Former NDP leader T.C. (Tommy) Douglas, on Oct. 19, 1983.CHRIS SCHWARZ/The Canadian Press
- Title: Tommy Douglas and the Quest for Medicare in Canada
- Author: Gregory P. Marchildon
- Genre: Non-fiction
- Publisher: University of Toronto Press
- Pages: 699
At a time when Canada’s beloved medicare system is struggling – some would say crumbling – it’s worth remembering how it came to be.
In Tommy Douglas and the Quest for Medicare in Canada, Gregory P. Marchildon reminds us that the gestation was long, and that, in the decades since the first experiments with publicly funded, single-payer health care, the struggle for acceptance and survival has been enduring.
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Another constant – at least for the first 40 years of medicare’s evolution – was the tireless advocacy of Tommy Douglas, the long-time Saskatchewan premier who is often described as the “father of medicare in Canada.”
As Marchildon notes in the foreword, the book is neither a history of medicare, nor a biography of Douglas. Rather, it’s the story of a man of extraordinary principles and values who toiled in a political and social environment that allowed him to pursue a bold project like medicare and succeed, at least partially, against all odds.
“Is the history of universal health coverage in Canada severable from T.C. Douglas?” Marchildon asks. “In the popular mind, it is not. Douglas was medicare, and medicare was Douglas to most Canadians, at least those who were born before the twenty-first century and have some knowledge of Canadian history.”
While Marchildon’s admiration for Douglas is obvious, thankfully, the book is not a hagiography. It’s clear that Douglas was often as loathed as he was loved. In fact, the “pragmatic idealist” reached the peak of his popularity long after his death, voted in a 2004 CBC poll as the “greatest Canadian of all time.”
The author is careful to note that some form of universal health coverage would have come to Canada (as it did in almost every Western democracy), Douglas or no Douglas. But, importantly, it would have not have come as early, nor taken the form it ultimately assumed – single-payer and single-tier universality.
In fact, much of the richness of the book comes from its careful exposition and analysis of the eternal (perhaps: infernal) debate in Canadian health policy circles: Should publicly funded health insurance (and other social programs, for that matter) be provided universally, or targeted exclusively to the needy?
History, as much as anything, can inform current policy and especially “health reform agendas,” Marchildon writes. And he’s right, especially when you realize that the arguments for private rather than public health care funding and delivery being put forward today are exactly the same ones being offered up from the 1940s through to today. And political partisanship and vested self-interests have been the greatest barrier to reform for the past 80 years.
Plus ça change …
Thomas Clement (T.C.) Douglas, a Scottish immigrant to Canada, had, by any measure, a remarkable political career. He held elected office, almost continually, from 1935 until 1979.
A Baptist minister, T.C. (as he was known for much of his political career) was elected as a firebrand federal MP in 1935, then became leader of the provincial Co-operative Commonwealth Federation leader in Saskatchewan in 1942. Two years later, in 1944, the CCF swept to power, the first socialist government in North America. Douglas won five straight majority governments, remaining premier until 1961. He then returned to federal politics as leader of the newly minted New Democratic Party, which he led until 1971, and then served as an opposition MP for another eight years until his retirement. (Douglas died of cancer in 1986, at the age of 81.)
The constant throughout was the preacher-politician’s fervent dedication to implementing and expanding universal health care. The quest began in Saskatchewan in 1947 with the first universal hospital insurance plan, then a more contentious expansion into publicly funded medical care in 1961.
Tommy Douglas and the Quest for Medicare in Canada begins with a detailed look at a single day, Oct. 13, 1961, when the medical care bill was first introduced, and Douglas’s impassioned defence of it in the legislature, “arguably the apotheosis of his political career.”
The controversy surrounding the bill, which would eventually be adopted in July, 1962, culminated in a 23-day doctors’ strike, and fierce national debate about the merits and demerits of medicare.
At almost 700 pages of very small print, including 175 pages of footnotes, the book is aimed at public policy nerds more than the general public.
But, to his credit, Marchildon, a professor emeritus at the University of Toronto, and the foremost scholar on Canadian medicare, does not write like a stuffy academic. He is obviously passionate about the topic, and the passion shines through.
There are even some lovely turns of phrase: Writing about Douglas’s shadow looming over the bitter doctors’ strike after resignation as premier, Marchildon says that he was “a little like Banquo’s ghost during the banquet in Shakespeare’s Macbeth.”
Today, in this time of existential crisis for Canada, the ghost of Douglas continues to hover over the medicare debate.
More than anything, Marchildon’s tome should lead us to wonder: Where is the Tommy Douglas of the 21st century, the savior medicare so desperately needs?
