FEBRUARY 15, 2005

Saskatchewan's centennial: a look at the cradle of medicare

The path to universal healthcare was far from smooth. Socialism,
strikes and slogans rock the wheat province

Saskatchewan and Alberta were inaugurated as provinces just days apart in 1905 and both provinces are gearing up for centennial celebrations this year. The two western provinces started off their Canadian presences similarly — as hulking, mostly rural former pieces of the Northwest Territories. They even had like political landscapes early on with the Liberals dominating. But after the Great Depression, Saskatchewan and Alberta would take markedly different paths shaped by the long reigns of the socialist Cooperative Commonwealth Federation (CCF) in the former and the right-leaning Social Credit Party in the latter. In this first of a two part series, we look at Saskatchewan, its healthcare, and its key role in the development of medicare.

The election of recent 'Greatest Canadian' victor Tommy Douglas and the CCF in 1944 was a turning point not only in Saskatchewan, but also the whole nation's history. It was the first socialist government ever to be formed in North America. Fear was rife, and the news was splashed all over the front pages of Canadian and US newspapers. But fortunately none of the fears and predictions of Premier Douglas's political opposition came to pass: there was no Stalin-esque forced farm collectivization, nor did it prove true that "the CCF socialists will use democracy to get into power, but will scrap it as soon as they get into office," as a typically blustery pre-election Regina Leader-Post editorial trumpeted.

What did happen was some much-needed house cleaning. During his first term in office Premier Douglas set upon the ho-hum task of reducing the province's debt. Then, in 1947, the CCF took a baby step toward realizing its medicare dream by introducing a universally affordable government hospitalization insurance plan. By 1956, the federal government was encouraging all the provinces to follow Saskatchewan's lead by agreeing to foot their own health insurance bills.

Premier Douglas did a good job selling the merits of universal state health insurance to the people of Saskatchewan. Indeed, the pitch was so good that the opposition Liberal party eventual adopted its own, remarkably similar, plan. It was all for nought, as Tommy Douglas went on to win the so-called 'medicare' provincial election of 1960 (he resigned a year later to enter the federal fray, and Woodrow Lloyd became premier). But it was really a battle to decide who would implement the expansion health services. The Liberals said they would let the people decide by plebiscite if they wanted medicare but the popular plan certainly would have passed. The only major party that dared attack the idea of medicare was the then-unelectable Social Credit.

For all its popular support, the CCF's medicare plan didn't exactly set Saskatchewan physicians' hearts aflutter. Dr Ernie Baergen, a retired family physician and long-serving head of the Saskatchewan Medical Association (SMA), was a primary witness of the medicare plan's severe growing pains. He was one of the new University of Saskatchewan College of Medicine's first graduates in 1957, and his earliest years of practice were coloured by battles with the government over medicare.

"The general point of resistance to the plan came down to the fact that the government was not being completely up front with us," he explains. "Premier Douglas initially promised that the medicare act would be satisfactory to both providers and recipients."

The Canadian Medical Association ran a campaign against the CCF medicare plan casting it as 'socialized medicine' and generally insinuating it would send medicine back to the dark ages. This, in hindsight, was an enormous tactical error. Its obvious hyperbole made doctors look greedy when that certainly wasn't the case. "The medicare act took away the worry about paying the bills — at the time we had information that about a third of the population wasn't covered and that was the appeal of the plan," says Dr Baegan. "It was as much the way medicare was introduced as what was introduced that upset doctors."

In the summer of 1962 Saskatchewan's physicians decided enough was enough and walked out. Their strike and its resolution were instrumental in shaping how medicine is practised in this country today. When the victorious CCF enacted the Saskatchewan Medical Care Insurance Plan the province's doctors felt compelled they had no other choice. "Part of the resistance was that we wanted no part of negotiating our fees," says Dr Baergen. "It was some years later that a mechanism was developed for negotiating fees."

The two-week strike provided Saskatchewan's MDs little opportunity for enjoying long prairie summer days. Dr Baergen was working in the Saskatoon City Hospital ED at the time. "I was never so tired in my life, but not from the volume of people, but by the uncertainty of the situation," he says, adding that he had to take some time off afterward to recuperate from the stress.

In the end, British politician, former practising physician and Lancet editor Lord Taylor was drafted in to negotiate an end to the strike. As part of the settlement doctors maintained the right to bill for extra services.

The public, on the whole, were none too pleased with either the government or the doctors over the strike fiasco. The next time Saskatchewanians went to the polls — on May 2nd, 1964 — they turfed the CCF out of office in favour of the Liberals. But by then medicare was firmly entrenched in Saskatchewan, and Prime Minister Lester B Pearson promised to bring universal coverage to the rest of Canadians.

Dr Baergen, who still lives in Saskatoon, continues to look back in anger at the early days of medicare. "Prior to this I had no interest in partisan politics. It became law and if you wanted to practise you had to respect the law," he says. "When all you get to eat is oats you eat oatmeal."

Nowadays, the CCF's heirs, the NDP, are in power in Saskatchewan once more, so its pretty safe to assume medicare in the 'wheat province' isn't going anywhere anytime soon.

Next issue: NRM takes a historical look at medicine in fellow centenarian province, Alberta.



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