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Physician Resistance and the Forging of Public Healthcare: A Comparative Analysis of the Doctors’ Strikes in Canada and Belgium in the 1960s

Published online by Cambridge University Press:  17 May 2012

Gregory P. Marchildon  and
Klaartje Schrijvers
Gregory P. Marchildon
Affiliation:
Gregory P. Marchildon, Canada Research Chair in Public Policy and Economic History, Johnson-Shoyama Graduate School of Public Policy, University of Regina, 110–12 Research Drive, Regina, Saskatchewan, Canada S4S 0A2. Corresponding author. Email: [email protected]
Klaartje Schrijvers
Affiliation:
Klaartje Schrijvers, Professor in Political History at the RITS (Film and Dramaschool Brussels), Independent Artist and Researcher, 21 Avenue Jean Volders, 1060 Brussels, Belgium
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Abstract

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Organised medicine in a number of advanced industrial countries resisted the post-war trend toward more state involvement in the funding and organisation of medical care. While there were eight doctors’ strikes during the peak of reform efforts in the 1960s, two of the most prolonged and bitter struggles took place in Canada and Belgium. This comparative analysis of the two strikes highlights the philosophy, motives, and strategies of organised medicine in resisting state-led reform efforts. Although historical and institutional contexts in the two countries differed, organised medicine in Canada and Belgium thought and responded in very similar ways to the perceived threat of medical insurance reform. While the perception of who won and who lost the respective doctors’ strikes differed, the ultimate impact on the trajectory of public healthcare on the medical profession was remarkably similar. In both countries, the strike would have a long-standing impact on future reform efforts, particularly efforts to reform physician remuneration in order to facilitate more effective primary healthcare.

Keywords

Doctors' StrikeCanadaBelgiumSaskatchewan1960sOrganised MedicineFee-for-ServiceMedical LiberalismEdmond LeburtonTommy Douglas
Type
Articles
Information
Medical History , Volume 55 , Issue 2 , April 2011 , pp. 203 - 222
Copyright
Copyright © The Author(s) 2011. Published by Cambridge University Press

References

1 R.F. Badgley, ‘Health Worker Strikes: Social and Economic Bases of Conflict’, International Journal of Health Services, 5 (1975), 9–17.

2 In the case of Australia, doctors also resorted to a strike to arrest the development of collective payment schemes through worker organisations: David G. Green, ‘The 1918 Strike of the Medical Profession against the Friendly Societies in Victoria’, Labour History, 46 (1984), 72–87.

3 See Stephen L. Thompson and J. Warren Salmon, ‘Strikes by Physicians: A Historical Perspective Toward an Ethical Evaluation’, International Journal of Health Services, 36 (2006), 331–54. On the lack of evidence concerning the post-war decline in the power of the medical profession, see David Mechanic, ‘Sources of Countervailing Power in Medicine’, Journal of Health Politics, Policy and Law, 16 (1991), 485–506.

4 Richard Rose, Learning from Comparative Public Policy: A Practical Guide (Abingdon: Routledge, 2005).

5 Gregory P. Marchildon, ‘Postmodern Federalism and Sub-State Nationalism’, in A. Ward and L. Ward (eds), The Ashgate Research Companion to Federalism (Farnham: Ashgate, 2009), 441–55.

6 On the determinative impact of major historical events on the subsequent development of public health insurance in advanced industrial nations, see Jacob S. Hacker, ‘The Historical Logic of National Health Insurance: Structure and Sequence in the Development of British, Canadian, and US Medical Policy’, Studies in American Political Development, 12 (1998) 57–130.

7 Daniel Béland and André Lecours, ‘Sub-State Nationalism and Social Policy Decentralization in Canada and Belgium’, Regional and Federal Studies, 17 (2006) 405–19.

8 Although contemporaries applied both ‘socialist’ and ‘social democratic’ labels to the CCF party and government, the Saskatchewan government was a reformist government in the tradition of social democratic and labourist governments in Europe, including the reformist-oriented Belgian ‘Socialist’ Party: see Seymour Martin Lipset, Agrarian Socialism: The Cooperative Commonwealth Federation in Saskatchewan (Berkeley: University of California Press, 1950), and Marcel Liebman, ‘The Crisis of Belgian Social Democracy’, Socialist Register, 3 (1966), 44–65.

9 Clarence Stuart Houston, Steps on the Road to Medicare: Why Saskatchewan Led the Way, (Montreal: McGill-Queen’s University Press, 2002), 28–40.

