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.

Gerard W. Boychuk is director of global governance at the Balsillie School of International Affairs and an associate professor in the Department of Political Science at the University of Waterloo, Ontario, Canada. He is also a research fellow of the Institute for Advanced Policy Research at the University of Calgary.

"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."

Preface

Part I: Introduction and Context

1. Explaining Health Insurance in the United States and Canada

2. Similar Beginnings, Different Contexts, 1910-40

Part II: Public Health Insurance in the United States

3. Failure of Reform in the Truman Era, 1943-52

4. The Medicare Package, 1957-65

5. Race and the Clinton Reforms

Part III: Public Health Insurance in Canada

6. Federal Failure, Provincial Success—Reform in Canada, 1945-49

7. National Public Hospital Insurance and Medical Care Insurance in Saskatchewan, 1950-62

8. Medical Care Insurance in Canada, 1962-84

9. The Iconic Status of Health Care in Canada, 1984-2008

Part IV: Conclusions

10. Contemporary Public Health Insurance in the United States and Canada

11. Conclusions and Implications

Notes

References

Index