctors, public health doctors, or general practitioners, where previously some overlap had existed. As a GP, Cliff had thus become excluded from all hospital work before I joined him, and even those laboratory and radiological investigations, which were deemed necessary for his patients, had to be referred to nameless physicians in emergency departments.

Good patient care requires that referring physicians receive reports of the findings made on their patients, but after referring our patients we heard no more, not even the results of laboratory tests or X-rays, and we seldom received reports from specialists, except in the rare case when a specialist was reluctant to continue care. Discharge summaries were almost unknown, so in two years as a GP, I received no reports on patients from a hospital doctor, or indeed any information that might have been helpful in caring for those sent home from hospital. In fact, the NHS system, no doubt accidentally, had succeeded in destroying all continuity of care for patients entering or leaving hospital.

All maternity patients were expected to receive their prenatal care at public health clinics. Public health nurses performed all home deliveries, and a mother’s doctor became involved only when an emergency arose, when the nurse ran into difficulties, or when an obstetrical tear required sutures. Thus Cliff, who’d previously had a flourishing maternity practice, was no longer allowed the pleasure of attending normal, uncomplicated deliveries. He’d always looked after the babies he delivered, but under the NHS, mothers were expected to take them to a local baby clinic staffed by public health nurses. During my training, I’d loved delivering babies and looking after them, and now I was totally cut off from them as patients. In my two years as a GP with Cliff, I did no well-baby care, vaccinated or immunized no infants, and saw only those children who were brought to me because of some illness.

Although I’d stayed on with Cliff for a second year as his prospective partner, and he’d hoped I’d stay with him permanently, he entirely understood my reasons for leaving not only his practice but the whole NHS system, and therefore Britain itself. Joan agreed with me, and both of us were attracted to Canada. We knew the prairies had great stretches of open countryside with villages and small towns scattered among the wheat-lands, and we innocently expected the Saskatchewan landscape would be something like the flat wheat fields of Essex, but on a larger scale.

Under this happy illusion, I answered an advertisement for a family doctor put out by the village of Hawarden, lying between the two main cities of Regina and Saskatoon. We learned from its secretary that the village’s doctor had moved away some months earlier; that the community hoped that the provincial government would build a health center there in future; that rent-free offices were available both at Hawarden and at Loreburn 12 miles away (Canada hadn’t gone metric then); that the village of Hawarden would provide us with a rent-free house; and that a small income would be arranged through contracts with local municipal governments. The basic payment from the surrounding township of Rosedale for holding office hours in Hawarden would be $100 per month, and the payment from the township of Loreburn for holding two weekly sessions in a satellite office in the village of that name would be $100 per quarter.

In exchange for these contracts from the two townships, I was to forego any mileage charges for making house calls to patients living on farms out in the countryside. Since English doctors had always covered all their own car costs while being paid only a small capitation fee for each patient registered on their NHS lists, from 5,000 miles away and with no idea of the distances to be covered, we saw these terms as ideal. Fees for medical care would be over and above the stipulated contract payments. We did the arithmetic and concluded that even before I’d earned any fees at all, we’d be able to survive.

Of course, we were laughably unprepared for the actual situation. Rural Saskatchewan was nothing like rural England, in spite of all these little villages we’d seen dotting the map every few miles, and when we arrived in Saskatchewan in the early spring of 1958, we realized how little we knew about its geography, its history, and particularly about the living conditions of its mainly rural population. At that time, Hawarden, like most villages of the same size, had no piped water and no sewage system, so every house had a biffy in the backyard. A deep well in the central pump house was the village’s only source of drinking water, and the chief link to the outside world was the CP rail line by which we’d arrived, its importance emphasized by a row of five imposing elevators, testimony to the overwhelming importance of wheat in the province’s economy.

After spending our first night in the local hotel, strategically placed at one end of Main Street beside the railway station, we were escorted separately—Joan to see the promised house and me to see the promised doctor’s office on Hawarden’s main street. Main Street was a wide, muddy thoroughfare bordered by four squat wooden stores, all embellished with impressive false fronts that instantly reminded me of the cowboy films I’d seen in my childhood. The bank, an imposing building at the other end of the street, appeared to be built of brick, though a closer look showed it to be a wooden structure like its neighbors.

