36 Steps on the Road to Medicare

36 Steps on the Road to Medicare: How Saskatchewan Led the Way

C. Stuart Houston
Merle Massie
Copyright Date: 2013
Pages: 208
https://www.jstor.org/stable/j.ctt32b7s3
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  • Book Info
    36 Steps on the Road to Medicare
    Book Description:

    The co-operative spirit of citizens in twentieth-century Saskatchewan nurtured innovation in health care and health policy. 36 Steps on the Road to Medicare showcases the decisions that led to the province's medicare system - the forerunner of Canadian health care. Stuart Houston and Merle Massie document the range of Saskatchewan leadership on Canadian, North American, and world stages: municipal doctors and municipal hospitals, the first Red Cross Outpost Hospital in the British Empire, tuberculosis diagnosis and treatment, a successful pilot comprehensive regional health care plan, government-sponsored cancer clinics, innovative LSD and patient-oriented treatment for psychoses, the first full-time cancer physicist in Canada, and the world's first concerted clinical use of the betatron and Cobalt-60 in cancer treatment. They show how North America's first social-democratic government, the Co-operative Commonwealth Federation - elected in 1944 and led by the incomparable Tommy Douglas - created the blueprint for comprehensive health care and how sequential steps on the road to medicare were implemented quickly and within budget. When federal support for national hospitalization became available, Saskatchewan could afford to initiate medicare in 1962. Other Canadian provinces soon followed Saskatchewan's lead. Updated to engage with current debates, 36 Steps on the Road to Medicare navigates the history of medicare and demonstrates the spirit of innovation that Canada will need to save it.

    eISBN: 978-0-7735-8957-5
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. ABBREVIATIONS
    (pp. vii-viii)
  4. ACKNOWLEDGMENTS
    (pp. ix-xii)
  5. FOREWORD
    (pp. xiii-xvi)
    SYLVIA O. FEDORUK

    Saskatchewan has been a leader in many aspects of health care. These developments arose from the co-operation and mutual help necessary among pioneer settlers, sparsely distributed in a relatively hostile environment. House-raising, barn-raising, and the building of community amenities such as schools and curling rinks made it logical for other co-operative developments also to occur.

    These accomplishments took place in an atmosphere of community, creativity, and trust. Individuals with foresight such as Drs Seymour, Ferguson, Blair, and Johns helped Saskatchewan to lead the world. In36 Steps on the Road to Medicare: How Saskatchewan Led the Way, Stuart Houston reviews...

  6. INTRODUCTION
    (pp. xvii-2)

    Most of the steps that led to medicare were forged in Saskatchewan. The events described in this book changed the course of health care throughout Canada.

    There is a certain danger in listing all the times Saskatchewan was “first,” leaving us open to charges of hero-worship, bragging, and jingoism. In this revised edition, my co-author Merle Massie and I enumerate these “firsts,” with one caveat: we do not say that all of these firsts are, therefore, key “steps” on the road to medicare that should be followed by other jurisdictions around the world. Some were. Others showcase Saskatchewan’s vivid and...

  7. CHAPTER 1 SASKATCHEWAN HOSPITALS: Off to a Slow Start
    (pp. 3-17)

    To maintain a little balance in an unabashed book of firsts, it seems only fair to admit that the area that became Saskatchewan in 1905 was slow off the mark – the advent of hospitals was delayed in comparison with adjacent Manitoba and Alberta.

    Of course, health care, for thousands of years, had been in the hands of medicine men and women in what became Saskatchewan. They had practical knowledge of effective herbal remedies, and a cultural and spiritual connection to community and to the land. When smallpox, that scourge of the North American First Nations, hit Saskatchewan in the winter...

  8. CHAPTER 2 DR SEYMOUR AND PUBLIC HEALTH
    (pp. 18-24)

    Maurice M. Seymour is the pacesetter in our story. Born 7 July 1857, in Goderich, Ontario, Seymour was one of three children of Captain Maurice Bain Seymour, who hailed from Ireland, and Maria MacDonald, who came from Scotland. He began his studies at Assumption College, Windsor, Ontario, in 1873 and then obtained his medical degree from McGill University in 1879. Rather unusually for those times, he took two years of postgraduate study before he went into practice.¹

    After employment with the Canadian Pacific Railway during its construction in 1881–83 and service in the Riel Rebellion in 1885, Seymour practised...

  9. CHAPTER 3 MUNICIPAL DOCTORS AND MUNICIPAL HOSPITALS
    (pp. 25-40)

    Saskatchewan’s early population growth required new innovations in municipal medical services, and from 1915, laid the foundation for modern medicare. Both municipal doctor plans and municipal hospital schemes found traction first in Saskatchewan.

    One major step on the road to medicare occurred in the Rural Municipality of Sarnia. The Holdfast history book,History and Heritage, quotes the motion passed by the council of the RM of Sarnia #221 in January 1914: “That Council advertise for a doctor … Also first correspond with Dr Schmitt of Newton, Illinois, in regard to locating here.” Perhaps Schmitt wrote to Holdfast in response to...

