Radical Medicine: The International Origins of Socialized Health Care in Canada by Esyllt W. Jones (review)

The origins of Medicare in Canada have long been wrapped in hero-worship of Tommy Douglas, the mythology of Prairie exceptionalism, and the waving of the Canadian flag. The story of "Canada's most cherished social program" (15) has been written largely as political history but, in Radical Medicine, Esyllt Jones recasts this narrative, foregrounding the interconnected ideas and agency of reform-minded advocates of socialized medicine. These reformers were not interested in merely socializing the costs of health care: they sought to radically transform medicine itself. Jones argues convincingly that "the ideas and people that came together in Saskatchewan in the 1940s and early '50s to build the CCF health program were part of a transnational … movement for greater health equality that percolated in the context of war, pandemic, and the October Revolution, then moved across the Atlantic world, reaching its apex at the close of World War II" (16).

But this is not a success story. In her close reading of the reformers' published and unpublished communications, Jones isolates "the obscured historical traces left by a failed alternative" (283), which she refers to as the "health centre model." Well before the CCF government took office in Saskatchewan, the general principles of the model had been established: equality of access, democratic local lay governance, multidisciplinary teams of health care practitioners working within a shared physical space, salaried remuneration for all practitioners, integration of the centre with the community it served, and fusion of the preventive and curative aspects of health care.

In her first three chapters, Jones illustrates not only how the health centre model was envisioned but also how aspects of it were realized from the 1920s through the mid 1940s. Educational tours to the Soviet Union in the 1930s showcased polyclinics that provided inspiration for (largely uncritical) international visitors, who, like celebrated Canadian physicians Frederick Banting and Norman Bethune, actively advocated for socialized medicine when they returned to their homelands. In working-class boroughs of London, England, similarly inspired radical physicians and Labour women played key roles in a movement that saw success in the construction of three local health centres. In Saskatchewan, the State Hospital and Medical League, founded in 1936, mustered broad popular support for health reform. Henry Sigerist, a prominent voice for socialized medicine in North America, was invited to Saskatchewan in 1944 by the newly elected Douglas to survey the province's health care needs and prepare a blueprint for future reform; the resulting Sigerist Report incorporated many ideas common to the medical left.

Jones employs a biographical lens to flesh out the role of individuals like Mindel Cherniak Sheps (chapter 4), mentioned only briefly in earlier works on Medicare. Sheps's "formal status never quite matched her level of responsibility and behind-the-scenes influence" (217) in attempting to implement the recommendations of the Sigerist Report. Chapter 4 also addresses the problems and compromises encountered in the creation of Saskatchewan's first health region, in Swift Current, in 1945. Jones points out that in this context, one of the key principles of the health centre model, local governance, became "a fast-moving train, impossible to steer" (216); in particular, a compromise fee-for-service agreement for physician remuneration would set a precedent that did not bode well for the future of the health centre model. In chapter 5, Jones usefully identifies commonalities rather than differences across the 49th parallel in the 1930s and 1940s. She points out the broad-based "movement qualities of the era" (245) that in the United States resulted in concrete if often temporary gains in health security, especially for rural Americans, through the construction of health centres and the implementation of various health insurance programs. Frederick Mott, one of the New Dealers who helped bring about those gains, along with fellow Americans Milton Roemer and Leonard Rosenfeld, accepted invitations from the Douglas government to apply their experience to the implementation...