10 On the Saskatchewan Hospital Services Plan, see Malcolm G. Taylor, Health Insurance and Canadian Public Policy: The Seven Decisions that Created the Canadian Health System, (Montreal: McGill-Queen’s University Press, 1978), 69–104.

11 A.W. Johnson, Dream No Little Dreams: A Biography of the Douglas Government of Saskatchewan, 1944–1961 (Toronto: University of Toronto Press, 2004), 240–1; Gregory P. Marchildon, ‘Interdepartmental Committee on Medicare, 1959’, Encyclopedia of Saskatchewan (Regina: Canadian Plains Research Center, 2005), 482; Vincent L. Matthews, memorandum entitled ‘Extended Health Insurance – Alternate Approaches in Saskatchewan’, 21 April 1959, RE679, College of Physicians and Surgeons of Saskatchewan, Saskatchewan Archives Board, Regina [hereafter SAB].

12 Aleck Ostry, ‘Prelude to Medicare: Institutional Change and Continuity in Saskatchewan, 1944–1962’, Prairie Forum, 20 (1995), 87–105.

13 Taylor, op. cit. (note 10), 265–6.

14 Taylor, ibid., 261. The two physician-based insurance carriers were Medical Services Incorporated (MSI), based in Saskatoon, and Group Medical Services (GMS), headquartered in Regina.

15 Of the ten Canadian provinces, only organised medicine in Alberta and British Columbia adopted the same practice as Saskatchewan for a limited time: C. David Naylor, Private Practice, Public Payment: Canadian Medicine and the Politics of Health Insurance, 1911–1966 (Montreal, McGill-Queen’s University Press, 1986), 95–6.

16 This arrangement – considered a conflict of interest in other jurisdictions – remained in place until the mid-1960s when criticism of the arrangement by a provincial Royal Commission led to the separation of the advocacy and trade union functions through the Saskatchewan Medical Association from the regulatory functions performed by the College. Royal Commission on Hospital Privileges (Chair, Justice Mervyn Woods), Blakeney Papers, R353, 138, SAB.

17 Taylor, op. cit. (note 10), 264–5.

18 Resolution repeated in document ‘Government in Medicine in Saskatchewan in 1960’ by Dr J.F.C. Anderson, R30.1, XXVIII.1 (3 of 3), College of Physicians and Surgeons, SAB.

19 Draft of news release for H. Dagliesh, 28 October 1959, R30.1, XXVIII.1, misc. files, College of Physicians and Surgeons, SAB.

20 Transcript of Premier T.C. Douglas, Provincial Affairs Series, ‘Prepaid Medical Care’, [hereafter Douglas radio broadcast on Medicare], 16 December 1959, R33.1–575a, T.C. Douglas Papers, SAB. At the time, Douglas stated that the medical profession would have four of the ten slots on the Advisory Planning Committee, three of whom would be from organised medicine and the fourth from the College of Medicine at the University of Saskatchewan.

21 Allan Blakeney, An Honourable Calling: Political Memoirs (Toronto: University of Toronto Press, 2008), 49; Johnson, op. cit. (note 11), 251. As a deputy minister in the government for almost a decade, Johnson’s judgment was that at the time Douglas announced Medicare ‘and indeed for a long time after, the premier and ministers still believed – indeed were confident – that a consensus could be achieved between them and the college.’

22 Douglas radio broadcast on Medicare, 16 December 1959, R33.1–575a, T.C. Douglas Papers, SAB.

23 Report of the Advisory Planning Committee on Medical Care to the Government of Saskatchewan – Interim Report 1961 and Final Report 1962 (Regina: Department of Public Health, 1962); W.P. Thompson, Medical Care: Programs and Issues (Toronto: Clarke, Irwin, 1964).

24 Recht op Gezondheid (Claims for Health), speech by Edmond Leburton given at the Socialist Party (BSP) congress of 19 September 1959, 14, Archive of the Flemish Doctors Syndicate VAS in Antwerp.

25 Institute Emile Vandervelde, PSP Bureau 1960, 14 October 1960 and KADOC [Documentation and Research Centre for Religion, Culture and Society], LCM [Catholic Health Insurance Fund], Direction Archive, 29, Executive Committee, 13 June 1961.

26 Marc Hooghe and Ann Jooris, Golden Sixties: la Belgique dans les années soixante: 1958–1973 (Ghent: Ludion-ASLK, 1999), 14.

