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| Tommy Douglas |
Sixty years ago in the spring of 1960 Saskatchewan's Co-operative Commonwealth Federation (CCF) government led by Tommy Douglas was about to enter a successful re-election campaign promising "a province-wide medical care program". Today medicare is considered a given in Canada but that wasn’t always the case. A series of politically risky moves on the part of Douglas and his government made it happen. These events deserve to be remembered.
In the midst of a pandemic the importance of having a government-run health care system will instantly be recognized by most Canadians, who have come to depend on it for over fifty years. While the United States continues as the world's leading private sector based health care system (although it spends large amounts of public dollars through programs such as Medicaid), in the current situation the leading U.S. public voice, Dr Anthony Fauci from the National Institute of Allergy and Infectious Diseases, acknowledged recently: "The system is not really geared to what we need right now... let's admit it..."
The failures of the U.S. health system go well beyond the COVID-19 pandemic. If we look back at some the historic developments that led to the establishment of Medicare by the Saskatchewan CCF, we can recognize there are elements of the story we would do well to remember at this precarious time. (For most of what follows I am drawing upon the account in the book Dream No Little Dreams: A Biography of the Douglas Government of Saskatchewan, 1944-1961, written by A.W. Johnson ; with the assistance of Rosemary Proctor.) Note that Johnson was a founding father of medicare.
Medicare was always among the plans of the CCF when they came to office in August 1944. Saskatchewan was emerging from a decade and a half of war and depression, a period of austerity and scarcity that meant it felt compelled to balance its budget (farmers post-depression in particular were allergic to debt). However, that did not stop it from the beginnings of medicare. In 1946 Saskatchewan legislated the Saskatchewan Hospital Services Plan to start on January 1, 1947, a plan to pay for hospitcal care that was universal, comprehensive and publicly administered. It was expensive but Saskatchewan did not hesitate to find the necessary funding. Financing came from general revenues and family premiums (taxes), which were set initially at $30 ($425 in current dollars) per year for a family of four (less for singles and couples).
Before taking office the CCF contemplated abolishing the sales tax, but opted instead once in office to make it more progressive by exempting 'necessities'. The tax was an important part of financing hospitalization. Indeed, the sales tax rate was raised from 2% to 3% in the 1950 budget in part to cope with cost pressures from hospitalization. Provincial Treasurer Clarence Fines commented in his budget speech:
... the tax has been criticized more than any other provincial tax but this criticism has usually been political, and not based on sound reasoning. As originally drafted with few exemptions the tax did have some vicious features. Any tax on food stuffs must be considered regressive. The same is true of tax on many other necessities for which the poorest person in the province must pay as much as the wealthiest. It has been my purpose to remove these regressive features.The speech then proceeded to list many of these in detail, including, for example, foodstuffs, drugs and prescriptions, soaps and cleaners, weed control chemicals and animal feeds.
Fines concluded:
There is no doubt that certain persons would be prepared to sacrifice badly needed health and education services in order that they may gain whatever political advantage they can by their advocacy of removing a tax which they introduced many years ago. I am confident however, that most intelligent people realize that such a proposal can not be genuine, unless the welfare of the people of the province is to be sacrificed. (Saskatchewan Budget Speech, March 8, 1950)The budget speech also attacked the federal government, making it clear that despite Saskatchewan's hospitalization initiative, the failure of the then St. Laurent Liberal government to act on proposals for a national program (made originally in 1945), and instead to take what Fines called "token action" served only to increase the "financial load" upon Saskatchewan. Bending to pressure the federal government acted in the late fifties. Once the federal legislation to create a national hospitalization program took effect on July 1, 1958 half the cost of Saskatchewan's now eleven year old program came from federal coffers. The extra dollars meant Douglas government could see it would have the financial capacity to enact medicare.