Next door to the bank was another large building that my guide identified as the drugstore, part of which formed the doctor’s office. The drugstore had obviously been closed for a long time, but at one end of it was a large plate-glass window and the door to the office. The small room we entered boasted two pieces of furniture—a flimsy little metal table and an equally flimsy chair. This was the old ice-cream parlor, my guide remarked cheerily. It’s the doctor’s waiting room now. Behind the waiting room was a large, dark room, lit by a single central unshaded 40-watt lightbulb hanging from the ceiling, and with only one small window on the side wall. The ancient floor was of oiled wood, and the room was empty, with not even shelving on the walls. My predecessor had, of course, taken all the furniture and equipment, which he owned, to use in his new practice.

Meanwhile, Joan was experiencing her own rude awakening as she and the children were escorted to the doctor’s house, a small wooden cottage covered in tar paper colored to look like masonry, which we learned was known as insulbrick. It had a tiny living room with an arch across the middle, unconvincingly designed to suggest that the two halves had separate functions. At the archway stood a metal oilstove, the only source of heat in the house. Two tiny bedrooms were off to one side, and there was a small kitchen at the back of the house. Opening the door to a cupboard under the sink, Joan noted that its drainpipe was only six inches long, and she was told that the correct procedure was to put a pail under the pipe and, as the pail became full, to throw the contents as far as possible off the back doorstep. Behind the house, at a suitable distance, stood the inevitable biffy, and she was assured that It would last at least another month. Fortunately our small daughter discovered a trapdoor in the kitchen floor, with stairs down to a large hole in the frost-speckled dirt under the house, and in the center of this basement was a portable toilet. It had to be emptied into the biffy every day, but at least we didn’t have to trail out in the snow all the time.

The previous doctor and his wife had, we heard, spent most of the Second World War in a concentration camp, so perhaps they were inured to hardship; but my plan to practice in the village was becoming severely tested. However, we couldn’t buy tickets to go back because our bank in England had forgotten to forward the money remaining in our account, so it didn’t arrive until weeks later. This delay in fact proved to be a blessing because while we waited for our money to arrive, we experienced such incredible kindness from everyone in the district that we became sure that we wanted to stay. They organized a kitchen and china shower for us at a dance in the village hall, and the owner of the local grocery store drove me 60 miles to Saskatoon so that I could secure my license to practice by presenting my credentials to the College and then buy the essential car and furnishings for my office—all in one day. The village secretary and her husband showed us how to order furniture from Eaton’s, and in the meantime lent us two folding beds, a table and chairs, and a hotplate to cook on. And, best of all, we were told we’d be moving into a much larger and better house before our furniture was due to arrive. Moreover, within three days of our arrival, I’d also been able to secure my appointment to the staff of Outlook Hospital, 26 miles away along two gravel highways (No.19 to its junction with No. 15, midway between Outlook in the west and Kenaston in the east). Dr. Tom Hatlelid of Outlook had taken me to meet the doctors in Rosetown, Biggar, and Kindersley at a district meeting, and once again I was able to experience the professional collegiality I’d been missing since my internship.

Exactly a week after our arrival, I opened the Hawarden office, but I’d already seen my first patient—a young woman in premature labor. Being able to admit her to hospital and successfully treat her there made me convinced that in spite of all the shocks we’d had, coming to rural Saskatchewan had been the right move. I had become a real general practitioner again, able to look after my patients properly. Even though I still hadn’t seen my equally appalling doctor’s office in Loreburn, we were both certain we’d made the right decision.

From first opening the Hawarden office, I found I was able to provide the degree of comprehensive care I’d dreamed of during my training but which had been impossible under the NHS. With no dentist and no vet within a reasonable distance, I was even asked to fill in for them during emergencies. Fortunately, I’d been warned while still in England to include dental forceps among my equipment, and equally fortunately, I had to use them only once. My only real success in veterinary work was the suturing of a newborn baby piglet whose mother had stepped on him, splitting his back open from head to tail. Fortunately that piglet survived, and a year later I was rewarded with a fine leg of pork. However, when asked to provide a peaceful quietus for a beloved but suffering old dog, I was less successful. A vet would have known how much morphine would be needed for a dog—a lot, as it turned out. Even two doses that would have felled a man weren’t enough, and they constituted my entire stock at the time. Eventually we decided the poor old animal would have to be shot, but at least the morphine had eased its suffering and made it somnolently unaware of what was happening.

