The founding of the Coopérative de Santé de Québec (1944)
For five years, Dr. Tremblay had been traveling extensively to promote the principles of cooperative medicine. Based on the studies he conducted, primarily involving US-based experiments, he came up with the ground rules for a functional medical cooperative. Skills of various kinds—education, advertising, administration, accounting, actuarial services, etc.—would be required. They would have to be acquired or assembled and would have to be available in each cooperative. If they were not, all promotional efforts would be in vain.
One thing added to the sense of urgency: Dr. Tremblay feared the imminent arrival in Quebec of Blue Cross, a US-based health insurance company already operating south of the border. In his view, the threat of a foreign intruder within the nascent Quebec market made swift action all the more necessary. At the same time, Dr. Tremblay was by far the most knowledgeable proponent of cooperative medicine and was thus the most qualified person to spearhead such an initiative.
Invitation to the founding meeting on April 24, 1944
A democratic and laborious birth
The working-class district of Saint‑Sauveur, where Dr. Tremblay's practice was based, was a favourable location in all respects. In January 1944, "study circles" began to meet on Sundays to examine the possibility of founding a healthcare cooperative in the area. This type of meeting was strongly encouraged within the cooperative movement.
As a result, the Société Saint-Jean-Baptiste (Dr.Tremblay served as its diocesan director) organized cooperation-themed study circles. The format appeared ideal for raising public awareness.
But the task at hand was a daunting one, and the means to reach the residents of Saint-Sauveur and appeal to their interest were limited. One effective means of communication, however, was L'Étincelle du Sacré-Cœur, a neighbourhood paper that provided information on locations and dates for study circles and on the progress being made. It appears that the initial participants in the study circles were contacted personally by Dr. Tremblay, either based on their ties to the cooperative movement or Catholic unions or simply because they were, like many low-wage earners, among Dr. Tremblay's patients.
This small nucleus, whose members all knew Dr. Tremblay, met regularly on Sunday mornings, either in the main hall at 3 Rue Boisseau or in the choir room in the basement of Saint-Sauveur's parish church.
Even though these participants left little trace of their involvement behind, they included Albert Faucher; Gérard Loiselle; Antoine Dussault, manager of the local caisse populaire (credit union); and various members of the Quebec City distribution cooperative, together with Dr. Jules-Édouard Dorion of nearby Saint-Roch. Dr. Dorion also had a working-class practice and was interested in "social medicine" (he played an active role in the cooperative until 1970). It also appears that these meetings reached out to members of the Catholic unions, the civil service union, the Société Saint-Jean-Baptiste, the Conseil supérieur de la coopération (senior cooperation council) and various local cooperatives (including the caisse populaire and the distribution cooperative). In sum, the outreach effort targeted all individuals who, by virtue of their activities or convictions, were committed to social reform or open to the idea of "social restoration". The names mentioned above also indicate that the proposed cooperative was of limited interest to the socially committed elite. In other words, the attendees were either people who were directly affected by the project or Dr. Tremblay's working-poor patients.
Defining the framework
Each of the study circle meetings focused on a specific aspect of healthcare distribution. For example, cost-related distribution disparities were discussed at the first meeting, held on January 23, 1944, at which Dr. Tremblay explained his line of thinking: "The middle classes are the ones having the greatest difficulty paying medical and hospital expenses."1 He also sketched the broad lines of a health cooperative. The minutes of the meeting confirm that these statements "related to problems experienced by and known to a majority of the attendees."
Various other topics were discussed at the second meeting, held on February 6, 1944. They included the question of whether individuals' budgets should anticipate and cover medical expenses and whether the state should be called on to resolve the problem. As the participants became more aware of the issues at stake, they began to consider potential solutions. The record shows that Dr. Tremblay's proposals were welcomed warmly. At the following meeting (February 13), the attendees asked an interim committee to draw up plans for a health cooperative. The committee members included Rosario Tremblay, chair; Laurain Gauthier, secretary; Antonio Verret, treasurer; along with Henri Vallières, Albert Pouliot, Antoine Dussault, Maurice Mathieu, Albert Faucher and Gérard Loiselle.
The committee began its work fewer than 48 hours later, on February 15, 1944. Its first priority was to map out the structure and the strategic goals of the budding cooperative. There were also various sub-committees, including the ways and means sub-committee, tasked with raising the start-up funds; the articles and bylaws sub-committee; and the sub-committee in charge of providing the cooperative with trained medical personnel. Sitting atop the structure was the board of directors, which had final decision-making powers. In addition, a monitoring sub-committee served as an intermediary between the members and management.
