Primary care Paradox

Posted on June 29, 2011 in Health History

Source: – news
Jun. 28, 2011.   Vincent Lam *

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).

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One Response to “Primary care Paradox”

  1. Kendra says:

    Through the events stated in the ” Primary Care Paradox” by Vincent Lam, it is clear that the CCF has greatly impacted the Health Care System of Saskatchewan as well as the rest of Canada. Tommy Douglas, other wise known as the “creator of health care” changed the economic history of Canada. He Provided an increase in wages of doctors, and allowed a greater amount of the population to access it. Even with the controversial nature of the CCF, it allowed for an increase of health care and improved Canada’s quality of life.


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