SOLVING THE HEALTH CARE PROBLEM. HOW OTHER NATIONS SUCCEEDED AND WHY THE UNITED STATES HAS NOT Pamela Behan Albany: State University of New York Press 2006, HB 172 pp, USD 60 ISBN: 978-0-7914-6837-1
The health system of the United States stands out amongst those of developed economies on two grounds: its cost and the lack of a universal health insurance program. In this short book Pamela Behan sets out to explore '... why the United States does not guarantee its citizens access to health care or protect them from its costs'. Devoting about as much attention to describing theory and method as to analysing and comparing three health care systems (the United States, Canada and Australia), Behan starts with a thorough introduction, canvassing a range of theories for explaining the direction of public policy. The author settles on some particular theories to test, and examines the comparative method of policy analysis. In general, Behan puts aside theories which attribute outcomes of policy to single casual factors, and focuses on what might be considered two classes of theory to be applied to the comparative analysis that follows. The first she describes as political institutional theories: approaches that stress the roles of the structures of government in shaping policy. The second Behan describes as 'power resources theory', a class-based view of history and society, calling attention to 'the balance of politically useful resources controlled by the capitalist and working classes in a given society' (2006:xiv).
While the author invites readers to skip this chapter and to launch into the descriptions and analyses of the three health care systems under review, I found this introduction of the problem, the theory and the method to be the most interesting and useful part of the book. It is concise and well structured.
The core of the book consists of three chapters, each describing the evolution of health care financing policy in the countries under review. Drawing largely on a narrow range of reputable secondary sources, each chapter describes briefly the history of settlement and the development of government before outlining the major turning points in the processes by which the respective colonial, then provincial/state and federal governments defined their roles in financing health care. Each of these chapters ends with an analysis of the factors that led to a system of 'national health insurance' (Canada and Australia) or prevented such a system from being adopted (the United States).
Each case study bears out the influences of political institutions and the distribution and utilisation of power that the introductory chapter foreshadowed. In her analysis of the Canadian experience, the author highlights the effect of third political parties in the emergence public health insurance at provincial and federal levels, and the relative lack of veto points, that is, institutional barriers to the enactment of the aspirations of executive government. The chapter on Australia highlights the several cycles of building and dismantling public health insurance since the Second World War as being a unique feature of that country's health financing policy. The author concludes this chapter with the view that decisive factors leading to the introduction of public health insurance in Australia have been the 'political polarisation of Australian society' (2006:33), as well as the creation of the Australian Labor Party and the opportunities presented by the parliamentary system for parties with a majority to implement their policies. …