Joan’s colleague, the geography specialist at the high school where she’d taught in England, had tried unsuccessfully to persuade us not to choose to come to Saskatchewan by giving us statistics on its weather, but like most English people, he’d no real knowledge of life on the prairies. Of course his maps, like ours, showed the main highways in the province, but he didn’t understand the nature of the road system any better than we did, or he really might have made us think again. Though the village secretary’s letter had said that two provincial highways ran close by the village, we discovered that neither went anywhere near the major city we’d been told to expect as our trading center, and that both were surfaced with gravel, a huge shock to us who were used to driving entirely on pavement.

Even worse than the road system of the province, we discovered, was its political situation. Had Joan’s colleague taught history and provided us with an outline of the gradual rise to power of the CCF, along with a description of the ideology governing that party, we’d certainly have chosen to go to a different part of Canada. By the time we’d learned enough history to understand Saskatchewan politics, we’d also learned to love not only Canada but the province, the people, my patients and doctor friends, and our new life, and, finding them worth fighting for, we stayed in Saskatchewan, even while many of my colleagues began to leave for other provinces.

Soon after we arrived, and while we were just beginning to understand Saskatchewan’s political history, I heard stories from my colleagues about the medical profession’s own proud history of contributions to the health and welfare of their patients.² George Peacock, who’d soon become a close friend, was one of my chief informants, but although he warned me that the governing political party was advocating a system like the British NHS, he was at the same time fairly confident that the independent non-profit medical insurance schemes such as Medical Services Incorporated (MSI) and Group Medical Services (GMS), which were already in existence and had been organized and subsidized by doctors, would suit patients better than any alternative dreamed up by politicians.

Before he put forward a wholesale government-run plan, modeled in part on the NHS, T. C. Douglas, then Premier of Saskatchewan, had talked of establishing health centers in rural areas. Such centers had been recommended in Dr. Henry Sigerist’s excellent report,³ commissioned by Douglas himself after his election victory in 1944. The Report argued that the government should devote more attention and funding to rural medical practices. Hawarden exactly fulfilled Sigerist’s recommended criteria for establishing a small health center with one doctor, the nearest hospital being 26 miles away, and the nearest larger ones being in Saskatoon about 60 miles away. Thus Hawarden’s council had good reason to hope for a health center, but though the village secretary and I wrote to the government in Regina in 1958, hoping for a positive response, we had no reply. During recent research into records held by the Saskatchewan Archives Board, I came across a directive from Walter Erb, then Minister of Health, stating that Hawarden wasn’t a suitable site for a health center. It was an internal memo, obviously occasioned by our letters, but once the minister had made his decision, no one in his department took the trouble to communicate it either to the village or to me. Had Douglas implemented Sigerist’s model for rural health services and provided the health centers that Sigerist envisaged, many rural practices besides my own would have remained viable and thus able to retain a local doctor, and Douglas would have performed as great a service to rural areas as he did by electrification.

Aware that we weren’t to obtain a health center, and dissatisfied with the premises provided for the doctor in Hawarden and Loreburn, my wife and I went into debt to have a large purpose-built office trailer made in Eastern Canada. It had a comfortable waiting room, an office/dispensary, well-equipped lab, washroom, consulting room, and an excellent examining room set up for minor surgery. The village of Hawarden provided a water cistern and septic tank, and the whole community was proud of our new office. However, it had no beds and no funds for staff; Joan was its unpaid secretary, dispenser, laboratory technician, and janitor. One cold spring day in 1961, after I’d made the round trip of 52 miles five times over gravel roads to see my sick patients at Outlook Hospital, we had to admit to each other that operating a rural practice in this way was simply insupportable, and that I should accept an offer to join a fellow GP in Saskatoon.

While it was my colleagues, and particularly George Peacock and other College leaders, who made me aware of the profession’s key role in the history of medical progress in Saskatchewan, it was chiefly our Liberal and Conservative friends in both Hawarden and Saskatoon who sketched out for us the history of the governing CCF party, which historian J. H. Archer has now described in his comprehensive history of the province.⁴ However, while friends and colleagues expressed misgivings about the party’s ideology, they tended to believe that Douglas might not be as far to the left as its written principles would suggest; after all, the Premier had been a Baptist minister, and he was undeniably intelligent, so surely he’d have learned to modify his socialism to fit a property-owning democracy whose main industry was agriculture. Certainly in the years that followed the Douglas government’s first election in 1944, much had happened around the world that should have made the Premier wary of a doctrinaire approach—at least to medical insurance, if not to other aspects of a planned economy.

