Health insurance in Canada and US
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Health insurance in Canada and US Antonia Maioni’s goal is to explain the development of health insurance in Canada and United States of America. She goes on to elaborate why the United States and Canada have different healthcare insurance systems even though these two countries are majorly similar in almost all other aspects for example they share the same economic, political and social attributes (Maioni, 1997 p. 411). She offers that the major contributing factor to this contrast is the fact that health reform was fostered by political institutions which formed party systems in the two countries. Institutions are, in her book, stated as the most significant challenge faced by health reformers. Organizations related to the health industry play a rather important role in shaping insurance policies within the United States and Canada (Martens & Roos, 2005 p.72). This is further explained to be as a result of the way the institutions condition the role of political parties in policies. Maioni analyzes the creation on the social democratic third party in Canada which was not present in the United States of America and the influence exerted on the development of health reforms by the third, left-wing party in Canada. Two institutional attributes; parliamentary government and federalism are used to explain the differences between Canada and the US. The parliamentary government in both countries has similar characteristics. They both have single-member plurality electoral systems whereby two-party dominance is emphasized hence reduces chances of a third party occurrence. The parliamentary government in Canada accommodates the existence of third parties unlike in the US whereby such rules do not occur. Presence of these third parties in Canada is very important in the development of health policies as they influence federal policymaking.(Green & Rowell, 2013) Under federalism Maioni, explains that it was the most important impact on the party system. She explains that Canada did not have a central institution that could effectively represent regions at the federal level which was quite unlike the case in America. She explains that lack of enough representation of the regions lead to the rise of third parties in Canada recognized at the federal level and also at the provincial level. Because of this decentralization in the Canadian federalism many policies (including the health policy) are a part of the provincial responsibility. This meant simply that the provinces in Canada had more independent power than state governments in the US. Thus the third party government in Canada have an important role to play in policy making. In Canada, during the 1940s the third party (CCF) helped in sparking the interest of the government in health reform. This was so, because their policy on universal health insurance was gaining popularity and the Liberal and Conservative official parties feared that CFF may undermine their electoral support (Beik, 2013 p.23). The Liberal party even went ahead and absorbed the third parties social reform platform and ended up winning the election. The CCF government proceeded to make sure that the health reform did not slip out of the political agenda. The CFF’s presence in the House of Commons limited the Liberal’s margin to change policies as they insisted the government made good the promises made on the reforms. A new third party was created in 1961, The New Democratic Party whose main objective was the public demand for medical insurance. This new party was the majority in the House of Commons and it exerted pressure to the government to make legislature that would please the NDP. The health reforms were not easy to implement and we see that the presence of the third party actually furthered the medical reform in the country. In United States of America, senior officials in government had a politicized attitude to health unlike their counterparts in Canada. When President Truman came into power, he vehemently supported a national health insurance system although he was severally blocked from implementing this by the conservative coalition formed by southern Democrats and Republicans (Thomasson, 2002 p.239). During the modification of the health reform a strategy was developed to replace the national health insurance system and they came up with one that focused on the aged. This was majorly because the aged were mostly shut out of the private insurance market (Maioni, 1997 p.420). Unlike in Canada, the US had a precedent for the ages whereas Canada focused on the universal idea by the CCF. Hence in United States of America the idea of national health insurance was erased. A Medicare bill was proposed and passed after a hearty debate in which incremental health reform is possible in the United States but also it highlights institutional constraints that limit the reform. The main advantage of Medicare was that even though the proposed health legislation was limited in scope it could be changed before final passage.. It is clearly seen that in United States of America a modified reform strategy was undertaken whereby government programs were specific to a group of clienteles whereas in Canada universal access in health insurance programs (Maioni, 1997 p.425). In Canada, due to the acceptance of the influential social democratic third party, caused the universal type of health insurance very possible as the party in power (The Liberals) was forced to take into consideration the third parties policy demands and in United States of America the lack of influential third parties led them to the dual-tiered health insurance system that focused on the aged and the poor. In conclusion, Maioni’s message is that the “parting of crossroads” by Canada and the US in regard to the health care system was due to the existence of dissimilar institutional configurations (Maioni, 1997 p.425). Maioni in her argument on the reasons for the contrasts in the two health insurance systems is very convincing as the historical events cited evidence exactly how the political parties directly influenced these two systems in separate paths. In her argument she ends up convincing one that indeed the health insurance in Canada and America did indeed rely on the political parties present in the countries. References:
Beik, J. I. (2013). Health insurance today: A practical approach. St. Louis, Mo: Elsevier.
Boychuk, G. W. (2008). National health insurance in the United States and Canada: race, territory, and the roots of difference. Washington, DC: Georgetown University Press.
Green, M. A., & Rowell, J. A. C. (2013). Understanding health insurance: A guide to billing and reimbursement. Clifton Park, NY: Delmar Cengage Learning.
Maioni, A. (1997). Parting at the Crossroads: The Emergence of Health Insurance in the United States and Canada. Comparative Politics, 29(4), 411-431.
Martens, P. J., & Roos, N. P. (2005). When health services researchers and policy makers interact: Tales from the tectonic plates. Healthcare Policy, 1(1), 72.
Thomasson, M. A. (2002). From sickness to health: the twentieth-century development of US health insurance. Explorations in Economic History, 39(3), 233-253.