One can hear echoed in the budget speech the anti-tax attitudes the government faced, but it decided nonetheless to forge ahead. At the time the tax increase did not hurt the party politically. The CCF, which had seen its popular vote and seats decrease in the 1948 election, increased its majority in the legislature and popular vote when it next faced the electorate in 1952.
Less than a year after the start of national hospitalization, the Douglas government commenced planning for universal health care, announcing its intention to proceed at a public meeting (held as part of a byelection) in the village of Birch Hills on April 25, 1959. Plans for the program were drawn up by an interdepartmental planning committee that reported to cabinet in November 1959. The plan identified ten objectives that would become familiar elements of Medicare such as universality. In the context of the current crisis, I want to draw attention to objective number four. It argued that "in the design of the medical care program... the preventive objective should always be kept at the forefront...Medical practitioners... must be encouraged to participate in preventive programs and apply preventive measures to personal health care."
A pandemic makes clear the ongoing importance of preventive public health programs and spending. But conservatives both south of the border - Donald Trump - and north of the border - Doug Ford - have made recent cuts to the public health component of our health care services. Trump eliminated a pandemic preparedness unit in the White House.
For the Douglas government, enacting and implementing medicare would be a multi-year, highly contentious struggle that involved making a series of difficult decisions. The controversies, particularly the struggle with the doctors and the 1962 strike are the better known part of the story. This article written on the 50th anniversary of the implementation of Medicare in Saskatchewan for Canadian Dimension looks back on those events. It starts off saying:
Medicare was born in Saskatchewan on July 1, 1962. It would be the first government-controlled, universal, comprehensive single-payer medical insurance plan in North America. It was a difficult birth. The North American medical establishment and the entire insurance industry were determined to stop Medicare in its tracks. They feared it would become popular and spread, and they were right.In order to finance the introduction of Medicare in 1962 the CCF government, now led by Woodrow Lloyd, raised the sales tax by two percentage points (1½% for health care). In addition they added one point each to personal income and corporate taxes. By today's political standards these represented enormous tax hikes. One should not understate the political risks assumed by the CCF. Although the CCF would be defeated in the next election after 20 years in office, Saskatchewan's Medicare would become permanent.
A few years later the precedent established by the CCF (along with other factors) would lead to implementation of a national cost-shared Medicare program on July 1, 1968. Among the other developments that were important was the report of the Hall Royal Commission on Health Services appointed in 1961 by the Diefenbaker governmennt. The author of the report, Emmet Hall, was a fellow Conservative and old seat-mate from law school of Diefenbaker. Opponents of medicare had pressured for the appointment of the commission. However, they were to be disappointed. The report delivered in 1964 to the Pearson government strongly supported the establishment of a national medicare program.
Two other important political developments of the early sixties mattered. T.C. Douglas became leader of the New Democratic Party, which was established in 1961, carrying the advocacy of medicare to the national stage. There was also internal debate in the Liberal Party. A key proponent of medicare inside the Liberal Party was policy guru Tom Kent. In his book A Public Purpose he describes some of the internal struggle as follows:
... there always were within the party people of conservative mind who did not want Canada to have, for example, medicare; their numbers increased... as former Liberals returned to activity. Throughout, however, the ideological conservatives were mostly people not actively engaged in politics; many were business "friends" of the party those whom I call "the men who come to lunch." They were a nuisance, because they worried Mike Pearson and wasted time for many of us, but there was never much danger they would succeed in staying to dinner, in getting measures such as medicare taken out of the program.In the end the pro-medicare forces were successful, in part because the Liberals wanted to win votes from the NDP and knew support for medicare was an essential condition of doing so. However, the conservative Liberals were pleased by Finance Minister Mitchell Sharp's delay in the introduction of medicare by one year.
With advent of the COVID-19 pandemic, we should all be grateful that the struggles to achieve medicare, beginning in the 1940s, were successful. We would be much worse off without it. The efforts to establish it were extremely difficult both politcally and financially. We will forever be in debt to those like T.C. Douglas and A.W. Johnson who worked hard and took risks to make it happen.