By this time, the British NHS, begun in 1948, had been showing obvious flaws and losing doctors for years, many of them to Saskatchewan, and a responsible politician might also have been expected to take note of the problems created by a similar health scheme in another Commonwealth country, described in Doctor Down Under by Dr. Doris Gordon, a former health minister in the socialist New Zealand government.⁵ Her book, published in 1958, was well known at the time, and it gives a graphic and authentic description of how a national health plan run by bureaucrats rode roughshod over the needs of patients while ignoring the advice of physicians and nurses. Gordon’s account of how civil servants ran New Zealand’s health service is instructive:

The record system had to be experienced to be believed, for a dozen directors or accountants had the right to keep them [records] in their own offices for one or two days and there were no duplicates. Clerks in records opened all my mail and hung it on clips until the appropriate file [was] returned to them. Then they affixed the latest and sent me the file. It was no uncommon occurrence to read an urgent inquiry twelve days after it had been mailed. Meantime some frantic secretary or doctor would telephone asking for the requested answer to their letter dispatched ten days ago; and all I could say would be, ‘no such letter has yet reached me?’ (p. 107)

That vivid account by an experienced doctor serving as a government minister in a state medical scheme should have been enough to warn her readers against such plans; but for politicians such as Douglas, ideology always seems to trump experience.

When its first national convention was held in Regina during July of 1933, Douglas’s party, the CCF, had adopted The Regina Manifesto,⁶ a name eerily recalling Karl Marx and Friedrich Engels’ Communist Manifesto of 1848. This new and radical Canadian political party had been organized in response to what its leaders described as the excesses of the capitalist system. The CCF leaders genuinely believed that capitalism should be replaced by a planned economy in which the means of production and distribution would be owned and operated by the people. For these doctrinaire leaders, the word ‘people’ was a code word meaning the state, as in communist countries, where ordinary people have no say in government. Planning would be the task of the government, and that word forms the title of Part 1 of the Manifesto, which ends chillingly:

It is now certain that in every industrial country some form of planning will replace the disintegrating capitalist system. The C.C.F. will provide that in Canada the planning shall be done, not by a small group of capitalist magnates in their own interests, but by public servants acting in the public interest and responsible to the people as a whole.

The Regina Manifesto concludes: No C.C.F. Government will rest content until it has eradicated capitalism and put into operation the full programme of socialized planning which will lead to the establishment in Canada of the Cooperative Commonwealth. As Archer comments, that last statement was perhaps the most contentious clause in the Manifesto (p. 224). Nonetheless, by the time of the 1938 provincial election, involving several parties, he records, The party had revised its platform to emphasize reform, but to drop references to land nationalization and to socialism, and Coldwell and Douglas had rejected co-operation with the Communists (p. 243). Archer comments that although the Liberals won this election, the CCF, while suffering a slight reduction in the total popular vote, emerged as the undisputed challenger to the Liberals; the other three contenders mustered only four seats—two to the Unity party, two to Social Credit, and none at all to the Conservatives.

In 1944, the newly elected CCF government passed the Health Services Act to implement one of the Sigerist Report’s recommendations, which was that a health services planning commission be created. The Saskatchewan Archives Act wasn’t passed until a year later, so we’ve no written evidence of Douglas’s opinion of the Report. Dr. Jack Anderson notes that the Health Services Planning Commission, which Douglas set up, consisted of three government employees with an unwieldy advisory committee of some 25 members—at first including one doctor, one chiropractor, one osteopath, one from the State and Hospital Medical League, etc.⁷ The three government employees wasted no time. Anderson continues: Without notice, the Commission of 3, chaired by Dr. Mindel Sheps, presented a plan for socialized health services, calling for a complete salaried service for the rural areas, with no private practice allowed. Crucially, the whole system was to be supervised and run by employees of the Department of Public Health, with no input from the College, i.e., the medical profession, or from its Council, elected by all Saskatchewan doctors. Instead of improved medical services to benefit patients, the Sheps plan put the government in charge of all rural doctors.

