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Charlotte Gray: On Medicare, and the Paradox of Tommy Douglas

Tommy Douglas, the longtime premier of Saskatchewan, was the father of medicare. Born almost exactly 110 years ago (Oct 20, 1904), he was an unlikely politician.

Book Cover Tommy Douglas

"Talking History" is a new biweekly series made possible through a special funding grant from the Department of Canadian Heritage. The series focuses on a wide range of topics in Canadian history, exploring the notion of history as a compelling form of storytelling of interest to large audiences. These articles by Canada's foremost historians and history experts use the power of narrative to bring the past to life, drawing connections between then and now to show how these stories are not just relevant, but essential to our understanding of Canada and the world today. 

Book Cover Charlotte Gray

This week, we're pleased to present Charlotte Gray, one of Canada’s pre-eminent biographers and historians, who has won many awards for her work, including the prestigious Pierre Berton Award for a body of historical writing, the Edna Staebler Award for Creative Non-Fiction, the Ottawa Book Award, and the CAA Birks Family Foundation Award for Biography. Over nine books, she has brought our past to life. Gray is a Member of the Order of Canada and was a panelist on the 2013 edition of CBC Radio’s Canada Reads. She lives in Ottawa.


If there is one unique national characteristic that Canadians are proud to claim, it is our healthcare system. Medicare tops opinion polls of what Canadians value. In the words of political columnist Jeffrey Simpson, the system “is the third rail of Canadian politics.” Touch it, and you die. As we hurtle towards the 2015 federal election, each party is already talking about its unswerving commitment to the preservation of medicare.

The irony is that this national program originated in what was then an impoverished backwater, and Canada’s richest province at the time tried hard to squelch it. Moreover, the man responsible for its introduction had no national appeal: he fizzled as a federal politician and his only electoral success came nearly two decades after his death. But that’s typical of Canadians. We take a while to catch on.

Tommy Douglas, the longtime premier of Saskatchewan, was the father of medicare. Born almost exactly 110 years ago (Oct 20, 1904), he was an unlikely politician. When he arrived in Canada with his family from Glasgow in 1919, aged fifteen, he was a tough little high school drop-out with poor prospects. He managed to become an apprentice printer and help his parents buy a house, but then he abandoned that career path in favour of becoming a Baptist preacher. Politics was the last thing on his mind.

So when I think about Douglas’s political achievements, I wonder how he got there from such an unpromising start. But let’s talk defining experiences. 

Crucial Experience Number One: As a boy Tommy injured his knee, and since the Douglases could not afford a specialist surgeon, doctors decreed amputation was the only option. Then a surgeon decided that Tommy’s knee would make an excellent teaching aid for his students, and performed the surgery without charge. Young Tommy would often ponder the kind of world where a rich family could buy the best health care for themselves while the son of a poor family faced permanent disability.

Crucial Experience Number Two: When Douglas arrived in Winnipeg in 1919, the city was in the midst of a general strike, triggered by the frustrations of First World War veterans who had come home to find no jobs, housing or decent wages. Within weeks of his arrival, young Tommy was watching the Royal Canadian Mounted Police firing on unarmed strikers.  Douglas would perceive a pattern to such clashes. “Whenever the powers that be can’t get what they want, they’re always prepared to resort to violence or any kind of hooliganism to break the back of organized opposition.”

Crucial Experience Number Three: Douglas’s years as a preacher in Weyburn, Saskatchewan reinforced his sympathies for the underdog. The 1930s were brutal for the province. In the midst of a worldwide depression, calamitous droughts transformed Saskatchewan into a dustbowl: hot, dry winds blew the topsoil off in ghastly black clouds. Douglas watched farm families go broke, children starve and bright youngsters surrendering dreams of a university education. This is what drove the Baptist preacher into politics. He decided that only governments could establish the kind of collective action that might pull Saskatchewan out of its downward spiral into poverty and depopulation.

Douglas’s first political venture came in 1935, when he was elected for Weyburn as a federal MP representing the newly formed Cooperative Commonwealth Federation (CCF), a party that appealed strongly to the rural vote. But he decided he could be more effective in provincial politics. He became leader of the provincial CCF and, to the astonishment of observers, led the party to a resounding victory in the 1944 Saskatchewan election. He proceeded to revolutionize the province, largely by using government to effect economic and social change. Despite repeated accusations from his opponents that he was a dangerous socialist, Saskatchewan voters gave him five straight majorities at the polls.

As I describe the trajectory of Douglas’s career, I realize that the only Canadians today who can imagine the challenges he faced are those who came from countries lurking at the lowest levels of the UN’s Human Development Index. In 1944, there were no safety nets for Saskatchewan residents. Most rural families lacked electricity, decent roads, indoor plumbing or any crop insurance. For factory workers, pay was wretched and there were no minimum safety standards. Welfare and pensions were minimal. And except for some threadbare municipal hospitals, there was little access to health care. Moreover, the province had a huge public debt, few decent roads, and a public service that ran on nepotism and apathy.