  10. CHAPTER 4 DR FERGUSON AND TUBERCULOSIS
    (pp. 41-68)

    In fighting the disease that for many years took the greatest toll on health and productivity, Robert George Ferguson was one of the most consistent and effective leaders in North America. Sixth in a family of sixteen, he was born 12 September 1883 near the Red River at Joliette, North Dakota, only seventeen miles south of the forty-ninth parallel. At age nineteen he was delegated by his family to choose a farm in Saskatchewan, of similar size to the one being vacated in North Dakota. He selected one at the south edge of Yorkton and moved his parents, brothers, and...

  11. CHAPTER 5 SIGERIST AND PENSIONERS’ CARE
    (pp. 69-78)

    Saskatchewan took a bold step toward medicare in 1944, not through health research or policy or management, but through politics. The province elected:

    “No person has had as profound an effect on the restructuring of health services in Canada as Tommy Douglas, that doughty little Scottish socialist fighter and orator”¹ (figure 5.1). Douglas was “among the greatest political campaigners Canada has known.”² His Co-operative Commonwealth Federation (CCF) party won a landslide victory, forty-three of the fifty-two seats, in the Saskatchewan election of 15 June 1944 and took office 10 July 1944. The ccf had a triumphant convention following this victory...

  12. CHAPTER 6 SWIFT CURRENT HEALTH REGION
    (pp. 79-92)

    Joan Feather opens her two landmark articles on the history of the Swift Current Health Region with the following statement:

    Southwestern Saskatchewan seems an unlikely place for a major experiment in universal, prepaid health services. Rolling grassland, short, hardy crops struggling against drought and wind, vast expanses without signs of human dwelling – how can such a place give rise to a sophisticated service structure? The explanation is to be found in the unique combination of past experience, local leadership, and government policy, skillfully merged into an experiment with remarkable staying power.¹

    What was the “past experience and local leadership” that...

  13. CHAPTER 7 MEDICAL COLLEGE AND UNIVERSITY HOSPITAL
    (pp. 93-95)

    The success of any future medicare program in Saskatchewan required a first-rate medical school. Although a two-year medical course had been offered at the University of Saskatchewan since 1926, Saskatchewan medical students had to move to other provinces for their clinical training. Sigerist’s report in 1944 recommended construction of a full, five-year medical school and a 500-bed university hospital in Saskatoon. Sigerist predicted the building and equipping of the hospital and medical school would cost $2 million,¹ with annual operating costs of $150,000.

    Even before the 1944 election, T.C. Douglas was planning for a five-year medical college if and when...

  14. CHAPTER 8 PROVINCEWIDE HOSPITALIZATION
    (pp. 96-104)

    Hospital services are costly. They require support from municipal and provincial governments to provide funding and sound policies. Above all, the primary concern should be for the patient. With momentum gained from experience with cottage and union hospitals and the Swift Current Health Region No. 1, Saskatchewan moved toward province wide hospitalization.

    22.The first province to provide capital grants for widespread hospital construction, 1945

    Saskatchewan took Sigerist’s advice to heart in becoming the first province to provide funds for capital construction of hospitals, a major step on the road to medicare.¹ Between 16 March 1945 and 1 March 1949,...

  15. CHAPTER 9 INNOVATIONS IN PSYCHIATRY
    (pp. 105-117)

    When Saskatchewan became a province in 1905, psychiatry and mental hospitals across Canada were in a backwater compared to the rest of medicine. The first opportunity to show leadership was scuttled by unfortunate advice from Ontario.

    Dr David Low of Regina, the provincial health officer (figure 9.1), was sent in 1907 to visit mental hospitals in eastern Canada and the United States. He was asked to consult widely and to make recommendations for construction of a mental hospital in the new province. He visited two up-to-date mental hospitals in New York State, at Ogdensburg and Ward Island, and the Protestant...

  16. CHAPTER 10 HIGH-VOLTAGE CANCER TREATMENT
    (pp. 118-137)

    Saskatchewan was slow off the mark in using radiation to treat cancer but, once up to speed, it led the world. As with the initial provision of radium in 1932, high-voltage treatment could be available only with government support.

    In 1922, Dr Ellice McDonald,¹ a Saskatchewan man who had been raised at Fort Qu’Appelle² and later specialized in cancer research at the University of Pennsylvania, visited University of Saskatchewan president Dr Walter Murray. McDonald informed Murray that the province of Quebec had just purchased a gram of radium for $75,000 and suggested that Saskatchewan should take similar action. In response,...

  17. EPILOGUE
    (pp. 138-146)

    The CCF government, from its election in 1944, had a clear goal: to build on Saskatchewan’s unique fifteen years of free diagnosis and treatment of the most expensive disease, tuberculosis, by adding health care for pensioners and widows, for those with cancer and mental diseases, and then provincewide hospitalization. These represented step-wise progressions from innovative policy formation, a view of community-based health and wellness, direct attacks on insidious diseases, to psychedelic experimentation – always within the annual provincial budget. Success in provincewide hospitalization as well as the example of the Swift Current Health Region became models upon which to build the...

  18. NOTES
    (pp. 147-180)
  19. INDEX
    (pp. 181-194)