Far from suggesting that members of the Department of Public Health control rural medicine, Sigerist had seen the government mainly as the backup paying agency, providing funds for necessary improvements. He’d stipulated that local governments should contribute to the cost of health services, and should continue to have an important share in their administration, with the provincial government providing additional grants that should vary according to the financial resources of the Rural Health Unit served (p. 5). A rural health unit would comprise one or more municipalities and the towns and villages located therein, and would have its own Health Services Commission, meeting regularly to discuss district health problems and consisting of representatives of the technical personnel, the teachers, and representatives of the rural municipalities, towns and villages involved (pp. 5–6). Municipal government initiatives, in cooperation with local doctors, had created the first Municipal Doctor Scheme (MDS) practice in Sarnia in 1916, and clearly Sigerist meant to preserve similar local democratic organizations.

Anderson comments on the College’s reaction to the far different proposals made by Dr. Mindel Sheps’s three-person commission:

Mr. Douglas, Premier and Minister of Health, was informed [by the College of Physicians and Surgeons] that such a plan was quite unacceptable. Many meetings were held with the Premier during socialized medicine’s infancy … Commission form of administration, free from political control, representing the citizens and those providing the services, with adequate advisory committees were promised in a letter by Mr. Douglas. (p. 5)

The letter from Douglas that Anderson mentions was dated September 19th, 1945, and written to Dr. J. L. Brown, who was, at that time, Chairman of the College’s Central Health Services Committee.⁸ It seemed to give doctors some reason to believe they could work with him on a medical plan for the province. In his letter, Douglas commented on the frank discussions between the government and the College, and on the principles they’d agreed to, the first of which was: that a health insurance scheme in the Province of Saskatchewan shall be administered by a Commission which shall be free from political interference and influence. In the same letter, Douglas wrote under clause 6b:

While the government is responsible for placing policy before the Commission and for matters of finance, collections, disbursements, audit and reports, the Commission shall nevertheless be independent in the manner and detail of the mechanics necessary to carry this policy into effect and to obtain the objectives desired by the Act". (College’s Brief to the Thompson Committee, p. 42).

Douglas also noted under clause 6d, The professional committees shall have unrestricted jurisdiction over all scientific, technical and professional matters pertaining to their own professions, and the Commission shall be guided by their advice.

Having themselves already sponsored successful independent non-profit prepaid insurance plans for those able to afford them, the province’s doctors quickly turned their attention to those unable to afford insurance. The College’s Brief records:

In 1944, representatives of the profession met with Mr. Douglas to discuss methods of providing a type of medical services insurance coverage to old-age pensioners and other indigent groups. Agreement was shortly reached, and a co-operative arrangement was effected, wherein the cost of these services was borne partially by Government and partially by the medical profession. (p. 7)

Admirers of Douglas and his government have tended to give them the credit he claimed not only for medical insurance but for plans such as hospitalization. However, Appendix 1-A of the College’s Brief notes that it was the doctors themselves who also initiated discussions of both hospitalization and improved rural health services:

At a meeting of the Central Health Services Committee in Regina on March 21, 1945, at which Mr. T. C. Douglas, the Premier, was present in his capacity as Minister of Public Health, Dr. J. L. Brown read these recommendations to the Minister:

(1) A province-wide state-aided hospitalization scheme, suitably controlled to offset undue abuse, and to co-ordinate hospital facilities to their most effective level pending further construction.

(2) Encouragement of an improved Municipal Health Service in rural areas toward provision of better facilities and equipment, and financial assistance to rural units where necessary as an aid to improving the distribution of medical men and allied services in such areas.

(3) Endorsation of voluntary groups already in operation which are providing health services in the province on a non-profit basis.

(4) That the Provincial Department of Public Health might well proceed to divide the province into public health districts and set these up when and as personnel (Health Officers, Public Health Nurses and Inspectors) become available. (p. 35)

Sigerist had, of course, recommended the establishment of larger rural public health districts, each centered on a hospital, and within them the smaller districts for individual rural practices (p. 5).

