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Icon and taboo: single-payer politics in Canada and the US

Published online by Cambridge University Press:  09 March 2020

Carolyn Hughes Tuohy
Carolyn Hughes Tuohy*
Affiliation:
Munk School of Global Affairs and Public Policy, University of Toronto, Toronto, Canada
*
CONTACT Carolyn Hughes Tuohy c.tuohy@utoronto.ca
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Abstract

In 1965 and 1966, the United States and Canada adopted single-payer models of government insurance for physician and hospital services – universal in Canada, but restricted to certain population groups in the US. At the time, the American and Canadian political economies of health care and landscapes of public opinion were remarkably similar, and the different policy designs must be understood as products of the distinctive macro-level politics of the day. Subsequently, however, the different scopes of single-payer coverage would drive the two systems in different directions. In Canada, the single-payer system became entrenched in popular support and in the nexus of interest it created between the medical profession and the state. In the US, Medicare became similarly entrenched in popular support, but did so as part of the larger multi-payer private insurance system. In the process universal single-payer coverage became politically iconic in Canada and taboo in the US.

Keywords

Health policycomparative public policypolicy narrativessingle payer systems
Type
Research Article
Information
Journal of International and Comparative Social Policy , Volume 35 , Issue 1: SI: Recent Social Policy in Canada and the United States , February 2019 , pp. 5 - 24
Copyright
Copyright © 2018 Informa UK Limited, trading as Taylor & Francis Group

