The good life, Aristotle argued, depended on finding proper equilibrium. Too much courage led to rash behaviour; too little made one a coward. Too much amiability produced obsequiousness; too little, irascibility. That such excess is undesirable was clear; the difficulty, he noted, was in knowing exactly how far to move in any given situation. This Aristotelian model is useful for thinking about health care funding: extremes are dangerous, but the exact balance between extremes – the ʹgolden meanʹ – is much more difficult to determine.

There are a number of desirable qualities in any health care system: these include cost...

If the most politicized aspect of Canadian health care is the way in which it is funded, running close second is the way in which influence over health policy is distributed between levels of government. Canada is not unique in this respect. Many Western health care systems – including those in the United States, Australia, Germany, and Spain – are based on a federal model. Even Britainʹs National Health Service (NHS) has become fragmented into four separate political jurisdictions (England, Scotland, Wales, and Northern Ireland) since devolution. The particular nature of intergovernmental relationships depends on the constellation of several different...

For a brief decade, the world experienced an exhilarating explosion of democratic reform. The fall of the Berlin Wall in 1989 and the end of South African apartheid in 1990 suggested that ʹrule by the peopleʹ had finally become a global phenomenon. At the same time, Western states examined their own systems of governance, and program reforms were built around values of accountability, transparency, the dissemination of power, and democratic participation. All provincial health care systems experienced some kind of reform and reorganization throughout the 1990s, and most were influenced by these ideas to a greater or lesser extent. More...

Do Canadians have arightto health care? Yes and no. Canadians like to think that the ʹright to health careʹ is one thing that has distinguished them from Americans. But there is no explicit statement in the Charter of Rights and Freedoms that guarantees a ʹrightʹ to health care. Europeans, in contrast, arguably do have such a right: Article 35 of the European Unionʹs Charter of Fundamental Rights stipulates that ʹeveryone has the right of access to preventative health care and rights to benefit from medical treatment under the conditions established by national laws and practices. A high level...

ʹPublic healthʹ and ʹpublic health careʹ are not synonymous. ʹPublic health careʹ generally refers to the way in which a health care system is funded, and it signifies that the provision of certain important health services are free or subsidized at the point of delivery for the general population (usually through a form of public insurance). ʹPublic healthʹ is, at its simplest, just that: the health of the public. But it is rarely that simple. Formally, public health is an approach that focuses on ʹpopulation healthʹ and attempts to address its determinants (Deber, McDougall, and Wilson, 2007). ʹPopulation health,ʹ according...

Many Canadians say that the problem with the Canadian health care system is that we donʹt have enough doctors. Former Canadian Medical Association (CMA) president Brian Day has argued that Canada would need to add 26,000 doctors to its health system immediately to bring the country ʹup to global standardsʹ (Ubelacker 2008). This position makes sense to those who have difficulty finding a family doctor or GP, or to those who have to wait several months for surgery. But it raises the question of exactlyhow manydoctors is the right number or whether gaps in health care service delivery...

Lucentis is a drug that was approved by Health Canada in 2007 to treat wet macular degeneration (WMD). Usually WMD occurs in older individuals, who are generally insured for pharmaceuticals under provincial health plans. The drug is considered to be quite effective. It is also extremely expensive, costing approximately $2,000 per individual per month. Before Lucentis (ranibizumab) was approved, however, doctors used a drug called Avastin (bevacizumab) to treat the same condition. Avastin is approved only to treat colorectal cancer, but has been widely used off-label for the treatment of WMD by doctors who have reported successful results. It costs...

Mental health care is not simply a subset of health care; it is qualitatively different from it. Rarely in any country does mental health receive the same emphasis that general health services do. But in Canada many major developments in health care policy have actually beendetrimentalto mental health care. The structure of the health care system in Canada often works at cross-purposes to mental health care; however, attempts at health care reform are themselves subject to so many political minefields that policy makers seldom consider the effects of reforms on mental health care when developing new policies. Like...

ʹBeveridgeʹ and ʹBismarckʹ systems are the two dominant health care models in Europe, while a third model, mandated private insurance, typifies the Netherlands, and is the basis of the U.S. health care reforms. Beveridge systems, named after the British economist whose 1942 report established the foundation for Britainʹs modern welfare state, are funded through general taxation. In this way, all individuals contribute to a public health insurance system, and all individuals are covered. As health care funding comes from general tax revenues, individualsʹ contributions are determined by income, rather than health risk. In some systems, a portion of citizensʹ income...

In recent years there has been substantial interest in looking to Europe for an alternative to the Canadian health care model (e.g., see Flood, Stabile, and Tuohy 2008). British Columbia Premier Gordon Campbell toured European states in 2006 to investigate some of these alternatives, while Canadian Medical Association (CMA) president Robert Ouellet did the same in 2009. However, if there are lessons to be learned from Europe, they are complex ones that do not promise easy solutions for Canada. It is important to remember that there is no such thing as a ʹEuropean modelʹ: all European states have distinct health...

The fascination with the comparison between American and Canadian health policy rests largely on the observation that, until relatively recently, the two systems were fairly similar. But they chose quite different paths, and the consequences have been pronounced. Canadaʹs shift, as we have seen, began in Saskatchewan in 1957, and was solidified in national legislation in 1984. In the United States, the attempt to provide a form of national health insurance began in 1912, when Theodore Roosevelt campaigned for the Progressive Party with the promise of a system of health insurance. But, despite the efforts of Franklin D. Roosevelt, Harry...

This book has attempted to explain, in some detail, how the Canadian health care system works, why it works this way, and how it compares with health care systems in other countries. What overarching conclusions can be made about health care systems, in general, and health care in Canada, in particular? Six points: first, there is no one ideal health care system; second, reform in any one direction usually has consequences for other aspects of health care; third, the Canadian system isnʹt that bad, but could be improved; fourth, the changes needed in Canadian health care are widely known and...