In 1946, the Swift Current District Plan, an insurance scheme to cover medical fees, came into effect in that region with the cooperation of local doctors, and in 1947, with the support of the medical profession, the CCF government introduced the first hospitalization insurance scheme in North America that would cover the entire population of the province. The College’s Brief of 1960 comments:

Contrary to popular belief, the medical profession in March 1945 advocated the introduction of a province-wide state-aided hospitalization plan … Unfortunately this [hospitalization] program since its inception has been administered by the Department of Public Health. The profession did not approve of this decision of Government … We believe that recent actions indicate that this type of administration is prone to implement unilateral decisions without prior agreement or adequate consultation. (p. 7)

Meeting in Saskatoon that year, and sharing the College’s disapproval at having the province’s hospitalization plan run by the Department of Public Health rather than by a commission independent of the government, the Canadian Medical Association (CMA) argued that the government’s role should be simply as a source of funds to support the indigent rather than as a provider of health insurance. However, even with hospitalization under the Department of Public Health, doctors recognized how valuable it was to both recipients and providers of medical care to have no financial barrier to medical treatment in hospitals, and they saw no associated danger to their own professional autonomy.

Before the hospitalization plan’s introduction in 1947, the Legislature had ratified the Saskatchewan Hospitalization Act of 1946, and the Regina Leader-Post for November 16th of that year includes a report that when moving second reading of the Act, Douglas had declared even then that Saskatchewan had reached the ‘first milestone’ on the road to complete socialized health services. That ominous claim seems not to have registered with most readers, including doctors. This report in the Leader-Post has added interest because it gives Douglas’s optimistic estimate that the [hospitalization] scheme could be financed with a $5 individual levy, with a maximum of $30 for a family. The report notes that this estimate didn’t mean the program would cost that much, but that the government was empowered to collect that sum from taxpayers. Whatever Douglas meant, the estimate indicates the tendency of politicians to embark on schemes without properly estimating their costs.

Writing in his Review of 1960, Jack Anderson makes this comment on the increasing costs of the Saskatchewan hospitalization plan: Originally estimated at 5 million dollars, it has climbed to 32 million dollars—a jump of 4 million dollars in one year—some 15 per cent in one year (p. 5). Tom Hatlelid, my colleague at Outlook, used to tell the story of his predecessor and the previous hospital administrator who connived at improving the hospital’s finances by allowing six seniors, all men, to be classified as patients throughout the winter so that they could live comfortably in the hospital at the provincial government’s expense, a tale that testifies to the gross inefficiency of a hospitalization system run by the central government through the Department of Public Health.

For some time, Douglas appeared to the medical profession to be more cooperative than others in his government and civil service. Dr. Mindel Sheps, the former leader of the 1946 planning commission, and her husband, Dr. Cecil G. Sheps, who’d been made Acting Chairman of the Health Services Planning Commission in February of 1946, seem to have faded into history soon afterward. The provincial government turned its attention to another survey of health services chaired by Dr. Fred Mott, appointed during the following summer. In 1949, with the assistance of federal grant money available to all provinces for the purpose, Dr. Mott was set to work, with the assistance of Dr. Malcolm G. Taylor (Ph.D.), who was in charge of research, statistical reports, and studies. They produced what MacTaggart describes as a two-volume opus, the Saskatchewan Health Survey Report, which he says has often been described as the classic of such projects (pp. 42–43).⁹ Nothing in their report, published in 1951, was opposed by doctors, and the profession signed on to it.

However, in his Review, Anderson records that in 1950, Douglas’s successor as Minister of Public Health, T. J. Bentley, repudiated the Premier’s undertaking to have a provincial health insurance scheme administered by an independent commission, opting instead in favor of control exerted through employees of the Department of Public Health (p. 5). The transcript of a meeting between the College’s Medical Advisory Committee, Douglas, and T. J. Bentley on January 5th, 1951 shows the profession’s dismay that the government had shifted what it had previously believed to be an agreed common position on the nature of a commission to run health care in the province, should a joint federal-provincial insurance scheme be established.¹⁰ For almost four hours, the delegation from the College, led by Drs. Jack Anderson and C. J. Houston, patiently attempted to pin the Premier down on his earlier promise of an impartial commission, but Douglas claimed that what his promise really meant by an independent commission was simply one that would be free from political interference or influence in the matter of hiring and firing staff, free from interference as to who should practise, free from interference in regard to professional and technical matters; but … would be responsible directly to the Minister and, through the Minister, to the Legislature and ultimately to the electorate (pp. 6–7).