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References

Angus Reid Institute. (2015, July 15). Prescription drug access and affordability an issue for nearly a quarter of all Canadian households. Vancouver. Retrieved from http://angusreid.org/prescription-drugs-canada/Google Scholar
Béland, D. (2010). Reconsidering policy feedback: How policies affect politics. Administration and Society, 42(5), 568–590.CrossRefGoogle Scholar
Blendon, R. J., & Benson, J. M. (2001). Americans’ views on health policy: A fifty-year historical perspective. Health Affairs, 20(2), 33–46.CrossRefGoogle ScholarPubMed
Blendon, R. J., Brodie, M., Benson, J., & Altman, D. E. (2011). American public opinion and health care. Washington, DC: CQ Press.CrossRefGoogle Scholar
Blumenthal, D., & Morone, J. A. (2010). The heart of power: Health and politics in the oval office. Berkeley, CA: University of California Press.Google Scholar
Boychuk, T. (1999). The meaning and making of hospital policy in the United States and Canada. Ann Arbor, MI: University of Michigan Press.CrossRefGoogle Scholar
Bryden, P. E. (2009). The Liberal party and the achievement of national medicare. Canadian Bulletin of Medical History, 26(2), 315–332.CrossRefGoogle ScholarPubMed
Canada. (1964). Royal commission on health services. Final Report. Ottawa, ON: Queen's Printer.Google Scholar
Canada. Standing Committee on Health. (2018, April). Pharmacare Now: Prescription medicine coverage for all Canadians 42nd Parliament, 1st Session. Ottawa: House of Commons. Retrieved from http://www.ourcommons.ca/Content/Committee/421/HESA/Reports/RP9762464/hesarp14/hesarp14-e.pdfGoogle Scholar
Canadian Medical Association. (1944). Report of the committee on economics. Canadian Medical Association Journal, 33(Suppl. 51), 32–45.Google Scholar
Cohen, R. A., Makuc, D. M., Bernstein, A. B., Bilheimer, L. T., & Powell-Griner, E. (2009). Health insurance coverage trends, 1959–2007: Estimates from the national health interview survey. National Health Statistics Reports 17, July 1.Google Scholar
Coutts, J. (2003). Windows of opportunity: Social reform under Lester B. Pearson. Policy Options, November. 9–20.Google Scholar
Douglas, T. (1961). Medicare: The time to take a stand. In Reprinted in Katherine Fierlbeck (Ed.), The development of political thought in Canada: An anthology (pp. 113–124). Toronto: University of Toronto Press 2011.Google Scholar
Environics Institute. (2015, June 30). Focus Canada – spring 2015. Toronto: Environics Institute for Survey Research.Google Scholar
Flood, C., Roach, K., & Sossin, L. (Eds.). (2005). Access to care, access to justice: The legal debate over private health insurance in Canada. Toronto: University of Toronto Press.CrossRefGoogle Scholar
Fronstin, P. (2005). Sources of health insurance and characteristics of the uninsured: Analysis of the march 2005 current population survey. Washington DC: Employee Benefits Research Institute EBRI Issue Brief No. 287. November.Google Scholar
Gallup/AIPO. (1945). Poll. November 23–28. Data provided by The Roper Center for Public Opinion Research iPOLL database. Retrieved from https://ropercenter.cornell.edu/ipoll-database/Google Scholar
Gawande, A. (2017, October 2). Is health care a right? The New Yorker.Google Scholar
Goldsteen, R. L., Goldsteen, K., Swan, J. H., & Clemeña, W. (2001). Harry and Louise and health care reform: Romancing public opinion. Journal of Health Politics, Policy and Law, 26(6), 1325–1352.CrossRefGoogle ScholarPubMed
Hamel, L., Wu, B., & Brodie, M. (2017, July 5). Data note: Modestly strong but malleable support for single-payer health care. Kaiser Family Foundation. Retrieved from https://www.kff.org/health-reform/poll-finding/data-note-modestly-strong-but-malleable-support-for-single-payer-health-care/Google Scholar
Harris, L. and Associates. (1965). Survey February. Data provided by The Roper Center for Public Opinion Research iPOLL database. Retrieved from https://ropercenter.cornell.edu/ipoll-database/Google Scholar
Hopper, J. R. (2017). Presidential framing in the 21st century news media: The politics of the affordable care Act. New York: Taylor and Francis. Kindle Edition.CrossRefGoogle Scholar
Hurley, J., & Guindon, G. E. (2008). Private health insurance in Canada CHEPA Working Paper Series 08-04. Hamilton, ON: McMaster University.Google Scholar
International Social Survey Programme. (n.d). Role of government I-IV (ISSP 1985-1990-1996-2006). Retrieved from http://zacat.gesis.org/webview/index.jsp?object=http://zacat.gesis.org/obj/fStudy/ZA4747Google Scholar
Jacobs, L. R. (1993). The health of nations: Public opinion and the making of American and British health policy. Ithaca: Cornell University Press.Google Scholar
Jacobs, L. R., & Shapiro, R. Y. (2000). Politicians don't pander: Political manipulation and the loss of democratic responsiveness. Chicago: University of Chicago Press.Google Scholar
Jacobs, A. M., & Weaver, R. K. (2015). When policies undo themselves: Self-undermining feedback as a source of policy change. Governance: An International Journal of Policy, Administration and Institutions, 28(4), 441–457.CrossRefGoogle Scholar
Johnston, R., & Blais, A. (1988). A Resounding maybe. The Globe and Mail. Toronto, December 19, A7.Google Scholar
