The Canadian health care revolution

By David Shribman

Thursday, April 16, 2015 | 2 a.m.

Consistent with the modest character of this province at the center of a country that revels in modesty, a modest commemorative sits in front of a modest two-story home. Right here, at 814 Saskatchewan Crescent in the Nutana residential neighborhood of Saskatoon, rests a small historical plaque that for months of the year is covered by snow — but that tells a story that transformed Saskatchewan in the early 1960s, spread to the other nine provinces of Canada by 1970 and, in the past decade, reached across the 49th parallel to Barack Obama’s America.

It is the story of universally accessible public medical insurance, and the irony is that its beginning in this peaceable kingdom was marked by anger, resentment, protests, and a 23-day doctors’ strike that affected 79 hospitals and imperiled the health of hundreds of thousands of people. And it was in this tiny house that Dr. Samuel Wolfe planned a remarkable medical airlift that imported doctors from Great Britain into this prairie province — a desperate but effective gambit that helped bring an end to the doctors’ strike and assure the future of government health insurance.

Today, that government-sponsored medical insurance is a vital element of the Canadian economic and cultural landscape — “part,” as Daphne Taras, dean of the Edwards School of Business at University of Saskatchewan, puts it, “of who we are as a country.”

But its birth was difficult and controversial, so much so that during the crisis, William Davies, the provincial health minister, slept with a 10-gauge shotgun at his side, and Clyne Harradence, a prominent lawyer from the central Saskatchewan city of Prince Albert, said, “I’m sure if I suggested that people go out and get their guns and deal with the legislation in that fashion, they’d have done it.”

This is not language one hears in Canada every day.

The crisis — and government health insurance for all of North America — began after Saskatchewan elected to office in 1944 the Co-operative Commonwealth Federation, the first socialist government in Canada.

The CCF’s charismatic leader, Tommy Douglas, proposed the health care measure at the beginning of the 1960s, promising, in language much like that employed by Hillary Clinton in 1993 and Obama in 2009, that “you will choose the surgeon and you will choose the specialist.” The province’s doctors argued that the legislation would render them slaves and, in a pamphlet now resting in the files of the Saskatchewan Archives, contended that “decisions affecting you ... would be subject to political considerations bearing no relation to your needs.”

Before long, signs appeared in medical suites: “This office will be closed after July 1st, 1962. We do not intend to carry on practice under the Saskatchewan Medical Care Insurance Act.”

Dr. A.B. Voth, a leading member of the Saskatoon medical society, told CFQC television: “This plan prepared by the government, no matter what the government says, is much more than just medical insurance. It places the control of medicine in the hands of the government and its appointees. And this we can never accept.”

The Saskatchewan College of Physicians and Surgeons called the measure “peacetime conscription.”

But for all the voices like that of Louis Genesove, a Moose Jaw doctor who was assistant director of the Canadian Council on Hospital Accreditation and who called the plan “cunningly contrived and viciously propagandized,” there were others, from the Farmers’ Union Ladies Lodge, the Saskatchewan Wheat Pool Committee and the Board of Federated Co-operatives, who wrote the provincial premier with unstinting support.

With 90 percent of Saskatchewan’s doctors on strike, Dr. Wolfe implemented his medical airlift plan, and a flood of British doctors entered the province to support what Time magazine called “a country cousin of Britain’s National Health Service.” Meanwhile, a women’s organization called Keep Our Doctors rallied against the measure in Regina, the provincial capital, some of the protesters holding placards reading “Democracy is Threatened.”

Leading the opposition was the Liberal Party chief, W. Ross Thatcher. “The socialists say, ‘Elect us, even with a 35 percent majority, and we will ram a scheme down your throat,’” said Thatcher, who, in a celebrated incident, tried to kick in a door in the provincial capital. He later served as provincial premier from 1964 to 1971.

Shortly after the medical legislation was passed, Douglas left office to head the newly formed New Democratic Party and in that role often defended Canada’s health care system. “Our friends in the United States are spending 9 percent of their gross national product ... on health care and 34 million of their people have no health care coverage,” he once said. “And in Canada we spend 7 percent of our gross national product, and every man, woman and child in Canada is covered by Medicare.”

A 2004 public poll by the Canadian Broadcasting Corp. named Douglas, who died in 1986, as the Greatest Canadian. Terry Fox, the amputee athlete who sought to run across Canada in 1980 to aid cancer research, was runner-up, followed by former Prime Minister Pierre Elliott Trudeau.

In recent years, Canadians have complained about wait times, especially for elective procedures such as knee replacements and diagnostic tests such as mammograms. (Indeed, one study found that wait times doubled between 1993 and 2013.) But the point — acknowledged across the border by almost everyone, Obamacare critic and supporter alike, with the exception of Sen. Ted Cruz, the Republican presidential candidate born in Canada — is that once government-mandated health insurance is instituted, it very likely is never going away.

That’s the lesson for all of North America from one of the continent’s most remote outposts, a place so isolated it has its own peculiar vernacular, for nowhere else on earth does the phrase “bunny hug” — elsewhere applied to an early 20th-century ragtime dance — mean a hooded sweatshirt with a front pocket. You could look it up (but you’ll need the Canadian Oxford Dictionary).

“When we think of Saskatchewan as being the most Canadian of provinces, it is medical insurance that’s one of the elements, because it speaks of our empathy for others,” says Rob Norris, a Saskatchewan provincial legislator. “When it’s minus 40 degrees out here on the prairies, neighbors have to look after one another, and it’s that sense of compassion and community that makes us Canada.”

David Shribman is executive editor of the Pittsburgh Post-Gazette.