Best 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 the second excerpt from Tommy Douglas, Vincent Lam’s new book in Penguin Canada’s “Extraordinary Canadians” series, the Giller-winning author explores the irony behind the birth of universal health insurance in Canada.

The 23 days of the physicians’ strike that began in July 1962 were a divisive time in Saskatchewan. Everyone knew of someone who suffered because they were unable to access their regular medical practitioner. Those who generally opposed the CCF seized on the drama to criticize the government on many fronts. As the strike wore on, some physicians who had moral and professional misgivings about withdrawing their services began to quietly open their doors, so that by the end of July roughly half of the province’s 900 or so doctors were providing medical care, in addition to 110 freshly recruited physicians from outside the province. The standoff between the college and the MCIC persisted, with both sides exasperated and exhausted.

At this point Premier Woodrow Lloyd, emulating Tommy Douglas, sought the assistance of the best possible outside expert to resolve the crisis. Lord Taylor, a British psychiatrist, was a Labourite who had earned his peerage for his role in developing the National Health Service. He agreed to serve, on the understanding that rather than a monetary payment he would be given a fishing trip in northern Saskatchewan. When he arrived in Regina on July 16, in the dark depths of the strike, Taylor expressed sympathy for both sides, announced that he would not serve as the premier’s advisor as expected, and that he intended to mediate between the Cabinet and the college despite not having been asked to do so. Taylor spoke with all major players in a series of meetings and discussions, kept the government and the college strictly separate, and soon established his control of the situation. The eccentric and forceful doctor was a theatrical presence as much as a mediator. He insisted on parking in the noparking zone at his hotel, leaving a piece of House of Lords stationary under the windshield as justification, and got away with it. He listened, cajoled, sympathized, raged and became so central to the process that he broke impasses with the doctors by threatening to go home. On July 23 Taylor announced at a press conference that an agreement between the college and the government had been signed.

Soon, despite all the hysteria that had preceded the law’s passage, Saskatchewan’s physicians were quite happy with the system. Despite the dire predictions, no one interfered with doctors’ medical decisions, or forced them to reveal patients’ secrets. They no longer needed to hire collection agencies to chase their patients, and bills were paid promptly. On average, physicians’ incomes actually increased under the CCF’s scheme. The public did not soon lose the sour taste that the bitter battle had precipitated, however, and some say that the conflict sowed the seeds of the CCF’s defeat to the Liberals in 1964 -their first loss in two decades. Even so, the Liberal government that took power made no changes to the insurance plan. One of the doctors who was a key strategist opposing the plan, Efstathios Barootes, later became a Conservative senator and an ardent defender of medicare, saying afterwards, “I have changed my mind.”

Douglas’s achievement in introducing medicare in Saskatchewan represented a deep conceptual shift that radically altered the provision of health care in Canada. He convinced a nation that in a civilized society, health care should be considered essential to individual and social well-being, and viewed both as a public right and a collective obligation.

However, the events surrounding the birth of universal health insurance in Canada were full of irony on several levels, the first being economic. Douglas came to power in an impoverished, bankrupt province. He couldn’t immediately deliver the full range of the CCF’s program for social democracy within a broken economy. As the province’s private and public finances strengthened, his government pressed forward with social innovations and ultimately universal health insurance. Medicare might have been more appealing to doctors when Saskatchewan was poor. After all, municipal plans had flourished during the Depression, when few citizens could afford to pay their doctor’s bills, and town doctors then preferred some government financial backing.

From the perspective of labour relations, a great irony was that the CCF -the party synonymous in Canada with workers’ rights to organize and strike -found itself importing strikebreakers in the form of replacement doctors from outside the province. Expressed in this measure was the notion that even labour rights, an area of staunch CCF support, had limits within society. In this case the government’s obligation to ensure the delivery of essential services could, and did, trump the rights of a group of workers to collectively deprive the public of those essential services.

In yet another twist of fate, though this program would be his proudest achievement, Douglas’s political fortunes suffered no greater short-term blow than during the birth of medicare. After almost two decades had been spent building Saskatchewan’s economy, civil service, social services, the political legitimacy of the CCF, and his own credibility as premier, the birth of medicare in Saskatchewan should have been a crowning achievement for Douglas. Instead, the surrounding events meant that he left provincial politics in circumstances of conflict and failed to win his federal seat in Regina in 1962. Douglas put all his political capital on the line for what he believed and paid a hefty political price in the short term. He was eventually proved to be right and initiated an essential feature of Canadian society, the universal public insurance of medical services.

* Excerpted from Extrardinary Canadians: Tommy Douglas, by Vincent Lam. © 2011 Vincent Lam, 2011. Reprinted with permission of Penguin Group (Canada).

< http://www.nationalpost.com/news/Primary+care+Paradox/5014391/story.html >

Tommy Douglas was indeed a remarkable man, but he’s cherished, alas, for the wrong reason.

Taking office in Saskatchewan in 1944 as the first socialist regime in North America, Mr. Douglas’s CCF government experimented with public ownership of the means of production: a wood-box business, a shoe business, a woollen mill, a horsemeat operation, a tannery. But the results were mostly farcical. (The investment in wood boxes apparently coincided with a boom in cardboard and plastic.) Mr. Douglas, however, did not invest in potash – although potash production in the Douglas years went from nothing much at all to four million tons a year.

Mr. Douglas paved roads, delivered hydro power to farmers and built sewage systems. But these prudent services don’t count as socialist achievements. Mr. Douglas’s fame rests on medicare as free and universal medical insurance. Thus, when the CBC designated Mr. Douglas as the Greatest Canadian six years ago, it cited medicare as his signature achievement. After a fashion, it was – although Mr. Douglas himself didn’t legislate it. (His forgotten successor did.) Yet, asterisks are necessary. If Mr. Douglas fathered medicare, a diverse assembly of politicians – Conservatives and Liberals – grandfathered it.

