Cover image for Parting at the crossroads : the emergence of health insurance in the United States and Canada
Parting at the crossroads : the emergence of health insurance in the United States and Canada
Maioni, Antonia.
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Publication Information:
Princeton, N.J. : Princeton University Press, [1998]

Physical Description:
xiv, 205 pages ; 24 cm.
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HD7102.U4 M32 1998 Adult Non-Fiction Central Closed Stacks

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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.

Author Notes

Antonia Maioni is Assistant Professor of Political Science at McGill University.

Reviews 1

Choice Review

Why did two countries, otherwise so similar in many ways, differ so significantly in their approach to health care financing? The evolution of the forces at work in Canada and the US between the 1930s and the 1960s suggests that political institutions played the most critical role. Specifically, Maioni (political science, McGill Univ.) argues that in Canada two institutional attributes--federal structure and parliamentary governance--encouraged the formation of a social-democratic third party that was able to demonstrate the viability of universal, publicly financed health insurance. In contrast, in the US the separation of powers, the absence of party discipline, the key role of congressional leadership, and regional voting blocs led to continual compromises and a more limited and targeted governmental role in health care. In the final two chapters Maioni discusses ways that past policy legacies continue to shape reform debates. Much of the material/analysis on the US has been covered by others, e.g., Roy Lubove (1986) and Paul Starr (1982), but many of the details on the Canadian experience have received less coverage. Thoroughly researched; extensive footnotes. Recommended for upper-division undergraduate through professional collections. J. M. Glasgow; emeritus, University of Connecticut Health Center

Table of Contents

List of Abbreviations
Ch. 1 The United States and Canada in Comparative Contextp. 3
Ch. 2 Parties and Institutions in Health Politicsp. 14
Ch. 3 The 1930s: Early Impasse in Health Reformp. 32
Ch. 4 The 1940s: False Starts and Failures of Postwar Health Insurance Proposalsp. 66
Ch. 5 The 1950s: Diverging Paths to Health Reformp. 92
Ch. 6 The 1960s: The Political Battle for Health Insurancep. 119
Ch. 7 Why Did They Part? Explaining Health Policy Trajectories in the United States and Canadap. 153
Ch. 8 Point of No Return? Policy Legacies and the Politics of Health Reformp. 166
Bibliographyp. 179
Indexp. 199