A number of guiding principles were established:
- The exceptions and restrictions required to ensure the cooperative's solvency were designed to "have the smallest possible adverse impact on the distribution of good medical services at a universally affordable cost."2
- Selective recruitment3 was intended to minimize risks.
- Advertising focused on groups rather than individuals.
In line with the cooperative's future bylaws, the interim committee insisted that the provision and administration of medical services should be entrusted to the doctors. It also stipulated that the members would have the right to elect the directors and that they would be required to play an active role in recruitment, in addition to showing a "genuine commitment to health education and preventive medicine."
At the committee's second meeting (February 23, 1944), the membership share price was set at $25, with a weekly contribution of 60¢. At the same time, 25¢ to 50¢ would be charged for house calls in order to prevent abuse by members4 (i.e., as a deterrent fee).
Chairman of the Board
(April 1944-February 1946)
In parallel with these efforts, the study circles continued to pursue their goals. The interim committee submitted a report on its activities and a discussion period was held. At the fifth meeting (March 12, 1944), various draft bylaws were examined.
At the sixth meeting (April 2), it was decided that the founding would officially take place on April 24, 1944, i.e., three weeks later. The advertising committee was asked to get to work without delay; it started out with some modest funding from the caisses populaires. In mid-April, an article in Chez nous, the official journal of the Société Saint‑Jean-Baptiste,5 announced the founding. L'Étincelle du Sacré-Cœur6 and L'Action catholique7 also delivered the news to their readers.
The advertising campaign was capped by various leaflets issued by the Catholic unions' general council. At the same time, Dr.Tremblay's speeches,8,9 in which he voiced opposition to the health insurance plan being studied by the federal government, served to bring information on the nascent cooperative to a wider audience.
The founding meeting was held at Académie Saint-Sauveur (137 Avenue des Oblats). Discussion focused on the cooperative's proposed bylaws, which were adopted at the following meeting, held at the Catholic union office (17 Rue Caron) on May 9. The cooperative's directors were also elected.
The board was primarily made up of the earliest participants: Dr. Tremblay, advisor; Henri Vallières, chair; Antoine Verret, treasurer; and Laurain Gauthier, secretary. All of them had been members of the interim committee, except for Dr. Tremblay, who had served as expert advisor. The other board members were Antonio Cayer, vice-chair; J. Omer Pagé, Henri Lallier, Albert Pouliot and Bernadette Lachance.
Barely three months after the first study circle, the health cooperative had come into being, thanks to the interim committee's volunteerism, Dr. Tremblay's knowledge and the study circles' dedication. On April 1510, a logo was also selected, corresponding to that of the Cooperative Health Federation of America plus the name "Coopérative de Santé de Québec".
Next chapter : The Coopérative de Santé de Québec (1944-1945)
- It should be noted that Dr. Tremblay divided society into three classes: the poor or indigent; the rich; and the middle class. The latter group also encompassed the working class, including all business-sector employees and the civil service.
- Minutes of the first meeting of the interim committee for the organization of a medical cooperative, p. 2.
- The exclusion of individuals over age 60 was already under consideration (Ibid., p. 3).
- Dr. Tremblay became aware of this problem after reading articles in Canadian Doctor magazine (February and May 1942) on the Hollinger miners' medical services association (Ontario).
- "La coopérative de santé" (Chez nous, April 15, 1944, p. 3).
- "La Coopérative de santé de Québec" (L'Étincelle du Sacré-Cœur, April 21, 1944).
- "La Coopérative de santé sera fondée le 24 avril" (L'Action catholique, April 21, 1944).
- "Projet de coopérative de santé" (L'Action catholique, April 1944, speech by Dr. Tremblay, diocesan director, at a meeting of the SSJB's Conseil Sacré-Cœur de Jésus). "Le plan d'assurance-maladie est inacceptable" (L'Action catholique, April 1944, Dr. Tremblay's address to the Catholic unions' general council).
- In Ottawa, a special committee on social security was tasked with drafting a health insurance bill, which it presented in July 1944 (Canadian Welfare Council: L'assurance-santé, quelles sont les données?).
- Letter to the Bureau of Cooperative Medicine, April 16, 1944 (Tremblay archives).