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National Health Insurance in the United States and Canada: Race, Territory, and the Roots of Difference (American Government and Public Policy)

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.

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.

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.

it's a fresh take on an old problem rooted in the important structural features of each nation.

This App'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.

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