In her novel Swimming into Darkness, Gail Helgason exercises considerable artistic licence in depicting Saskatchewan doctors' partial withdrawal of services in 1962.1,2 Although some called this a strike, it was more like a lockout.
The Co-operative Commonwealth Federation (CCF), now the New Democratic Party (NDP), had recently brought in legislation to provide for universal public insurance for medical care. This gesture of apparent social conscience was more than it seemed. Buried in the fine print was an abrogation of doctors' democratic right to negotiate their working conditions. Section 49(g) of the legislation stated, “The Medical Care Commission [i.e., the government] shall determine the terms and conditions of service.”
The Saskatchewan doctors felt that they had to resist the loss of such freedom, not only for themselves but on behalf of others who might one day be similarly constrained. But this did not mean a strike; rather, most doctors decided that they would work outside the Act. Thus the doctors would have their freedom and the government its insurance, but the insurance would be between the patient and the government. This was in keeping with Premier Tommy Douglas' oft-repeated statement that “we only want to pay the bill” and its implication that there was no desire to control the doctors.
However, when Douglas became the first leader of the national NDP, he wanted to include medicare in his platform. To achieve this objective, Douglas' successor in Saskatchewan amended the Act in May 1962, adding section 28, which made it illegal for a patient to even voluntarily pay a doctor's bill. This measure, the government thought, would mandate doctors to work within the Act when the amendment came into force on July 1, 1962.
Saskatchewan's doctors could not tolerate this Star Chamber legislation, nor could we run our offices with no income. As a result, we closed our offices but continued to operate hospitals and emergency departments. True, our services were for emergency cases only, but the definition of “emergency” was broad. We unequivocally accepted a patient's designation of his or her condition as urgent, although we did draw the line at marriage medicals (yes, in those days you could not get married until you had submitted a medical certificate).
After several weeks the government unilaterally called in a mediator: Lord Stephen Taylor, a socialist English peer who had been instrumental in initiating Britain's national health plan. Taylor essentially agreed with the doctors, and on his recommendation the legislature wiped out the 2 offending clauses. The doctors went back to work, and the government had its medical care insurance plan.
Helgason's fictional treatment of these events suggests that the public opposed the doctors' action. My recollection is to the contrary. When Tommy Douglas ran for Parliament in June 1962, just days before the plan was implemented, he was soundly beaten.
I recall clearly the last patient I saw in June of that year. As he left my office he shook his fist in my face and said, “Doctor, if your office is open in July I will never see you again.”
A puzzled reporter from the now-defunct Washington Star came to the provincial medical association's press relations office. He said he had talked to many people and found 2 apparently contradictory things. First, they wanted the government legislation; second, they supported the doctors. We resolved his confusion: people wanted health insurance, but not at the expense of doctors' civil rights. They were concerned about the slippery slope — a concern that was epitomized in a Saskatoon newspaper cartoon featuring the provincial premier (see illustration).
The final blow to government support occurred when the premier called an election a year after the strike. The Liberals, campaigning in support of the doctors, soundly defeated the CCF/ NDP.
As Helgason's novel portrays, emotions and, indeed, hatreds ran deep in the crisis of 1962. The province was on the brink of violence. A priest who supported the doctors recommended carrying guns. Government supporters physically threatened doctor supporters with rivet guns used to drive studs into concrete. I believe that they loosened the wheel bolts on my mother's car.
In the end, reason prevailed over ideology, government has stuck to financing, and medicare in Saskatchewan has worked, all of which demonstrate that the fascist clauses in the Medical Care Insurance Act of 1962 were unnecessary.