Healthcare policy in the U.S. and Canada

”To achieve reasonable access, there must be a monopoly buyer (the government) and regulator.”

Professor Maioni, the author of Parting at the Crossroads: The Emergence of Health Insurance in the United States and Canada, came to speak to us on November 24th. Stressing that healthcare policy must be integrated in social policy, she discussed the similarities and differences between the two countries, starting with their similarities up to the time when Canada developed public health insurance.

The success of Canada’s universal healthcare may well be attributed to the Canadian federal system which permits sub-national policy laboratories. Thus the introduction of the Saskatchewan Hospitalization Act of 1946 is the origin of the federal Medical Care Act of 1966.

One problem in the development of public health policy, in Dr. Maioni’s opinion, is the reluctance of experts and researchers in developed nations to examine what is being done in nations considered “not similar”. She believes that comparative analysis can be the most rewarding source of policy development and she deplores the mindset in the U.S. and Canada that there is nothing to be learned from any but the most similar countries, which leads to a failure to undertake truly global research.

She concluded her remarks by pointing out that in the U.S., which funds sectors of the population (e.g. the elderly, indigent, etc.), citizens worry about access to healthcare in terms of affordable insurance, whereas Canadians worry about the future of the universal healthcare plan.

Professor Maioni’s presentation was followed by a very lively Q & A that led off with the question: “Can one say that better social policy is achieved in less politically adversarial climates?” It covered issues such as the shortage of doctors in Canada, prevention rather than treatment, the use of traditional knowledge and medicines, the state of health among Canada’s First Nations peoples, private-public partnerships in healthcare, and the issue of choice … too much choice given to the uninformed individual can be much worse than no choice. This applies to choosing among the range of healthcare plans in the U.S., or choosing among a number of seemingly equally qualified practitioners.

When asked about key decisions were that had affected her career, Dr. Maioni answered that there were three:

  1. The decision to stay in school
  2. The decision between becoming a practitioner or an observer
  3. The decision to get married which affected where she would live and what her career path would be.
  4. From all evidence, she chose wisely in the three cases.