National Health Insurance in the United States and Canada: Race, Territory, and the Roots of Difference

National Health Insurance in the United States and Canada: Race, Territory, and the Roots of Difference

National Health Insurance in the United States and Canada: Race, Territory, and the Roots of Difference

National Health Insurance in the United States and Canada: Race, Territory, and the Roots of Difference

Synopsis

After World War II, the United States and Canada, two countries that were very similar in many ways, struck out on radically divergent paths to public health insurance. Canada developed a universal single-payer system of national health care, while the United States opted for a dual system that combines public health insurance for low-income and senior residents with private, primarily employer-provided health insurance -- or no insurance -- for everyone else. In National Health Insurance in the United States and Canada, Gerard W. Boychuk probes the historical development of health care in each country, honing in on the most distinctive social and political aspects of each country -- the politics of race in the U. S. and territorial politics in Canada, especially the tensions between the national government and the province of Quebec.

In addition to the politics of race and territory, Boychuk sifts through the numerous factors shaping health policy, including national values, political culture and institutions, the power of special interests, and the impact of strategic choices made at critical junctures. Drawing on historical archives, oral histories, and public opinion data, he presents a nuanced and thoughtful analysis of the evolution of the two systems, compares them as they exist today, and reflects on how each is poised to meet the challenges of the future.

Excerpt

Spending a sabbatical year in Ann Arbor and East Lansing, Michigan, and Durham, North Carolina, in 2005 powerfully reinforced my perceptions of the continuing pervasiveness of the issue of race in American politics. I became more and more convinced about an argument that I had been making to my students: if an American were to visit Canada and vice versa and each visitor was then asked to summarize in a single phrase the most distinctive aspect of the political and social system of the country they had just visited, the Canadian observer would likely point to the prevalence of the politics of race in the United States and the American observer would likely point to the territorial politics of language and region in Canada—especially the issue of Québec's place in the Canadian federation.

Given this, it is surprising that very few accounts of the development of health care policy in the United States pay adequate attention to the role of racial politics. In providing an overview of existing explanations of the lack of national health insurance in the United States, Jill Quadagno considers an explanation that “attributes the failure of national health insurance to the racial politics of the South” (2005, 13). She provides only a single citation (with no page number) to an example of this argument—Robert Lieberman's Shifting the Color Line. Surprisingly to readers following up Quadagno's reference, the index to Lieberman's book does not include a single reference to health insurance. The passage and citation are very revealing. One would expect—as Quadagno clearly does—that there ought to be a number of works attributing the lack of national health insurance in the United States to the politics of race. As her own citations reveal, however, there are none. Similarly, very few accounts of the development of health care policy in Canada pay adequate attention to the role of territorial politics. Even fewer comparative works examining the two countries refer to either of these important factors in explaining the distinct trajectories of development of their health care systems. None points to these differences as providing an essential explanation for why the contemporary health care systems in the two countries look so different.

At the same time, health care remains a central issue in both countries. In 2005 poll respondents in both the United States and Canada ranked health care as the single most important domestic policy issue (Ipsos-Reid 2005, 18–19). Health care was a central fixture in the 2006 Canadian federal election. Health care reform was an important element of President Bush's 2006 State of the Union address and is already emerging in the 2008 Democratic presidential primaries. Health care has been at the top of the public policy agenda in both the United States and Canada now for more than a decade and a half. In both countries this current concern . . .

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