Health Care in Canada: A Citizen's Guide to Policy and Politics

By Couture, Josée | Canadian Review of Social Policy, January 1, 2012 | Go to article overview

Health Care in Canada: A Citizen's Guide to Policy and Politics


Couture, Josée, Canadian Review of Social Policy


Health Care in Canada: A Citizen's Guide to Policy and Politics Katherine Fierlbeck University of Toronto Press, 2011

Universal health care has long held a prominent position in Canadian nation building. Moreover, health care will always be political: it can be a source of patriotism, a tool used to gain electoral support, or an indicator of conflict between its construction as a need or a commodity. There is no denying that full participation in the decision-making processes concerning health care issues requires an understanding of the inner-workings of the system, what the reform options are, and the different interests advanced by key actors. Health Care in Canada: A Citizen's Guide to Policy and Politics aims to provide its readers with the necessary information to prepare them for contributing to the discussion.

The development of the Canadian health care system is examined through a critical analysis of the political landscape, intellectual debates, power struggles, and various processes around the system. Katherine Fierlbeck's main argument is that the development of Canadian health care policy has been determined by the legacy of structures of federal governance and the country's constitutional framework, coupled with the historical interplay of financial and political motivations. She stresses that no perfect system exists and, though many covet the successes other countries have experienced, these systems are likely not transferable as they were developed in specific political cultures and institutional contexts.

Health Care in Canada is only one of a handful of current books on the subject that are not primarily intended as university course textbooks. It is informed by a historical comparative methodology, and Fierlbeck presents alternative cases and features in a neutral manner, providing supporting and opposing evidence for each one; only afterwards does she reveal her position and substantiate it further. Though the breadth and scope of the book is tremendously lofty, its approach is quite pragmatic.

This book wastes no time jumping right into the thick of things from the very first page. Explaining the intricacies of political, economic, and moral debates, Fierlbeck breathes life and meaning into the dry archival materials of policy, law, and legislation. The language she engages is mostly accessible, except for a few words, concepts and legal terms peppered throughout the text. The story Health Care in Canada is committed to tell is extremely complex and, regrettably, difficult to reduce to bare fundamentals. Even deciphering the figures demands expertise. Almost every sentence holds a new piece of information, threatening to overwhelm its audience and forcing many to contemplate a second read through. There is such a volume of data that brevity necessitated a glossing over of certain aspects less central to the main discussions (for instance, extra-billing and user fees). …

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