Steps on the Road to Medicare: Why Saskatchewan Led the Way (review)

By all reports, Canada's health care system is in trouble. Current headlines point to concerns about SARS and its containment, long waiting times for many diagnostic (and in some cases therapeutic) treatments, busy emergency rooms (often being used as walk-in clinics), closed medical practices leaving many Canadians without family doctors, lack of long-term health care facilities for the aging population, and the list goes on. Health care services may have declined, but Canadians are not ready to abandon the universally accessible, publicly funded system. We still take pride in our federal Canada Health Act.

C. Stuart Houston reminds us how and why the medicare system was conceptualized and enacted. In Steps on the Road to Medicare, Houston argues that Saskatchewan co-operative community spirit and individualism were the greatest contributing factors to why this province led the way towards universal medicare in Canada. Houston chronicles numerous Saskatchewan 'firsts' - such as municipal doctor legislation, free diagnosis and treatment of tuberculosis, a health plan for pensioners and widows, among others - and describes the role of individuals like Maurice Seymour, Robert George Ferguson, Allan Blair, Harold Johns, and Tommy Douglas who introduced these initiatives. These men sought a publicly funded system to provide better health care against acute, infectious diseases (like typhoid, scarlet fever, diphtheria, tuberculosis) and to initiate preventative health strategies for Saskatchewan residents, and eventually for all Canadians. In the concluding chapter, Houston challenges us to 'emulate the co-operative spirit, altruism, and ingenuity' demonstrated by the Saskatchewan people towards maintaining the original universal health care vision and ideals in meeting many of today's challenges to Canada's health care system.

This is a brief and selective introductory account of Saskatchewan medicare initiatives. Houston has not drawn extensively from the secondary source literature on the topic or presented any new primary material for this account. The chapters are often uneven and disconnected. Individuals (leaders) are emphasized more than co-operative community spirit (Saskatchewan rural people), which is never fully expanded upon. Students attempting to situate these health care initiatives within a larger context will have difficulties and will inevitably have questions relating to political barriers, economic challenges, power struggles, regional conflicts and changes in diseases and treatments, among other issues. Its value for specialists wanting more than 'firsts' and 'individual' initiatives will be limited.

It is clear that Houston, a Saskatchewan physician and University of Saskatchewan medical imaging professor, enjoyed writing this book - for himself and others in the Saskatchewan medical community who are proud of their 'firsts' and the 'individuals' who introduced these measures. The audience for this book will be non-specialist readers interested in Houston's reflections and anecdotes, which he has collected over the years. For example, this includes a conversation that Houston had with Tommy Douglas in 1983 over the decision to authorize the development of cobalt bomb cancer treatment during the 1940s. A leader that the author states was 'the right man in the right place at the right time,' much more on Douglas could have been included in this book. Acknowledging possible 'charges of hero-worship, bragging and jingoism,' Houston nonetheless celebrates the ideals and innovations of these Saskatchewan men, hopeful that solutions to today's health care system problems will be forthcoming. Yet today's medical world is quite a different one from that of these medicare pioneers. The challenge will be fixing our troubled health care system without betraying its original intent but acknowledging the changing medical context of today's aging population, chronic illnesses, and costs of high-technology medicine.