Canadian health care and its vulnerabilities.

Abstract

,H TOW CANADIAN HEALTH CARE IS VIEWED IN THIS country is a reflection of the dilemmas that confront U.S. medicine. Medicare first attracted the attention of American observers during the 1970s, when national health insurance proposals were being considered by the Congress (Marmor 1993). Following this episode, interest in system quickly subsided among all but a small coterie of health policy specialists. When health care reform regained preeminence on the American political agenda in the early 1990s, Canadian practices once again emerged as rich fodder for lessons designed to guide public policy development. As political scientist Antonia Maioni stated: Canada's health insurance system ... [became] a useful target and a political weapon in the reform debate, alternatively used as a model of what American health reform ought to aspire to, or as an ominous warning about the problems inherent in government in a national health insurance program (Maioni 1994, 2-3). Today the backdrop for American interest in health system is the controversy over managed care. U.S. health care has entered an unmistakably chaotic period, marked by rampant corporatism, a swelling wave of complaints against insurance gatekeepers, and increasing privatization of Medicaid and Medicare through large-scale public contracts