A new book that we think will be of interest to all health system leaders, researchers and enthusiasts deserves a special mention. Tommy Douglas and the Quest for Medicare in Canada, by Greg Marchildon, provides a riveting and detailed account of the origins of our health system by tracing the life and influence of arguably one of the greatest Canadians (Marchildon 2024).

The book covers a period of rapid change in our country – from the 1930s to the 1980s – explaining how a preacher-turned-politician overcame major obstacles to lay the groundwork for our uniquely Canadian version of universal health coverage.

We held an event at the University of Toronto Bookstore on January 21, 2025, to hear Greg Marchildon speak about how he came to write this book and how he put the puzzle pieces together to understand the origins of medicare. We invited Arjumand Sidiqqi – a leading scholar on the influences of social policies on the nature and causes of health inequities and former co-editor-in-chief of Healthcare Papers – to provide remarks, which we are delighted to publish here. For more about the book launch see: https://ihpme.utoronto.ca/event/ihpme-book-launch-tommy-douglas-and-the-quest-for-medicare-in-canada/

- Sara Allin, Co-Editor-in Chief, Healthcare Papers

Remarks by Arjumand Siddiqi at the Book Signing Event for
Tommy Douglas and the Quest for Medicare by Gregory Marchildon (Edited for Readability)

Thanks so much. What an honour and a pleasure it is to be with you today to celebrate Greg Marchildon’s book about Tommy “T.C.” Douglas. Like all good historical biographies of righteous people, Greg’s account of Tommy Douglas is absolutely inspiring. But as the author points out early in his book, his intention is not just to tell the story of Tommy Douglas, but to tell the story of the creation of medicare. As Greg poignantly asks (and answers): “Is the history of universal health coverage in Canada severable from T.C. Douglas? … when all the evidence is sifted, T.C. still emerges as the single most important individual among the cast of characters who had a role in the introduction of medicare.”

As a scholar of health equity, the subjects of Greg’s lifelong work are very near and dear to me.

When I was first asked by Sara and Greg to join all of you today, I immediately harkened back to the many years I spent in the US, initially for graduate school and then for my first stops as I launched my academic career. While I was there, I had access to academic medical centres, which provide some of the best healthcare that the country has to offer, but I distinctly remember thinking the entire time (and in fact telling friends) that if I get anything more than a cold, please ship me back to Canada!

Well, as of yesterday (January 20, 2025), a moment that will drastically change lives in the US and beyond, I am particularly glad that I did ship myself back to Canada. We have formally entered what may be one of the most morally shocking and unstable times that the world has seen in quite a while. It is therefore all the more significant that we gather today to appreciate Greg’s remarkable book about a remarkably principled man.

It is also no secret that we have problems with our healthcare system today. Indeed, massive swaths of our population are unable to access family doctors, the current crisis in home care and nursing is concomitant with a rapidly aging population and issues of discrimination in care are a regular fixture in the news pages. I think it has to be said: “We aren’t quite living up to what Tommy dreamt for us.”

Tommy was a man who believed in equity, in humanity and in the human right to health. And, importantly, he believed in the government’s responsibility to ensure these things for its citizens.

Mind you, though, as Greg points out, Tommy was not so much a dreamer as he was a “pragmatic idealist.”

And that got me thinking about what we could learn by reasserting Tommy’s spirit and to find our way out of the crisis conditions in which we find ourselves today.

At the heart of Tommy Douglas was a principled man. In fact, the issue is not just that Tommy was a righteous, principled man. As Greg describes it, the issue is that Tommy lived his life consistent with his principles. And I think that is where the lessons lie. While being principled is inspirational and generally laudable, it is also critically important to the process of building equitable institutions. Here are three ways I think that shows up:

1. Principles allow us to speak truth to power and to persist in the struggle. Consider for a moment the timeline that Gregory presents early in his book, which outlines Tommy Douglas’ nearly four-decade-long campaign to see national medicare to be realized. During this time, he battled powerful forces, including the Canadian Medical Association that favoured a targeted approach to improve care gaps. As Gregory writes,

“The doctors, through the CPS […..] as well as the Canadian Medical Association, said that the only useful role for the government was to subsidize the purchase of private health insurance for those unable to afford the premiums. Douglas derided this alternative as ‘tin cup medicare’ because it required what he viewed a humiliating means test.”….

