Nothing Succeeds Like the Right Kind of Failure: Postwar National Health Insurance Initiatives in Canada and the United States (original) (raw)

Parting at the Crossroads: The Development of Health Insurance in Canada and the United States, 1940-1965

Comparative Politics, 1997

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Douglas versus Manning: The Ideological Battle over Medicare in Postwar Canada

2016

The accepted narrative of the history of medicare in Canada does not do justice to the struggle between premiers Tommy Douglas of Saskatchewan and Ernest Manning of Alberta over two very different models of universal health coverage. Douglas and Manning were committed advocates of their respective models for ideological reasons, but these political differences had their origins in their conflicting interpretations of Christian teachings and biblical interpretation. These differences are examined in detail in order to arrive at a richer understanding of the values and the key policy design features of their respective models of medicare. Ultimately, Douglas’s model of medicare would be adopted in the rest of Canada even though Manningcare was the preferred choice of doctors, insurance companies, the business establishment, the majority of provincial governments, and fundamentalist Christians such as Manning who believed that Douglas’s model resulted in an abdication of individual responsibility and moral choice.

National health insurance: Some lessons from the Canadian experience

Policy Sciences, 1975

In the current American debate over national health insurance an examination of the Canadian governmental experience is very instructive. Canada is enough like the United States to make the effects of Canadian health insurance policies rather like a large natural experiment. The Canadian experience--universal government health insurance administered by the ten provinces with some fiscal and policy variations--can be used to predict the impact in the United States of proposed national health insurance plans on the medical care system, and the reaction of mass publics and national policymakers to these effects.

The Monumental Battle for National Health Insurance in Post-World War II America, 1945-1965

At the end of World War II, many Americans were looking to resume the social progress achieved during the era of the New Deal. Abruptly elevated President Harry S Truman believed it was time to take the next step toward social security by enacting a program of compulsory national health insurance. Though over 75% of Americans supported it, no such program was enacted until twenty years later when Lyndon B. Johnson obtained health insurance for the elderly as part of his Great Society. This study examines the reasons why national health insurance passed during an era of great social tumult yet was unable to be achieved during a previous era of relative domestic calm and prosperity when it had substantial support. Using the previous works of social and political scientists, traditional historical accounts, materials of the Truman and Johnson Libraries, the contemporaneous literature of interested parties and journalists as well as transcripts of speeches and press conferences, this paper analyzes the political and sociological forces at work in the nation during these periods. In addition to the traditional account of Johnson’s political effectiveness, this research finds four other changes in the United States which help to account for the success of a national health insurance program in the 1960s. These include the increasing mobilization of interest groups representing senior citizens, the declining effectiveness of appeals by the American Medical Association that such a program was “socialized medicine,” the changes in the philosophy of labor unions in the ensuing period, and the influence of civil rights movement upon health insurance efforts. Taken together with the “honeymoon” period boost given Johnson after the Kennedy assassination, ex-president Harry S Truman was able to witness his dream of national health insurance become a reality when Medicare was signed into law in his presence in 1965.

Why the United States has no national health insurance: stakeholder mobilization against the welfare state, 1945--1996

Journal of health and social behavior, 2004

The United States is the only western industrialized nation that fails to provide universal coverage and the only nation where health care for the majority of the population is financed by for-profit, minimally regulated private insurance companies. These arrangements leave one-sixth of the population uninsured at any given time, and they leave others at risk of losing insurance as a result of normal life course events. Political theorists of the welfare state usually attribute the failure of national health insurance in the United States to broader forces of American political development, but they ignore the distinctive character of the health care financing arrangements that do exist. Medical sociologists emphasize the way that physicians parlayed their professional expertise into legal, institutional, and economic power but not the way this power was asserted in the political arena. This paper proposes a theory of stakeholder mobilization as the primary obstacle to national heal...

Canada, Health and Historical Political Economy

Journal of Australian Political Economy, 2014

Healthcare in Canada is at an important political and economic crossroads. In 2014, the 10-year Canadian Health Accord will conclude, and the role of the federal government in supporting both health research and health delivery--the latter being a responsibility of the provinces should be the subject of intense public discussion. The 2004 Health Accord responded to a perceived crisis in the Canadian system, known as Medicare, by guaranteeing stable additional federal funding for the provinces and setting out a number of objectives oriented around quality of care. Over the next year, public figures and health experts from province to province will debate which financing models effect optimal health delivery in the face of rising, off-loaded costs. The federal government's refusal to bargain with provincial Premiers as a whole on federal funding, as well as its ongoing encouragement of 'experimentation' across provincial health systems, will increase pressure towards syste...

The Policy History of Canadian Medicare, guest editor's introduction

Canadian Bulletin of Medical History, Vol. 26, no. 2, pp. 247-260, 2009

Despite its importance in Canada, the history of Medicare has rarely been examined by historians of medicine. Of the many possible reasons, three stand out. First is the political nature of the policy and the historical profession's shift from political history in recent decades. Second is the challenge posed in researching a complex public policy involving numerous administrative and financial instruments. Finally, there is the decentralized nature of the Canadian federation in which the history of Medicare belongs as much, if not more, to the provinces than a single, national-level government.

Health Reform in Alberta: Fiscal Crisis, Political Leadership, and Institutional Change within a Single-Party Democratic State

McGill-Queen's University Press eBooks, 2013

Like other Canadian provinces, Alberta undertook significant health-care reforms during the 1990s. The Alberta approach, while driven by fiscal pressures similar to those experienced by other provinces, was shaped by its own unique interplay of institutions, ideas, interests, technological change, and economic forces. A growing fiscal crisis, combined with a change in political leadership, but not in the governing party, led to aggressive reform in health care. Once economic growth returned, commitment to health-care reform waned. However, the enduring legacy of initial health reforms has been a shift away from the Ministry of Health and local health-care in decision-making institutions and interests (i.e., traditional forms of governance) to new decision-making institutions and interests (i.e., new forms of governance). Overall, this had a centralizing effect on decision-making. The intent of this chapter is to discuss how Alberta addressed health policy reform around six key policy decisions: the regulation of health services delivery by private facility operators; the introduction of health regions; the introduction of a population-based funding model to support health regions; the introduction of a voluntary, centralized wait-times registry; the expansion of drug benefits to cover the children of parents moving off of social assistance to return to work, and palliative care

Constructing Canada: The 2007-2010 United States health care reform debate and the construction of knowledge about Canada’s single payer health care system

In this paper, I explore how knowledge about Canada’s health care system was constructed by both opponents and proponents of American health care reform, and how this knowledge was subsequently used. I use a constructivist social problems theoretical framework in order to guide a qualitative content analysis of articles from top-circulating American newspapers. Constructivist social problems theory is relevant to this study, because different knowledges about Canada emerged out of the problematization of American health care. Proponents of American health care reform grounded their claims in a knowledge that praised Canada, while opponents of American health care reform grounded their claims in a knowledge that was critical of Canada.