ST. PAUL LEGAL LEDGER CAPITOL REPORT
When our unfailingly nice neighbors to the north were asked a few years ago in a national contest to choose the “Greatest Canadian’’ of all time, the inventor of the telephone (Alexander Graham Bell) and the sensational and beloved hockey player known as “The Great One” (Wayne Gretzky) finished far behind the top choice, Tommy Douglas.
You likely ask, Tommy who?
The story of Thomas Clement Douglas is amazing and inspirational enough, even if he had not become a political leader. Born in 1904 to parents of humble means, he was a scrappy and smart kid who overcame a serious injury to become a lightweight boxer. He learned the printing trade but also excelled as a scholar and academic, eventually earning a master’s degree in sociology and studying for a doctorate. He also served for a time as a Baptist minister, preaching a social gospel of justice and reform. And finally, Douglas excelled as a gifted and honest politician, an inspirational speaker, and one of Canada’s most beloved leaders over several decades. He was widely celebrated before his death in 1986.
But what really put Tommy Douglas in the Canadian history books was his successful advocacy in the late 1940s and 1950s, as premier (equivalent to governor in the United States) of Saskatchewan, of a universal health care system that eventually was embraced by all of Canada.
As a boy, Douglas had injured his knee and appeared to be headed for a lifetime of crutches, or perhaps even amputation. By a stroke of luck, an orthopedic surgeon in Winnipeg offered to operate on Tommy as a teaching case for his medical students, and the operation likely saved his leg. At the time, poor families or those of average means had little or no access to the medical care and hospitals that wealthier households could afford.
“I felt that no boy should have to depend either for his leg or his life upon the ability of his parents to raise enough money,” Douglas later wrote in his memoir. “I came to believe that people should be able to get health services irrespective of their individual capacity to pay.”
Against some fierce opposition, including at one point a doctors’ strike, Douglas pushed through a Saskatchewan system of taxpayer-funded health care financing that was so successful and popular that it eventually was adopted by the national government and other nations. As author T.R. Reid notes in his best-selling book “The Healing of America,” the “National Health Insurance model that Tommy Douglas pioneered on the prairies of Saskatchewan has spread around the world.”
And as Minnesota and other states figure out what to do next amid the confusion surrounding implementation of the federal Patient Protection and Affordable Care Act (pejoratively known as Obamacare), governors ought to study Tommy Douglas and strive to leave a similar mark.
Our own Mark Dayton could be that Douglas-like figure, and Dayton during his 2010 campaign backed a single-payer model for Minnesota. On taking office, the state’s huge budget crisis immediately intervened and we have yet to see whether and how Dayton advances toward a goal of universal, affordable, high-quality health care for all Minnesotans.
He already has competition for national leadership on this front. Vermont Gov. Peter Shumlin and that state’s Legislature are well along the path toward planning for a state system guaranteeing universal coverage and a publicly financed single-payer model, although the system may not be fully in place until 2017.
States really must take the initiative and begin looking at various public options, because the Patient Protection and Affordable Care Act is more Band-Aid than cure for a badly flawed national health care system. While PPACA will insure millions who don’t have coverage now and end some of the health industry’s harsher practices, millions of Americans and tens of thousands of Minnesotans will remain uncovered or economically threatened by health care costs.
“The sad truth is that even with this ambitious reform,” writes Reid, “the United States will have the most complicated, the most expensive and the most inequitable health care system of any developed nation. The new law won’t get us to the destination all the other industrialized democracies have reached: universal health care coverage at reasonable cost.”
Many international models present themselves, and the Minnesota model doesn’t have to be a perfect replica of Canada’s single-payer system. Reid in his book finds plenty of fault with Canada’s system and suggests improvements. He also outlines the four basic systems of health care in the world: the Bismarck model, found in Germany and Japan, featuring private, competing nonprofit providers and payers; the Beveridge model, found in the U.K. and Scandinavian countries, and featuring more classically socialist public ownership of hospitals and clinics; a National Health Insurance model, like those in Canada and Korea and Taiwan, combining features of the previous two models — private-sector providers with government as a single-payer; and finally, an “out-of-pocket” model, a no-government nonsystem found only in the world’s poor and undemocratic nations, in which the affluent get care and the poor get sick and die.
The United States actually suffers from an incredibly complex mishmash of all the above systems, Reid argues. Most insured workers are covered by something like the Bismarck model. Military personnel and veterans and many Native Americans are covered by a completely public Beveridge system. The elderly and welfare recipients are covered by a Canadian-style National Health Insurance model, while for the 50 million uninsured Americans, “we’re Cambodia, or Burkina Faso, or rural India.” And largely because of this last group, the United States spends more on health care and has worse average health outcomes than almost any other wealthy advanced democracy.
The thing to remember is that universal health care coverage doesn’t have to start at the national level, Reid notes, and “if one of our 50 states were to try [the Douglas example] and make it work, the demonstration effect could spread across the United States.”
A version of this column originally appeared in the St. Paul Legal Ledger Capitol Report on Thursday, August 11, 2011.