As almost all newspaper or magazine readers know, Canada figured
prominently in the turbulent U.S. debates over health care reform
in the early Clinton presidency. Furthermore, future news analysts
and policymakers will undoubtedly again use Canada to cite the
"good" and the "bad" aspects of single-payer national health
insurance. Beyond the debate about the desirability of
Canadian-style health care reforms, Antonia Maioni sees another
question: Why did the United States and Canada, alike in so many
ways, part "at the crossroads" to produce such different systems of
health insurance? She answers this previously neglected query so
interestingly that her book will hold the attention of anyone
concerned with health care in either country or both.
The author explores the development of health insurance in the
United States and Canada, from the emergence of health care as a
political issue in the 1930s to the passage of federal health
insurance legislation in the 1960s. Focusing on how political
institutions influence policy development, she shows that Canada's
federal structure and its parliamentary institutions encouraged a
social-democratic third party that became pivotal in demonstrating
the feasibility of universal, public health insurance. Meanwhile,
the constraints of the U.S. political system forced health care
reformers to temper their own ideas to appeal to a wide coalition
within the Democratic party. Even readers previously unfamiliar
with Canadian politics will find in this book important clues about
the "realm of the possible" in the uncertain future of U.S. health
care.
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