Tommy Douglas, the pragmatic socialist

Posted on November 22, 2010 in Health History

Source: — Authors: – News/Opinions/Opinion
Published Monday, November 22, 2010.   Neil Reynolds, Columnist

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.

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