National Health Insurance in the United States and Canada: Race, Territory, and the Roots of Difference

Abstract

Reviewed by: National Health Insurance in the United States and Canada: Race, Territory, and the Roots of Difference Alecia Blake (bio), Latronda Davis (bio), Ayana Johnson (bio), Tonja Khabir (bio), Carlos Mahaffey (bio), Denise Smith (bio), Nythea Campbell, MPH (bio), and Patricia Rodney, PhD, MPH (bio) National Health Insurance in the United States and Canada: Race, Territory, and the Roots of Difference. Gerard W. Boychuk. Washington, DC: Georgetown University Press, 2008. 234 pp. National Health Insurance in the United States and Canada: Race, Territory, and the Roots of Difference compares the pathways of insurance reform in the United States (U.S.) and in Canada. The author, Gerard W. Boychuk, traces how the historical development of the U.S. contributed to the failure of health insurance reform, and contrasts this history with Canada's territorial politics and how it influenced health care policy there. The author identifies cultural distinctions related to health policy and reform in both countries. He argues that American individualism and distaste for big government contribute to the ongoing failure to develop a national U.S. health insurance plan, while Canadians' collective consciousness and preference for centralized government facilitates a national plan. The book is divided into four sections, which provide a chronology of health care reform in the U.S. and Canada. The author clearly delineates the specific political and social dynamics that initiated or impinged reform. First, he emphasizes the history of support and u8pposition for a national health insurance program in the U.S. along racial lines. Race is and has been an important social force shaping health care policy in the U.S., and has long been a salient characteristic of national politics that overall has defeated efforts at reform. Boychuk argues that opposition to a national health insurance from the American Medical Association (AMA) and segregation within the medical profession reinforced resistance to reform. The South, for most of its history, has rejected any policy changes that appeared to defy the racial status quo. Boyuchuk clearly elucidates challenges that faced public programs such as Medicare (for example, Title IV compliance, which integrated hospital care). Boychuk uses a similar case to describe Canada's medical insurance system, and how its history differed from the history of health policy in the U.S. Though innovations began at the provincial level, federal cost-sharing was a major problem with the Canadian process. Boychuk, an Associate Professor at the University of Waterloo in Ontario, emphasizes that Canadian reform was not simple or automatic. He also acknowledges that although the U.S. could learn from Canada, the difficulty of health reform in the U.S. was inevitable, given the differences in the two countries' histories. By identifying and explaining historical nuances and similarities—and how these affect reform—Boychuk offers a useful and intelligent comparison of public health reform in neighboring countries. The research is current, accurate, and comprehensive. The author notes that in both countries, polls conducted in 2005 ranked health care as the single most important domestic policy issue. Boychuk illustrates his discussion of health reform in the contemporary socio-political climate in both countries with a host of tables, charts, graphs, and notes. The research in this timely and relevant book is sometimes profound, and it should [End Page 750] certainly inform current debate on health care reform in the U.S. Despite the complexity of the racial history Boychuk analyzes, the author offers some hope for the future of reform in the U.S. His book is an invaluable addition to the literature on health systems reform. A limitation of the book for the general reader is the technical nature of much of the text, which is geared towards an audience including health care professionals, policy makers, and politicians. The author missed an opportunity to engage everyday citizens who will be the important beneficiaries of health care reform. Alecia Blake, Latronda Davis, Ayana Johnson, Tonja Khabir, Carlos Mahaffey, Denise Smith, Nythea Campbell, and Patricia Rodney The reviewers are affiliated with the Masters of Public Health Program at Morehouse School of Medicine in Atlanta. Please address correspondence to Dr. Rodney at prodney@msm.edu. Copyright © 2010 Meharry Medical College