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 insurance—or no insurance—for 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 country—the 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.
Table of Contents
Preface
Part I: Introduction and Context
1. Explaining Health Insurance in the United States and Canada
2. Similar Beginnings, Different Contexts, 1910-40
Part II: Public Health Insurance in the United States
3. Failure of Reform in the Truman Era, 1943-52
4. The Medicare Package, 1957-65
5. Race and the Clinton Reforms
Part III: Public Health Insurance in Canada
6. Federal Failure, Provincial Success—Reform in Canada, 1945-49
7. National Public Hospital Insurance and Medical Care Insurance in Saskatchewan, 1950-62
8. Medical Care Insurance in Canada, 1962-84
9. The Iconic Status of Health Care in Canada, 1984-2008
Part IV: Conclusions
10. Contemporary Public Health Insurance in the United States and Canada
11. Conclusions and Implications
Notes
References
Index
Reviews
"Boychuk is a bold revisionist, challenging received wisdom about what explains the divergent paths Canada and the United States have taken in the past four decades in financing and administering medical care. Race relations—and Quebec’s special place in Canada—are crucial in ways others have not emphasized, which makes his book a worthy addition to the literature."—Theodore Marmor, Yale University
"In this engaging and beautifully written book, Gerard Boychuk marshalls rich historical evidence to explain how conflicts over race and territorial politics led the U.S. and Canada on divergent paths."—Jill Quadagno, author of One Nation, Uninsured: Why the U.S. Has No National Health Insurance
"A fresh take on an old problem rooted in the important structural features of each nation."—James Morone, author of Hellfire Nation and coeditor of Healthy, Wealthy and Fair
"This book's clear, nontechnical writing style lends itself to student use. But it deserves attention from scholars as well because of its broad scope, historical sweep, theoretical critiques, and clearly expressed comprehension of both American and Canadian health care systems, neither of which is that easy to understand by itself."—Donley Studlar, professor of political science, West Virginia University
Awards
Co-winner of the 2009 Donald V. Smiley Prize for the Best Book in Political Science of the Canadian Political Science Association
About the Author
Gerard W. Boychuk is director of global governance at the Balsillie School of International Affairs and an associate professor in the Department of Political Science at the University of Waterloo, Ontario, Canada. He is also a research fellow of the Institute for Advanced Policy Research at the University of Calgary.
