Roots of reform

Steps on the road to medicare C. Stuart Houston Montreal: McGill University Press; 2002 176 pp $22.95 ISBN 0-7735-2550-5

I was born the same year as medicare. We both celebrated 40 years in 2002 and are still going strong — if a little financially stressed — in our home province of Saskatchewan. But while my origins are easy to trace, the arrival of Canada's cherished health care system was less premeditated and more intriguing.

In Steps on the Road to Medicare: Why Saskatchewan Led the Way, retired radiologist and medical historian Stuart Houston traces the roots of medicare to the pioneering spirit of the prairies. He pinpoints 27 “firsts” for health care in Saskatchewan, all of them falling before the big one: the institution of the first universal health insurance scheme in 1962. Long before medicare was a gleam in any politician's eye, the town of Holdfast, Sask., was about to lose its doctor. Dr. Henry Schmitt, who had come up from Illinois the year before, was not making enough money. Doctors collected directly from their patients, and people who couldn't afford to pay often didn't. Schmitt indicated he would move down the road to Craik, where the population was larger and so would be his income.

Holdfast and surrounding townships were populated by immigrant farmers growing wheat in the vast open prairie. The second generation was just taking over from the first, and many of them were my kin. The people of Holdfast and area took a bold step to save their doctor by offering him a stipend of $1500 in 1915 and $2500 in 1916. Schmitt accepted the offer, becoming the first municipal doctor in North America. A year later, the government of Saskatchewan passed legislation making the arrangement legal.

The minister of agriculture — under whose jurisdiction this scheme fell — was said to have observed: “We watch your experiment hopefully but skeptically.” But the Dirty Thirties proved the value of the municipal scheme; crop failures meant that many rural people could not afford medical attention any other way. Initially, money for municipal doctors was based on a property tax, but in 1934 legislation was amended to permit, for the first time, a personal income tax for the purpose of supporting health care.

In 1945 the people of Swift Current and surrounding towns took another step on the road to medicare: they voted to establish universal medical and hospital care for their 54 000 residents, funded by a mix of personal taxes, property taxes and government grants. The provincial premier, Tommy Douglas, was said to have been lukewarm to the idea. He had won a landslide victory in 1944 on a health care platform, but had planned to introduce medical reform gradually, beginning with preventive medicine.

Nonetheless, Douglas honoured the vote and passed the required legislation. It was the first scheme of its kind, predating Britain's national health insurance plan by two years. Medical specialists in Regina and Saskatoon didn't think much of it, leading one doctor to remark that “there have been times when we in the Swift Current area felt like black sheep.”

But doctors almost unanimously approved another first in 1947: the introduction of province-wide hospital insurance, followed by a plan to build hospitals with public dollars. The scheme was monitored closely by other provinces before they took similar steps.

There were many other milestones on the road. In the 1920s Saskatchewan led the fight against tuberculosis with free treatment and trials of a vaccine. It was the first province to sponsor cancer clinics and led the world in the use of betatron and cobalt-60 in cancer treatment. Saskatchewan also introduced ground-breaking reforms in the treatment of psychiatric patients.

The establishment of universal health care in 1962 was met with resistance by many in the medical profession, but there are few in Saskatchewan today who are not proud to call this province “the home of medicare.” It would be almost a decade before public health care schemes were established across the country.

Why did health care innovation find fertile ground in Saskatchewan? In Houston's words:

In a province without a large city, there were few rich people or powerful corporations. Rarely did people have surplus cash, but there was an abundance of good will, of trust in one another, of a willingness to help each other, and of a sense that lives could be improved through communal effort.

Houston's book affirms that spirit. His storytelling is straightforward and full of interesting characters, and he packs a lot of wisdom into 128 pages. In December, Roy Romanow released his landmark report on the future of health care in Canada. Houston's book is the preamble, the story of where medicare began.

Amy Jo Ehman Journalist Saskatoon, Sask.