Mr. Douglas did introduce the country’s first universal-coverage hospital insurance program in 1947 – the same year in which Social Credit premier Ernest Manning introduced full-coverage medicare (covering hospital and doctor costs) for all senior citizens in Alberta. Even in Saskatchewan, Mr. Douglas didn’t start from scratch: Thirty years earlier, the province had established municipally operated hospitals authorized to provide free service without regard to people’s ability to pay.

Many jurisdictions had long recognized a certain universal right to medical treatment. By the time the federal government enacted medicare, Ontario was already offering coverage – essentially universal – through a combination of this historic right, private Blue Cross hospital insurance and Physicians Services Incorporated, a private, not-for-profit insurance program operated voluntarily by 8,000 doctors. Yes, Mr. Douglas fathered a government monopoly – but he didn’t father comprehensive medical insurance.

(The U.S. is no exception. Federal law requires hospitals to treat any patient who seeks it – either in public or private ones, regardless of citizenship, legal status or ability to pay – in other words, universally. The Emergency Medical Treatment and Active Labor Act extends this right to anyone who enters an emergency room, whether or not any “emergency” exists. The legislation stipulates that the patient can disregard the medical expenses incurred, without impairment of credit rating.)

Tommy Douglas was, beyond doubt, a Great Canadian. Amid the madness of our own debt spiral, his singular achievement appears more remarkable than ever. He set an example of fiscal restraint (and, ironically, of limited government) that no other Canadian premier approached in the 20th century. In 17 years as premier, he produced 17 balanced budgets. From this perspective, he governed in a uniquely rational, disciplined and principled way.

When Mr. Douglas took office in 1944, Saskatchewan had a debt of $218-million – 38 per cent of provincial GDP. By 1949, he had reduced the debt to $70-million. By 1953, he had eliminated it. By 1961, when he left office, he had produced 17 successive budget surpluses. By reducing the debt, and thereby reducing interest costs, he was able to spend more on public services – without raising taxes.

There have always been two kinds of democratic socialists: the Christian socialists (who cherished thrift) and the Keynesian socialists (who celebrated debt). A Baptist minister, Mr. Douglas – as premier of a poor and humble province – preferred Proverbs to Keynes. (See Proverbs 21:5: “Steady plodding brings prosperity.”)

In the end, it’s a shame that Lester Pearson and Pierre Trudeau (in designing, implementing and adapting medicare) didn’t listen to Mr. Douglas’s advice. “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.”

Mr. Douglas, the pragmatic socialist, was right. Free medical care lets people remain personally indifferent to costs, discourages thrift and encourages debt. Medicare needs Tommy Douglas memorial user fees.

< http://www.theglobeandmail.com/news/opinions/opinion/tommy-douglas-the-pragmatic-socialist/article1806775/ >

Like millions of other Canadians, Michael Kirby has first-hand knowledge of the toll mental illness takes on an individual, and his or her loved ones.

“My sister suffered from serious depression all her life,” he says. “She had anorexia as well. She was hospitalized in a psychiatric ward and attempted suicide at one point.”

Unlike many of his fellow citizens, though, Kirby isn’t reticent about his family’s experiences.

“People suffering from mental illness don’t want to talk about it,” he says, his comment backed up with the fact that approximately 75 per cent of adolescents and adults who experience mental illness never seek help. “Many of them feel there is still a stigma.”

Not only has Kirby been willing to talk about it, he’s spent the past decade of his life doing something about it. The chairman of the Mental Health Commission of Canada, established in 2007 and headquartered here in Calgary, has been instrumental in bringing greater awareness of mental health issues to the Canadian public, along with helping to diminish the discrimination and stigma experienced by its sufferers.

He’s done such a good job, in fact, Kirby has been awarded this year’s medal of honour by the Canadian Medical Association, the highest honour bestowed upon a citizen who is not a member of the medical profession.

While his curriculum vitae includes everything from consulting to the energy and utilities industries and the financial sector, the Nova Scotia native is best known in political circles as a longtime adviser to former prime minister Pierre Trudeau, followed by more than two decades as a Liberal senator.

It was in the Senate that his passion for advocating on behalf of the mentally ill took flight. As chairman of the standing Senate committee on social affairs, science and technology, he was charged in 2001 with developing a federal health policy able to support a long-term health care plan.

“We realized something needed to be done about mental illness,” he says. “In report after report on the state of the health-care system, it was barely mentioned.”

The committee published a series of reports culminating with its final report in 2006, entitled Out of the Shadows At Last, which recommended the formation of an arms-length commission that would deal with the issue of mental illness “in a way that would create some kind of national focal point.”

The decision to base the Mental Health Commission of Canada in Calgary, he insists, wasn’t a political one, as some critics at the time suggested.

“As a Maritimer, I felt we should have the commission located somewhere outside of Central Canada,” he says. “Maritimers understand the feeling of being ignored, as the West often feels. In this day and age, national institutions should be all over the country.”

Calgary being his favourite western city was another impetus for stationing the bulk of his approximately 50 researchers and advocates in this city. Its original mandate, he says, was three-pronged: run an anti-stigma program to change public attitudes; conduct a first-ever national mental health strategy; and set up a knowledge exchange centre, with the two latter programs run out of Calgary.

< http://www.calgaryherald.com/health/Former+senator+Michael+Kirby+saluted+mental+health+work/3392684/story.html >