Tommy’s argument wasn’t routed in finances, logistics or effectiveness, or anything of the sort. In the face of attacks that provided cheaper alternatives, Tommy doubled down on medicare because it was the plan that spoke most to his principles.

As Greg goes on to say, “T.C. then defended the very concept of universality, answering the question of why his government was making a sizeable public investment in a universal plan as opposed to a targeted approach.” For T.C., equity in outcomes wasn’t good enough. He wanted equity in the process as well.

What would this look like today? It would look like a conversation in which we are unapologetic about prioritizing equity, humanity and the right to health in making decisions about our healthcare system. It would be like doubling down so that these principles aren’t sacrificed to fit a budget or a timeline or anything else. It is not that those things do not matter – after all, recall that Tommy wasn’t a dreamer but a pragmatic idealist! But, we simply cannot sacrifice our principles to get there.

2. Principles create an everlasting, bankable good on which we can draw, especially in hard times. Well, I think this principled leadership is, in large part, what has made us hold on to this day to the ideal of universal healthcare.

I think about times I would go back to Vancouver to visit my parents during the holidays, and I would regale them with all sorts of comments that I had heard Americans make about Canada. One such regular comment was, “I heard you have really long lineups in your healthcare system.” I will never forget my dad saying to me, “Well, next time you should tell them, at least EVERYONE gets to be in line.”

This sensibility in everyday Canadians that fundamental to our healthcare system is the principal of equity and, moreover, that this is a point of Canadian pride is Tommy Douglas’ enduring legacy – creating that strong sense that at the heart of our healthcare system are a set of principles, and that they matter is priceless.

In fact, I would argue that when we see the system falling short, particularly with respect to inequitable care, we know it precisely because our deeply embedded default is that our system should do better. And that was instilled by the decades-long struggle to enact a system with equity at its core.

3. While healthcare is important, this spirit and inspiration extends well beyond health itself. Polling data suggest that Tommy Douglas is one of the most famous Canadians of all time. Polling data also suggest that when Canadians are asked to define what makes us Canadian, our universal healthcare system is near the top of their responses. What does that tell you? It tells me that what Tommy Douglas created, and more importantly, what he stood for, has penetrated the Canadian psyche in ways that transcend healthcare.

That does not at all mean that we live up to those ideals. Indeed we fall short in big, systemic ways each and every day, for Indigenous people, for Black and other racialized people, for women and for our elderly. I hope you realize what I’m realizing, which is that this encompasses the vast majority of the population.

But it does mean that there is a part of the collective Canadian imaginary in which equity is embedded. And that matters.

Consider the words of the great Canadian environmental scientist, David Suzuki, in his recent open letter to US President Donald Trump that was published in the Toronto Star (Suzuki 2025). In talking about why he returned to Canada after his postdoctoral work in 1961, a time when US universities were thriving and it would have been natural to stay in the US, he says:

“I chose to return because Canada was different, not better than the US, and those differences reflected values that mattered most to me. Canada had a health-care system available to all, regardless of economic status. … Tommy Douglas … was a hero to me, a champion for the poor and disadvantaged.”

The letter goes on to say, “I have never regretted my decision to return home to Canada, and I thank you, Mr. Trump, for reminding me why. I hope all Canadians reflect on this country and why we will fight to preserve our differences with your great nation.”

As David Suzuki makes clear, Tommy Douglas is a big reason why we have that fight in us.

I want to close with a final note, which is about Gregory’s scholarly contribution. Those of us who study equity day in and day out, think we know so much about it. We have indicators of whether institutions are equitable. We have fancy statistical models that tell us whether institutional equity is giving us equity in healthcare and health outcomes and so on. But Gregory’s book gives us something we couldn’t possibly otherwise learn. It gives us the important story, right from the trenches of the process through which we build equity. It (hopefully) prevents us from taking for granted our country’s healthcare system, because it demands that we respect what Tommy Douglas went through to make it happen. And, for that, I give my sincere thanks to Gregory.

Thank you
Arjumand Siddiqi
January 21, 2025
Toronto, Ontario

 

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