- Radical Medicine: The International Origins of Socialized Health Care in Canada by Esyllt W. Jones
While the left and right may agree that good health is important, how to and who pays for modern health care remains deeply contentious. This conversation has a long history, and in Radical Medicine, Esyllt Jones confronts the latent nationalism that has reinforced the idea that a healthcare system symbolically represents core values. Canadians pride themselves on Medicare, but Jones demonstrates that Canada's Medicare was not a product of local, or even socialist ideas, but instead the result of political compromises, grassroots activism, international cooperation, and at times racist and sexist practices of exclusion. The result is more of a mixed bag of values, than a romantic origin story.
The book contains six chapters, each organized around a central idea or person. Chapters 1, 2, and 5 concentrate on transnational exchanges, first from westerners traveling to the Soviet Union to witness their experiment in communist health care. Jones shows how Soviet ideas radicalized important visitors, not the least of whom was Henry Sigerist. She next demonstrates that the contemporaneous British experience combined working-class activism with a drive for decentralized political power, ideas that later moved across the Atlantic to Canada. Chapter 5 looks at American New Deal bureaucrats, Fred Mott and Milton Roemer, who joined the Canadian experiment, bringing their considerable expertise in rural medicine and health care planning. Henry Sigerist hovers over these scenes as a godfather-like character channeling ideas and enthusiasm into Saskatchewan by orchestrating a network of skilled thinkers and promoting intellectual analysis (including in the BHM, where he was then editor).
Chapter 3 locates the reader in Saskatchewan amidst the excitement created by the election of the first socialist government in North America. Premier Tommy Douglas, often hailed as the father of Medicare, is an important figure, but Jones helps to complicate his legacy as progenitor. The early days of implementing the election promise of a reformed healthcare system did not in fact spring up from nowhere, or from Douglas alone. She illustrates how pre-existing grassroots movements in healthcare activism met with an influx of people and ideas, fueled by political opportunities but hemmed in by the need to win elections.
Chapter 4 takes a close look a one of the Sigerist-led Health Survey commissioners, Mindel Cherniak Sheps. A Jewish woman with a medical degree, raised in Winnipeg, Jones gives an intimate portrayal of her work and its reception to illustrate how politics of exclusion continued to chafe at the ideals of equality that many claimed were at the heart of the reforms. This chapter critically explores how sexism in the 1940s and 1950s affected decisions at a personal level, for Cherniak Sheps, and how this attitude affected wider considerations for how professions were included in the system. Running parallel with sexism was the colonial framework that produced tremendous gaps in provision or even basic consideration for indigenous people's health or participation in health care decisions.
The book ends where Medicare begins. Jones shows that Medicare emerged through a set of compromises that ultimately abandoned the health center model [End Page 305] and failed to reject capitalism. This tension also existed in the conversations of her central actors who wrestled with how to build a system that depended on a progressive tax structure, inspired scientific innovation, reduced or even eliminated reliance on insurance models, centralized hospitals as places of public health and medical care, and balanced decision-making power between bureaucrats and patients. The story is complex and Jones reminds readers that even on the left, historically those most passionate about health care and equality struggled to agree on the precise shape of the system that optimized the relationship between health and equality.
Radical Medicine fills an important historiographical gap, updating the literature but also placing the Canadian story in a broader context informed by political, social, and medical historiographies. At times Jones's interest in biography overwhelms the narrative, burying tantalizing insights and tensions...