1. Health Care in Canada and the United States April 1, 2002

2. Myths of Canadian Health Care the Canadian model is a universal health care system the Canadian model is a universal health care system universality is a unique trait of Canadian (as opposed to American) health care provision universality is a unique trait of Canadian (as opposed to American) health care provision there is a more limited public role in health care financing and provision in the US there is a more limited public role in health care financing and provision in the US – main difficulty with comparisons is the wide variation among US states

3. Public Health Care Financing, Provision, and Regulation in the United States public health care spending public health care spending state regulation of private insurance state regulation of private insurance uncompensated care uncompensated care NO hospital in the US can legally refuse treatment to someone requiring emergency medical attention NO hospital in the US can legally refuse treatment to someone requiring emergency medical attention depending on state, large numbers of publicly owned hospitals (receiving gov’t subsidies for uncompensated care) depending on state, large numbers of publicly owned hospitals (receiving gov’t subsidies for uncompensated care) all not-for-profit hospitals receive designation based on providing some degree of uncompensated care all not-for-profit hospitals receive designation based on providing some degree of uncompensated care mix of hospital control varies widely by state mix of hospital control varies widely by state

4. National Stereotypes – Canada and the United States “Canada...is a more...statist, collectivity-oriented... society than the United States.” S.M. Lipset, Continental Divide “Canada...is a more...statist, collectivity-oriented... society than the United States.” S.M. Lipset, Continental Divide “The differences between the two countries are particularly striking with respect to the role of government in medical care.” S.M. Lipset, Continental Divide “The differences between the two countries are particularly striking with respect to the role of government in medical care.” S.M. Lipset, Continental Divide

5. Main Messages...Health Care there are important differences – but more complex and subtle than often assumed there are important differences – but more complex and subtle than often assumed universal public coverage for hospital and physician care for the non-elderly in Canada (public coverage only for the poor in US) universal public coverage for hospital and physician care for the non-elderly in Canada (public coverage only for the poor in US) Canadian laws prohibit private insurance coverage of publicly-insured services Canadian laws prohibit private insurance coverage of publicly-insured services private role greater in Canada than often assumed, public role greater in US than often assumed private role greater in Canada than often assumed, public role greater in US than often assumed generalizations regarding the American system may not adequately capture wide differences between the states generalizations regarding the American system may not adequately capture wide differences between the states

6. Section 3: Public Policy -- Summary policy areas policy areas multiculturalism multiculturalism post-secondary education post-secondary education social assistance social assistance employment equity/affirmative action employment equity/affirmative action health care health care why? why? these are some of the areas in which we are supposed to be different these are some of the areas in which we are supposed to be different some of these are areas in which the cry of “Americanization” is heard most loudly some of these are areas in which the cry of “Americanization” is heard most loudly

7. National Stereotypes – Canada and the United States there are really no notable differences between the two countries (What Border?) there are really no notable differences between the two countries (What Border?) vs. “Canada...is a more...statist, collectivity-oriented, and particularistic (group-oriented) society than the United States.” (S.M. Lipset, Continental Divide.) vs. “Canada...is a more...statist, collectivity-oriented, and particularistic (group-oriented) society than the United States.” (S.M. Lipset, Continental Divide.) questions... questions... does public policy in the areas we’ve examined consistently tend to support one side over the other? does public policy in the areas we’ve examined consistently tend to support one side over the other? in what ways do comparisons of public policy support each interpretation? in what ways do comparisons of public policy support each interpretation?

8. Main Messages...Multiculturalism are policy differences between Canada and the US substantive or symbolic are policy differences between Canada and the US substantive or symbolic are policy differences between Canada and US reflective of differences in public opinions/values? are policy differences between Canada and US reflective of differences in public opinions/values?

9. Main Messages...PSE important differences between the two countries important differences between the two countries – no evidence of a more limited role for the state in the provision of public post-secondary education in the US – important differences among states

10. Main Messages...Social Assistance current differences may not adequately represent historical patterns of policy similarity and difference current differences may not adequately represent historical patterns of policy similarity and difference the politics of race is a crucial difference between the two countries and has an important effect on public policy the politics of race is a crucial difference between the two countries and has an important effect on public policy

11. Main Messages...Employment Equity context – NOT political culture – helps explain differences in program design in the two countries context – NOT political culture – helps explain differences in program design in the two countries politics of employment equity in Canada have been significantly shaped by the politics of affirmative action in the US politics of employment equity in Canada have been significantly shaped by the politics of affirmative action in the US

12. Main Messages...Health Care myths about Canadian/American health care myths about Canadian/American health care – there are important differences – but more complex and less subtle than often assumed generalizations regarding the American system may not adequately capture wide differences between the states generalizations regarding the American system may not adequately capture wide differences between the states

13. Institutional Differences A Summary

14. Institutional Differences – Individual Rights vs. General Welfare Canada United States Charter/Bill of Rights -rights subject to limits -rights as “trump” Legislature -one effective legislative chamber -two legislative chambers designed to limit each other Federalism -adopted to make union possible (accommodate Quebec) -adopted to disperse power -- harder for gov’t to infringe individual rights Executive -fusion of power -PM can generally get any legislation passed -President shares power with Congress -more veto points -harder for gov’t to enact legislation

15. Individual Rights vs. General Welfare Individual Rights/Limited Gov’t General Welfare Canada United States

16. Individual Rights vs. General Welfare Individual Rights/Limited Gov’t General Welfare Canada United States Canada

17. Institutional Differences – Opportunities for Mass Participation Canada United States Executive -PM appointed by party controlling most seats in H of C -President elected -primaries -primaries -general election -general election Judiciary -appointed by PM in closed process -insulated from political pressures -appointed by President, ratified by Senate -open, public, politicized process Mechanisms of Popular Input -elections limited -no referendums or other mechanisms of popular input -multiple elections -referendums (certain states only)

18. Opportunities for Mass Participation High Mass Participation Low Mass Participation Canada United States

19. Models of Democracy Individual Rights/Limited Gov’t General Welfare High Mass Participation Low Mass Participation Canada United States

20. Final Exam if mark is higher than mid-term exam... if mark is higher than mid-term exam... – final 35% – mid-term 15%

21. Final Exam 3 answers – all of equal weight 3 answers – all of equal weight two sections two sections – overview section two questions two questions –overview of institutional section –overview of public policy section – public policy section five questions – one from each policy area five questions – one from each policy area in-depth questions requiring students to outline major argument of lecture and illustrate with specific examples in-depth questions requiring students to outline major argument of lecture and illustrate with specific examples choice choice one answer from each section (mandatory) one answer from each section (mandatory) additional answer chosen from either section additional answer chosen from either section