National Health Insurance in the United States and Canada

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

GERARD W. BOYCHUK
Copyright Date: 2008
Pages: 256
https://www.jstor.org/stable/j.ctt2tt2r5
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  • Book Info
    National Health Insurance in the United States and Canada
    Book Description:

    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 insuranceùor no insuranceùfor 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 countryùthe 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.

    eISBN: 978-1-58901-377-3
    Subjects: Health Sciences, Political Science

Table of Contents

  1. Front Matter
    (pp. i-x)
  2. Table of Contents
    (pp. xi-xii)
  3. ILLUSTRATIONS
    (pp. xiii-xiv)
  4. PREFACE
    (pp. xv-xviii)
  5. ACKNOWLEDGMENTS
    (pp. xix-xx)
  6. ABBREVIATIONS AND ACRONYMS
    (pp. xxi-xxii)
  7. PART I Introduction and Context
    • CHAPTER ONE Explaining Public Health Insurance in the United States and Canada
      (pp. 3-21)

      In the second debate of the 2004 presidential election, George W. Bush’s strategy was to paint his opponent, John Kerry, as being out of step with American public opinion—characterizing Kerry as being on the “far left bank” of the American mainstream. In doing so, one of Bush’s key targets was Kerry’s proposed health care plan: “He said he’s going to have a novel health care plan. You know what that is? The federal government is going to run it. It’s the largest increase in federal government health care ever. And it fits with his philosophy. . . . That’s...

    • CHAPTER TWO Similar Beginnings, Different Contexts, 1910–40
      (pp. 22-38)

      Many readers may be surprised to find that it was an observer of Canadian politics who would in 1839 refer to a war between the “races”—a reference to linguistic and territorial tensions that would still be starkly evident in the Canadian federal system nearly eighty years later when public health insurance reform would first emerge on the political agenda. While public health insurance debates in Canada took place in the context of recurrent and sometimes incendiary tensions between English Canada and a French-speaking national community primarily centered in Québec, public health insurance proposals in the United States emerged on...

  8. PART II Public Health Insurance in the United States
    • CHAPTER THREE Failure of Reform in the Truman Era, 1943–52
      (pp. 41-58)

      The issue of national health insurance emerged again on the political agenda in the United States as World War II drew to a close. This time, however, debates over health insurance were marked by two important shifts in context. First, the most visible shift from the perspective of health insurance reformers was the winning of presidential support for the cause of national health insurance, with President Roosevelt giving reform leaders private assurances of his support (Poen 1979, 29). In January 1944 Roosevelt asked Congress to affirm an economic bill of rights including “the right to adequate medical care,” which did...

    • CHAPTER FOUR The Medicare Package, 1957–65
      (pp. 59-79)

      As had been the case during the Truman reforms, the politics of public health insurance reform remained entangled with the politics of civil rights through the Medicare era. As David Barton Smith argues,

      Other than the general ebb and flow of electoral politics, the struggle for national health insurance has been described essentially as a self-contained process of vested interests and advocates. In reality, the boundaries between the civil rights struggle during this period and the battle that led to the passage of Medicare were far more blurred in the minds of both protagonists and the public at large. ....

    • CHAPTER FIVE Race and the Clinton Reforms
      (pp. 80-92)

      As Clinton’s quote so clearly emphasizes, race continued to play a significant role in policy debates in the 1990s. At the same time as health care reform was being debated, a major “culture war” was taking place—reaching its apotheosis in the mid-1990s. Concurrent with making proposals for health reform, Clinton committed to major welfare reform “ending welfare as we know it” and crime control—both issues conjuring up powerfully racialized imagery. While health care reform did not pass, welfare reform took center stage when the Republicans gained control of Congress in 1994. To the Republican congressional majority, welfare reform...

  9. PART III Public Health Insurance in Canada
    • CHAPTER SIX Federal Failure, Provincial Success—Reform in Canada, 1945–49
      (pp. 95-108)

      In the World War II and early postwar period, territorial politics helped shape federal interest in health insurance in Canada but, paradoxically, also set boundaries on the possibilities for national health insurance reform. Federal proposals, as had been the case in the United States in the same period, failed—ultimately as a result of the territorial politics inscribed in the system of Canadian federalism. The federal attempt at reform, however, temporarily relaxed the constraining effects of federalism on provincial-level reform and thus provided a brief window of opportunity for the breakthrough of successful reform in Saskatchewan in 1947.

      The initial...

    • CHAPTER SEVEN National Public Hospital Insurance and Medical Care Insurance in Saskatchewan, 1950–62
      (pp. 109-123)

      The advent of hospital insurance at the provincial level did not automatically translate into the successful implementation of a hospital insurance program at the federal level. Instead, the failure of the federal–provincial negotiations in 1945 pushed subsequent reforms at the federal level into a period where they would have to be undertaken without the support of the medical profession and, as outlined in the following section, under political leadership considerably less predisposed toward direct public intervention in the health insurance field. Neither the federal government nor the Ontario government—whose agreement was key to the adoption of a federal...

    • CHAPTER EIGHT Medical Care Insurance in Canada, 1962–84
      (pp. 124-140)

      It is difficult to overstate the seriousness of the crisis facing Canadian unity during the period in which medical care insurance was debated and introduced. As independentiste sentiment in Québec flared, bombings first took place in Québec’s largest city, Montréal, in 1963. The tension reached crisis proportions seven years later when, in the wake of the kidnapping of the British Trade Commissioner James Cross and kidnapping and murder of Québec cabinet minister Pierre Laporte, the federal government temporarily suspended civil liberties across Canada on the basis of “apprehended insurrection” in Québec. Over this period, the rise of the militant separatist...

    • CHAPTER NINE The Iconic Status of Health Care in Canada, 1984–2008
      (pp. 141-154)

      The strategy to use the national health insurance framework as a touchstone for citizen identification with the federal government proved stunningly successful—even if this success was more evident, as we shall see, outside of Québec than within. Public health insurance was transformed into an icon of national citizenship as well as an emblem of Canadian distinctiveness vis-à-vis the United States—most powerfully in the English-speaking provinces. In the 1990s the federal role languished as the federal government targeted health care transfers to achieve its goals of budgetary restraint. Following the near victory of secessionist forces in the Québec referendum...

  10. PART IV Conclusions
    • CHAPTER TEN Contemporary Public Health Insurance in the United States and Canada
      (pp. 157-183)

      The American and Canadian health care systems have each played—and continue to play—an important role in health care reform debates across the border. The use of cross-border examples has tended to be highly politicized, and the example of health care in the other country is often held up as an example to be followed or, more usually, as a dire warning. As a result, cross-national commentary in the health care field has often become a matter of “domestic policy-warfare” (Marmor, Okma, and Latham 2002). This has resulted in widespread misperceptions on both sides of the border regarding the...

    • CHAPTER ELEVEN Conclusions and Implications
      (pp. 184-194)

      Health care reform remains a critical political issue in both the United States and Canada. What does the reinterpretation of the historical development of public health insurance suggest about current efforts at reform, their likely direction, and their chances of success? In answering these questions, this chapter briefly recapitulates the alternative interpretation of the development of public health insurance in the United States and Canada. It then briefly considers the theoretical and conceptual implications of this reinterpretation. Finally, it considers the policy implications of this alternative explanation for current debates regarding health care reform in both countries.

      The differences that...

  11. NOTES
    (pp. 195-212)
  12. REFERENCES
    (pp. 213-224)
  13. INDEX
    (pp. 225-234)