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Two Roads to Health Care: U.S. and Canadian Policies 1945-1975

In dealing with principles on which to base major changes in our health care system, we would be well advised to first examine countries which in their social, economic, political, and constitutional structures resemble those of the United States. Given its federal constitution, closely related social philosophy, political thought, as well as similar economic, geographic and social conditions, Canada is selected for comparison as it is, in many pertinent respects, more similar to the United States than most other countries so frequently studied. This paper examines policies which led to distinct approaches to health care in the United States and Canada. Two major differences are identified in areas of basic health care philosophy and in the role assumed by the federal government. First, in terms of underlying principles, the United States lacks consensus as to appropriate financing and organization of its health services, as reflected in its ongoing conflicts of voluntarism vs. compulsion or private vs. public auspices. Canada, however, continues to maintain a consensus as to its goals of a universal, comprehensive system of publicly administered health insurance. The second difference rests in the current predominance of the United States federal government in development and implementation of health policy as compared to a greater role by Canadian provincial governments in the initiation and actual administration of health care programs.