Kent, T. (2009). When minority government worked: The Pearson legacy. Policy Options, October. 26–30.Google Scholar
Kiley, J. (2017, June 23). Public support for ‘single payer’ health coverage grows, driven by Democrats. Pew Research. Retrieved from http://www.pewresearch.org/fact-tank/2017/06/23/public-support-for-single-payer-health-coverage-grows-driven-by-democrats/Google Scholar
Lau, R. R., & Schlesinger, M. (2005). Policy frames, metaphorical reasoning, and support for public policies. Political Psychology, 26(1), 77–114.CrossRefGoogle Scholar
Lowi, T. J. (1972). Four systems of policy, politics, and choice. Public Administration Review, 32(4), 298–310.CrossRefGoogle Scholar
Maioni, A. (1998). Parting at the crossroads: The emergence of health insurance in the United States and Canada. Princeton, NJ: Princeton University Press.Google Scholar
Marchidon, G. P., & Schrijvers, K. (2011). Physician resistance and the forging of public healthcare: A comparative analysis of the doctors’ strikes in Canada and Belgium in the 1960s. Medical History, 55, 203–222.CrossRefGoogle Scholar
Marmor, T. R. (2000). The politics of Medicare (2nd ed.). New York: Aldine de Gruyter.Google ScholarPubMed
Marmor, T. R., & Hamburger, T. (1993). Dead on arrival: Why Washington's power elites won't consider single payer health reform. Washington Monthly, September. 27–32.Google Scholar
Maruthappu, M., Ologunde, R., & Gunarajasingam, A. (2013). Is health care a right? Health reforms in the USA and their impact upon the concept of care. Annals of Medicine and Surgery, 2(1), 15–17.CrossRefGoogle ScholarPubMed
Mason Meier, B., & Bhattacharya, D. (2012). Health care as a human right. In Kronenfeld, J. J., Parmet, W. E., & Zezza, M. A. (Eds.), Debates on U.S. Health care (pp. 32–47). Thousand Oaks, CA: SAGE.Google Scholar
McDonough, J. E. (2011). Inside national health reform. Berkeley: University of California Press.Google Scholar
McDonough, J. E. (2015). The demise of Vermont's single-payer plan. The New England Journal of Medicine, 372(17), 1584–1585.CrossRefGoogle ScholarPubMed
Mendelsohn, M. (2002). Canadians’ thoughts on their health care system: Preserving the Canadian model through innovation. Ottawa: Commission on the Future of Health Care in Canada.Google Scholar
Moran, M. (1999). Governing the health care state: A comparative study of the United Kingdom, the United States and Germany. Manchester: Manchester University Press.Google Scholar
Morone, J. A. (2017). How to think about ‘medicare for all’. The New England Journal of Medicine, 377(23), 2209–2211.CrossRefGoogle Scholar
Nadeau, R., Bélanger, É., Pétry, F., Soroka, S. N., & Maioni, A. (2014). Health care policy and opinion in the United States and Canada. New York: Routledge.CrossRefGoogle Scholar
Nanos, N. (2009). Canadians overwhelmingly support universal health care; think Obama is on right track in United States. Policy Options, November. 12–14.Google Scholar
Naylor, C. D. (1986). Private practice, public payment: Canadian medicine and the politics of health insurance, 1911–1966. Kingston and Montreal: McGill-Queen's University Press.Google Scholar
Norton, M., DiJulio, B., & Brodie, M. (2015, July 17). Medicare and Medicaid At 50. Kaiser Family Foundation. Retrieved from https://www.kff.org/medicaid/poll-finding/medicare-and-medicaid-at-50/Google Scholar
Oberlander, J. (2003). The political life of Medicare. Chicago: University of Chicago Press.Google Scholar
Organization for Economic Cooperation and Development. (1993). OECD health systems: Facts and trends 1960–1991. Paris: OECD.Google Scholar
Pauly, M., & Redisch, M. (1973). The not-for-profit hospital as a physicians’ cooperative. The American Economic Review, 63(1), 87–99.Google Scholar
Pierson, P. (2000). Increasing returns, path dependence, and the study of politics. American Political Science Review, 94(2), 251–267.CrossRefGoogle Scholar
Sanofi Canada. (2016). The sanofi Canada healthcare survey. Laval, QC: Sanofi Canada.Google Scholar
Sanofi Canada. (2018). The sanofi Canada healthcare survey. Laval, QC: Sanofi Canada.Google Scholar
Soroka, S. N. (2007, February). Canadian perceptions of the health care system A report to the health council of Canada. Ottawa: Health Council of Canada.Google Scholar
Starr, P. (1982). The social transformation of American medicine. New York: Basic Books.Google Scholar
Starr, P. (2018). A new strategy for health care. The American Prospect, Winter.Google Scholar
Taylor, M. G. (1979). Health insurance and Canadian public policy: The seven decisions that created the Canadian health insurance system. Montreal: McGill-Queen's University Press.Google Scholar
Tuohy, C. H. (1999). Accidental logics: The dynamics of change in the health care arena in the United States, Britain and Canada. New York: Oxford University Press.Google Scholar
Tuohy, C. H. (2018). Remaking policy: Scale, pace and political strategy in health care reform. Toronto: University of Toronto Press.CrossRefGoogle Scholar
Tuohy, C. J. (1992). Policy and politics in Canada: Institutionalized ambivalence. Philadelphia: Temple University Press.Google Scholar
West, D. M., Heith, D., & Goodwin, C. (1996). Harry and Louise Go to Washington: Political advertising and health care reform. Journal of Health Politics, Policy and Law, 21(1), 35–68.CrossRefGoogle ScholarPubMed