In fact, of course, such an organization meant the commission would be entirely under the control of the Minister and the Department of Public Health and would have no independence at all. If they hadn’t already realized it, this example of the Premier’s semantic agility must have convinced the delegation that they’d placed too much trust in Douglas. As Clarence Houston admitted at the time, Most of the dealings between the College and the Government have been more or less gentlemen’s agreements (p. 8). Doctors would know better in future. In any case, Douglas told the delegation, talks on a joint federal-provincial scheme had broken down, and since such a scheme would have provided the necessary funds for provincial health care, he asked, What is the pressing necessity at this time of our trying to work out a basis of agreement on something that is not, within the immediate conceivable future, likely to be set up? Anderson challenged, Are you not working toward a general scheme of health insurance in the province? Douglas was forced to reply, That’s what we hope, and to agree to further discussion of the issue (p. 11).

In my own rural practice, over 50% of families had MSI coverage, and about 5% were covered by GMS. Another 5% were sufficiently prosperous and, therefore, didn’t bother with health insurance. A few were desperately poor, and all their neighbors gave them the unobtrusive help typical of prairie communities. In the cities, a slightly higher proportion of patients had voluntary coverage. Obviously for any government, the cheapest method of making that coverage universal would have been to subsidize those who couldn’t afford to pay for it.

However, CCF ideology required the state to control the entire economy, so complete bureaucratic control over all aspects of medical care came to dominate the government’s agenda. The Saskatchewan Public Health Report of 1956 states:

There is virtually no governmental supervision over the benefits, coverage, or costs of the voluntary medical care plans. Theoretically, municipalities require approval by the Minister of Public Health before entering into agreements for provision of medical care to local residents. In practice, however, such agreements are undertaken between municipal councils and the voluntary plans without ministerial approval. This presents a problem which remains to be solved. The real difficulty is that the voluntary plans leave unprotected some 25 per cent of persons in the municipality and their costs are very much higher than those plans providing prepaid medical care under official auspices. (p. 38)

Apart from its bias in favor of government control of health insurance rather than the existing and successful plans, the final statement in this Public Health Report is simply false, as shown by a document in the T. C. Douglas Papers, preserved by the Saskatchewan Archives Board. This document is A Proposal for Prepaid Medical Care to the Board of the Weyburn-Estevan Health Region as jointly submitted by Medical Services Incorporated and Group Medical Services, dated November 4th, 1955, and it sets out the following principles on its first page:

1.  Although the plans are voluntary non-profit organizations, nevertheless this presentation is being made on the assumption that 100% of the eligible residents will be enrolled and participate in the program as set forth in the contract.

2.  The plans shall cover all eligible residents regardless of age, or economic status.

3.  The benefits shall be comprehensive and no waiting periods and no exclusions for pre-existing conditions.¹¹

The Saskatchewan Archives Board preserves similar proposals for three other health regions, so whoever was responsible for the Public Health Report of 1956 should have been well aware that the terms offered by the private insurance agencies would have covered all persons in the municipality, and not just 75%.

The first example of coverage under government auspices existed in the south of the province, where on July 1st, 1946, the Swift Current Health Region had been established, providing medical care to all 54,000 residents in the region, with funding from personal and property taxes as well as from government grants. The general practitioners in the region had been particularly hard hit by the disastrous provincial economy during the thirties, and many still carried a debt load from that time, so they were receptive to a plan that guaranteed their incomes, even though their fellow practitioners outside the region were wary of the amount of government control exerted through the Health Region Board. Under the plan, fee-for-service physicians in the region were paid at 75% of the College’s fee schedule, whereas the private plans paid physicians at 85%, but Swift Current doctors benefited by having no uncollectable debts from uninsured patients. Naturally, because of the degree of control the Department of Public Health could exert in the region, the government considered the Swift Current plan to be an ideologically and fiscally suitable blueprint for a plan to cover the whole of Saskatchewan.

As Drs. Badgley and Wolfe point out in a book devoted to lauding Douglas’s plan:

By 1959 the doctors’ own insurance plans were mushrooming. In that year they covered to a varying extent forty per cent of the population of Saskatchewan. During the same years the government had not expanded the scope of the municipal doctor plans [the number of plans fell from 180 in 1950 to 126 in 1960]. Indeed, it had cut back on certain programs provided for the poor, and had refused to co-operate with the doctors’ wish to spread