27 Annual Report 1960. KADOC, Archive of the Algemeen Syndicaat, Box 24; also: ‘De Eenheidswet’ [‘Loi Unique’], Belgisch Staatsblad [Belgian Bulletin of Acts], 13 January 1961.

28 Guy Vanthemsche, De Beginjaren van de Sociale Zekerheid in België. 1944–1963 (Brussels: VUB Press, 1994), 140.

29 Naylor, op. cit. (note 15), 184–5.

30 Robin F. Badgley and Samuel Wolfe, Doctor’s Strike: Medical Care and Conflict in Saskatchewan (New York: Atherton Press, 1967), 30 and 54.

31 Douglas quoted in Naylor, op. cit. (note 15), 182–3.

32 Allan M. Briens, ‘The 1960 Saskatchewan Provincial Election’ (unpublished MA thesis: University of Saskatchewan, 2004), 30.

33 Naylor, op. cit. (note 15), 185–6.

34 Quoted in speech by T.C. Douglas: Legislative Assembly of Saskatchewan: Debates and Proceedings, Volume 11, 25 October 1961, 71.

35 Quoted in speech by T.C. Douglas, Debates, Volume 11, 25 October 1961, 72.

36 In a Gallup poll conducted in late 1960, six out of ten Canadians supported a state-led (single-payer) medical care insurance plan ‘even if this meant an increase in taxes’: Naylor, op. cit. (note 15), 191.

37 Douglas himself had always been willing to compromise on the issue of remuneration: Gordon S. Lawson, ‘The Road Not Taken: The 1945 Health Services Planning Commission Proposals and Physician Remuneration in Saskatchewan’, Canadian Bulletin of Medical History, 26 (2009), 155–87.

38 Thompson, op. cit. (note 23), 65; Naylor, op. cit. (note 15), 193–5.

39 Advisory Planning Committee on Medical Care, Interim Report of the Advisory Planning Committee on Medical Care to the Government of Saskatchewan: September 1961 (Regina: Queen’s Printer, 1962).

40 Letter with attached pamphlet, E.P. O’Neal (Secretary–Treasurer, B.C. Federation of Labour) to W.G. Davies, 1 June 1962, R-30.1, XXVIII.1 (2 0f 9), W.G. Davies Papers, SAB.

41 Letter, W.S. Lloyd to Rev. C. Jackson, 27 June 1962, R 30.1, XXVIII.1 (4 of 9), W.G. Davies Papers, SAB.

42 Naylor, op. cit. (note 15), 200–1; letter, W.G. Davies to Rev. N.T. Quigley, 25 May 1962, R30.1, XXVIII.1 (3 of 9), W.G. Davies Papers, SAB.

43 Badgley and Wolfe, op. cit. (note 30), 49; Taylor, op. cit. (note 10), 297; W.S. Lloyd’s address to the College of Physicians and Surgeons of Saskatchewan, 3 May 1962, R 30.1, XXVIII.4, Saskatchewan Medicare/College of Physicians and Surgeons of Saskatchewan, SAB.

44 J.V. Craven, ‘A Strike of Self-Employed Professionals: Belgian Doctors in 1964’, Industrial and Labor Relations Review, 21 (1967), 18–30.

45 Vanthemsche, op. cit. (note 28), 154.

46 Belgian Doctors Bulletin, 23 (1960), 996–7.

47 ‘Article’ in Mededelingen van het Algemeen Syndicaat [Announcements of the General Syndicate], 11 January 1961, VII, 9 (KADOC, Archief Algemeen Syndicaat, Box 25).

48 Protocol between the Minister of Social Healthcare and the AGMB, 20 October 1961 (KADOC, Achive General Syndicat, Box 25).

49 Preparation of the law (KADOC, Archive P.W. Segers, nr. 10.8.1.3.1/1). Important representatives of this new generation were the doctors André Wynen, Roger Thoné, Toon Malfliet, Alex De Bruyn, and Mundeleer.

50 Maquis or ‘macchia’ is a type of high ground covered in thick vegetation where Corsican bandits used to hide. The name was adopted by a number of underground movements in French-speaking countries.

51 See on this subject André Wynen, Où allez-vous docteur Wynen? 25 ans de combat médical: le patron des médecin belges répond à Omer Marchal [Where Are You Going Dr Wynen? 25 Years of Medical Battle: The Belgian Head of Medicine Answers Omer Marchal ] (Brussels: Didier Hatier, 1989). This thesis was also confirmed by Dr Toon Malfliet (interview with Toon Malfliet by Philippe Van Meerbeeck, 1995 VRT Image Archive, for the television programme Boulevard Doctors). See also, ‘Le processus de syndicalisation dans la function médicale: la constitution et le development des chambers syndicales de médecins’, Courrier hebdomadaire du Centre de recherche et d'information socio-politiques [hereafter CRISP CH], 231 (1964), 12–14.

