Debates concerning health care in Canada and the United States have reached a significant juncture. There is regular cross-border dialogue and comparison in this policy field, and approaches to reform emanating from historically disparate paths in each country seem to be converging. Universality and privatization both seem to be untenable. In the United States, the possibility of universal access to health care services is addressed in ambitious, idealistic, and contradictory ways, with increasing alarm and frustration. In Canada, universal health care is being eroded by rising levels of private sector involvement in both the insurance and delivery of health care...

The above statements clearly indicate that health care in Canada is considered to be a right of citizenship. Patterns of entitlement were gradually institutionalized in the 1940s, 1950s, and 1960s, and now seem to be threatened by fiscal restraint measures, the neo-liberal trade agenda, and various reform efforts that have resulted in marginal erosion of the health system. In the face of such challenges, the right to health care is consistently defended. The bulwark that is created against retrenchment has a clear political message: citizens are entitled to universal health care, and they expect that their social rights will be...

The resonance of T.H. Marshall’s work on citizenship is remarkable. In a series of lectures, Marshall was able to cogently explain the evolution of citizenship over three centuries, and, at the same time, capture the essence of contemporary and emerging sentiment concerning social inequality and entitlement. However, the social rights thesis has been consistently defended as an infungible, sustainable element of the state–society relationship, in spite of Marshall’s caveat that citizenship is an evolving concept. In this chapter I examine closely Marshall’s third stage of citizenship development – social rights – to evaluate the extent of change in Canadian...

The Canadian health care system as a social policy experiment has proven to be a successful redistributive program. It is also a political symbol that distinguishes Canada from the United States, and as such transforms Canadian identity. Current changes in the system relating to patterns of deinstitutionalization, rising costs of pharmaceuticals, and the epidemiological contours of disease, in addition to the recognition that there might not be enough public money to meet demand, are causing health policy analysts to rethink the ways in which health services are funded and delivered.

On a more conceptual plane it can be observed that...

In Chapters 2 and 3 I explained that the social rights thesis was outdated. In this chapter I argue that the changing dynamics of citizenship, in addition to the effects of a post-Keynesian, global economy, altered the substance of social rights. Also, I will consider the implications of the institutionalization of the right to health care in Canada, and argue that social rights stasis is reinforced by citizens’ resistance to the commodification of health services and the politics of federalism. This will serve as a more empirical response to the conceptual question that was considered in the previous chapter.

Stasis...

Stasis, caused in part by social rights claiming, is problematic because it reinforces medical and institutional models of health care. This presents a paradox because at the same time that defenders of the social rights thesis criticize medical and institutional models, their defences of the right to health care actually serve to maintain those models. As explained in Chapter 2, citizens’ expectations are rising; citizens expect that the health care system will keep pace with their demands and provide the latest medical technology, access to pharmaceuticals, and alternative medicines and services. At first glance, these expectations seem to be inconsistent...

The social rights thesis, coincident with the development of the welfare state, was designed to protect a certain relationship between citizens and the state. In Canada, this relationship can be discerned in debates concerning the universal health care system. Two general comments can be made about this relationship. First, this relationship serves to ensure equality. Citizens have come to expect that government will maintain commitments to universality in health care, and governments continue to promise that they will do so. Second, the relationship is defined by passivity, reinforced by the executive system of government. Because it was the entitlement side...

To the question of how to attenuate stasis while protecting entitlement, there is no definitive answer. Nevertheless, the analysis presented in this book is intended to provide some foundational support for understanding the right to health care and the need for moving beyond the social rights stage of policy and citizenship development. The evolution of rights discourse over the post–Second World War decades, as it applies to health care in Canada, reveals both individual and collective elements of entitlement. The enduring collective element is distinctly premodern, within the normative realm of discourse. The individualistic trend can be attributed to...