During his 17 years as premier, Tommy Douglas changed all that. Soon the province was crisscrossed with new roads, farm families had electricity and indoor plumbing, factory workers had insurance and decent wages, and resource companies started investing. But one of Douglas’s 1944 promises remained unfulfilled, because Douglas could not find the money. There was still no universal, government-funded health care, and Ottawa politicians made it clear the feds weren’t going to help.

So Tommy Douglas decided to go it alone. Saskatchewan physicians were furious: with the support of powerful organizations like the American Medical Association, they did everything they could to block his plans including calling a strike. But the Douglas government, which had just won a healthy majority in the 1960 election, introduced publically-funded healthcare anyway. When Canadians outside Saskatchewan saw what had happened there, they successfully pressured Ottawa to make medicare a nation-wide program. By 1972, after a furious fight in Ontario, the whole country was covered.

I have to admit that the health care system we have today would disappoint Tommy Douglas. It is not the universal, accessible, well-managed system he dreamed of, although it continues to be government-funded which makes it much cheaper than the US healthcare system. If I arrived at the Emergency Department with a broken leg I would get good care, but if I needed a knee replacement I might have to wait several months. 

Nevertheless, the Canadian healthcare system that Douglas fathered has come to be, for many of us, one of Canada’s greatest assets as well as a defining difference between Canada and the United States. Moreover, Douglas promoted a much larger idea—the enormous potential of co-operative action for the common good. Although faith in government has dwindled since 1972, we still assume that government can be a force for good. 

The paradox of Tommy Douglas is that Canadians outside his beloved Saskatchewan never really warmed to him. After his 17 years in Regina, he spent a further 17 years in Ottawa, for much of which he was the leader of the New Democratic Party (the successor to the CCF party.) But he failed to achieve an electoral breakthrough for the NDP: his old-fashioned boxy suits and preacher voice were anomalies in the Canada of Pierre Trudeau.

However, he would have enjoyed a widely-watched CBC television program in 2003, The Greatest Canadian. Viewers voted Douglas into the Number One spot. He beat out not just the man I championed in the contest, Canada’s first prime minister Sir John A. MacDonald, but also Prime Ministers Lester Pearson and Pierre Trudeau, and hockey great Wayne Gretsky.

Tommy Douglas, and medicare, have achieved mythological status in the national imagination.


Further Reading: 

Book Cover Tommy Douglas

Extraordinary Canadians: Tommy Douglas, by Vincent Lam

Tommy Douglas was a Scottish-born prairie politician who believed in the enormous potential of co-operative action for the common good. Award-winning novelist and medical doctor Vincent Lam brings special insight to his portrait of Douglas, who grew up to become a champion boxer and a Baptist minister and then later exchanged the pulpit for a political platform. A powerful orator and tireless activist, he served for 17 years as premier of Saskatchewan, where he introduced the universal health care program that would eventually be adopted across Canada. As the new leader of the New Democratic Party, he was a staunch advocate of programs aimed at improving the well-being of ordinary Canadians and a steadfast defender of civil liberties. By his example and unflagging efforts, Douglas made democratic socialism a part of mainstream Canadian political life.

Life and Political Times of Tommy Douglas

The Life and Political Times of Tommy Douglas, by Walter Stewart

Vision and eloquence, two qualities valued in a political leader, were what Tommy Douglas was all about. Social policies we take for granted today -- Medicare, a Canada-wide pension plan, bargaining rights for civil servants, a Wheat Board to protect farmers -- were first advocated by Douglas. Medicare, his finest achievement, was first wrestled into place in Saskatchewan, and finally embraced by all of Canada.Tommy Douglas was a canny politician, but he never lost sight of his principles. He told his own party that, whenever it came up with a good idea like Medicare, political opponents were bound to take over. But that didn't matter to him. What mattered was that the ideas took root, to benefit every Canadian. Walter Stewart has written a passionate, clear-sighted biography of one of Canada's pre-eminent political trailblazers.

Book Cover Dream No Little Dreams

Dream No Little Dreams: A Biography of the Douglas Government of Saskatchewan 1944-1961, by A.W. Johnson

Medicare is viewed by many as the greatest achievement of the Douglas government. Dream No Little Dreams offers rich insight into the initial planning stages of Medicare and details the protracted struggle with the medical profession that followed as Douglas fought to implement it. Johnson also addresses the question of how socialists were going to pay for all their ambitions, and situates the answer in the context of developments in national policy and in federal-provincial fiscal arrangements from the war years through to the 1960s.

Book Cover Chronic Condition

Chronic Condition, by Jeffrey Simpson

Medicare is the third rail of Canadian politics. Touch it and you die. Every politician knows this truism, which is why no one wants to debate it. Privately, many of them understand that the health-care system, which costs about $200 billion a year in public and private money, cannot continue as it is—increasingly ill-adapted to an aging popula­tion with public costs growing faster than government revenues.  
In Chronic Condition, Jeffrey Simpson explores the options we have to grapple with this growing problem, including cuts in non-health-care spending, tax increases, various types of privatization, and finding savings within health care itself. His research takes him to emergency rooms and private clinics across Canada as he listens to health professionals, researchers, and administrators outline the challenges they face. Simpson examines the tenets of the medicare system that Canadians cling to so passionately.

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