52 Report SK Liège of the meeting in Marche-en-Famenne 17 August 1961 and the meeting in Aarlen 28 August 1961 (Archive SK Liège).

53 See Klaartje Schrijvers, ‘De artsenstaking van 1964: Een studie van een conflict tussen twee elites’ [‘The Doctors’ Strike of 1964: A Study of a Conflict Between Two Elites’] (unpublished MA thesis: University of Ghent, 2002). This research was only possible because the founder of the Syndical Chamber of Liège had preserved a large archive never previously consulted. This combined with extensive interview evidence permitted a reconstruction of the Belgian doctors’ strike.

54 ‘Prenez conscience du fait que l’heure est grave. La lutte est commencée. Ne vous trompez pas: il s’agit là d’une tentative d’étatisation!’ Circular letter of the Comité Médical d’Action, Liège, 30 November 1961 (Archive Chamber Liège) and KADOC, Archive General Syndicate, Box 25. Although the structure was tempting, it took a while before the other four chambers were founded. In March 1963, André Wynen founded the chamber of Henegouwen-Waals-Brabant. One of the main protagonists in the doctors’ strike, Wynen also played a crucial role in the formation of the other chambers. On 31 May, Mundeleer founded the chamber of the Brussels agglomeration. In August, the chamber of Antwerp-Limburg-Vlaams-Brabant and the chamber of Oost-West-Vlaanderen were founded. In the meantime, a National League of Chambers was created and directed by Roger Thoné. The province of Namur joined with the creation of the Chamber Henegouwen-Waals-Brabant on 4 October See: Le processus de syndicalisation, op. cit. (note 51), 12–14.

55 Unofficially, this chamber already existed. See: Letter, W.J. Carels to liberal senator Norbert Hougardy, 24 February 1962 (Archive Chamber Liège).

56 Internal regulation of the SK Liège-Luxembourg, May 1962 (Archive SK Liège).

57 Interview, Klaartje Schrijvers with André Wynen, 16 November 2001.

58 White Paper of the AGMB, after approval of the Loi Leburton, in: Belgisch Geneesherenblad, 15: 31 August 1963, 808 (Archive VAS [Flemish Doctors’ Syndicate] Antwerp).

59 Parliamentary documents, Chamber, nr 527, i: Wetsontwerp tot instelling en organisatie van een regeling voor verplichte ZIV [Amendment for the Establishment and Organization of the Compulsory ZIV], 8 March 1963; Craven, op. cit. (note 44), 23.

60 White Paper of the ABGB, after approval of the Loi Leburton, in Belgisch Geneesherenblad, 15: 31 August 1963, 807 (Archive VAS Antwerp).

61 Ibid., 817–820. See also Le processus de syndicalisation, op. cit. (note 51), 11.

62 Guy Spitaels, ‘Loi instituant et organisant un régime d’assurance obligatoire contre la maladie et l’invalidité’, in Année Sociale (1963), 136–7.

63 Report of the Staten–General, 19 October 1963 (Archive SK Liège).

64 ‘Plebiscite Sought on Medicare’, Saskatoon Star-Phoenix, 19 May 1962: R30.1, XXVIII.1 (7 of 9), W.G. Davies Papers, SAB.

65 Letter, W.S. Lloyd to H. Fowler, C. Gibbings, B. Johnson, L.L. Lloyd, B. Hamilton, W. Smishek, A. Gleave and T. Beaubier, 23 May 1962, R20.1, XXVIII.1 (3 of 9), W.G. Davies Papers, SAB.

66 Badgley and Wolfe, op. cit. (note 30), 75.

67 Letter, W.S. Lloyd to D. Cross, 23 May 1962, R30.1, XXVIII.1 (3 of 9), W.G. Davies Papers, SAB.

68 Stan Rands, Privilege and Policy: A History of Community Clinics in Saskatchewan, (Saskatoon: Community Health Cooperative Federation, 1994), 61–82.

69 Quoted in letter, E. Grey-Turnor to Dr G.D. Turnor (St Andrew’s Hospital, London), 26 June 1962, folder #2, pamphlet file, Medical Care Prepaid, SAB.

70 Letter, W.G. Davies to A. Gillanders, 29 May 1962, R 30.1, XXVIII.1 (3 of 9), W.G. Davies Papers, SAB; Gordon S. Lawson and Luc Thériault, ‘Saskachewan’s Community Health Service Associations: An Historical Perspective’, Prairie Forum, 24 (1999) 251–68.

71 A.E. Blakeney, ‘Press Coverage of the Medicare Dispute in Saskatchewan: I’, Queen’s Quarterly, 70 (1964), 352–61: 356. According to Blakeney, both The Lancet and the British Medical Journal ‘condemned the doctors’ strike as unethical’.

72 Quoted in W.S. Lloyd’s speech to CCF-NDP Convention, Saskatoon, 18 July 1962, R61.6, SAB.

73 Blakeney, op. cit. (note 71).

74 Letter, J.H. Brockelbank (Deputy Premier) to Archbishop M.C. O’Neill, 5 July 2009, R30.1, XXVIII.1 (5 of 9), W.G. Davies Papers, SAB.

75 Statement by Woodrow Lloyd, Legislative Building, Regina, 12 July 1962, R30.1, XXVIII.1 (5 of 9), W.G. Davies Papers, SAB.

76 Gregory P. Marchildon, ‘Private Insurance for Medicare: Policy History and Trajectory in the Four Western Provinces’, in C.M. Flood, K. Roach and L. Sossin (eds), Access to Care, Access to Justice: The Legal Debate over Private Health Insurance in Canada (Toronto: University of Toronto Press, 2005), 429–53.

77 Minutes of the meeting held by the National League of SK in Brussels 4 January 1964 (Archive SK Antwerp) and Keesings Historisch Archief, 17 January 1964, 23.

78 Letter of Dr Jous (director of the SK Liège) to Dr Alex De Bruyn (director of SK East and West Flanders), 18 December 1964. Archive SK Liège.

79 René Broens, De Witte Citadel: Een verkenning van het taalgebruik van de Syndicale Artsenkamers Wynen-Henrard in de Syndicale Berichten [The White Citadel: An Exploration of the Discourse of the Syndical Doctor Chambers Wynen-Henrard in the Syndical Messages], (unpublished MA thesis: Catholic University of Leuven, 1977), 22–3 and interview by Klaartje Schrijvers with André Wynen, 16 November 2001.

80 De Standaard, 1 April 1964.

81 See correspondence of the SK Liège-Luxembourg in the months January and February: Klaartje Schrijvers, op. cit. (note 53), 154–164.

82 De Standaard, 2 April 1964.

83 ‘Grève Press? Bouton/Press Button Strike’, undated document (Archive SK Liège).

84 Some doctors admitted to the press that they joined the strike because they feared reprisals of their colleagues, see De Standaard, 2 April 1964; interview by Klaartje Schrijvers with Jef Deloof, an anti-strike doctor in Aalst who was prevented from continuing his work during the day because of regular phone calls during the night from pro-strike activists, 17 December 2000.

85 Quotes from Het Volk, La Libre Belgique, La Métropole, and De Nieuwe Gids in De Standaard, 2 April 1964.

86 Interview with Toon Malfliet by Philippe Van Meerbeeck, 1995 VRT Image Archive, for the television programme Boulevard ‘Doctors’).

87 Among other accidents there was the death of a child from Tongerlo on 4 April that caused a great deal of controversy. However, it could not be proven the doctors were to blame. Interview with several doctors as a result of this accident, in: VRT Radio-archive, MGT54771, nr. 3, 6 April 1964.

88 Archive RTBF (the French speaking public television station), documentary ‘Médecins en colère’ in the series Années belges, 31 March 1998.

89 Speech of minister Piet Vermeylen, 12 April 1964, MGT 54771, nr. 4. VRT Radio-archive.

90 Mots d’ordre of the strike committee of the SK Liège-Luxembourg, 13 Apr. 1964. Archive SK Liège.

91 De Standaard, 17 April 1964

92 VRT Radio-archive, MGT 54817, nr. 3, 1964 April 18 and De Standaard, 20 April 1964.

93 J.W. Gouldner, ‘Why the Doctors Lost their Strike’, Society, 3, 4 (1966), 14–18.

94 John Stewart, ‘Ideology and Process in the Creation of the British National Health Service’, Journal of Policy History, 14, 2 (2002) 113–34; Carolyn Hughes Tuohy, Accidental Logics: The Dynamics of Change in the Health Care Arena in the United States, Britain, and Canada (Oxford: Oxford University Press, 1999), 37–61.