Comparative Analysis: Health Insurance in US and Canada (HLST 2020)

This report provides a comparative analysis of the health insurance systems in the United States and Canada, examining the historical divergence of their healthcare methodologies. The report focuses on an article titled 'Parting at the Crossroads', which explores the reasons behind the differing health insurance systems in both countries. The author's analysis highlights the role of political institutions, health reform demands, and historical events, such as the influence of the CCF-NDP in Canada and the Medicare for the Aged Act in the US. The report discusses the convincing and unconvincing aspects of the article, emphasizing the differences in funding, coverage, and government involvement. The report concludes by highlighting the key differences in political culture and federalism between the two nations, emphasizing that the lack of adequate access to health insurance remains a persistent problem in both the countries. The report also includes a bibliography with the primary source used for the analysis.

Running head: ANALYSIS
Parting at the Crossroads: The Emergence of Health Insurance in the United
States and Canada
Name of the Student- Aditya Prayag
Student Number- 215922636
Name of the Course Director- Kenneth Lam
Course Number and Title- HLST 2020
Date of submission

1ANALYSIS
Introduction- Health Insurance refers to special kinds of insurance coverage that envelop
the costs of an individual’s surgical and medical expense. Taking into account the overall burden
of expenses related to healthcare system and the general healthcare of a person, insurers
formulate routine financial structures in the form of payroll tax or monthly premium that helps in
providing the money to pay for the benefits. The healthcare prevailing in Canada is publicly
funded, and Canadian citizens who are permanent residents of the place are eligible to apply for
specific public health insurances from their territory and/or province. Conversely, most non-
government and private health coverage in the United States is employment based. This
assignment will critically discuss the findings that are presented in an article of comparative
politics titled ‘Parting at the Crossroads’.
Key points- Aims and objectives of the article are associated with the fact that the author
tried to explore and provide an explanation on why the United States and Canada have embarked
upon two different parts and resulted in the development of varied forms of health insurance
systems. Owing to the fact that both the countries had similar kind of health insurance system
before the 1960s, made the author unravel the underlying factors that resulted in a change of
Canadian system. She conducted a theoretical debate and examined the role that healthcare
reform demands played on the political institutions that were largely responsible for governing
the insurance systems prevailing in both the countries. The statements presented by the author
were based on a comparative historical analysis. She identified major political institutions as
primary game rulers, who were mainly responsible for shaping and designing the state and the
party systems. This acted as a major determinant of the insurance policies that were formulated
by the government. She also stated that these political institutions were for the most part
responsible for either elevating or reducing the opportunities of health policies that were

2ANALYSIS
accessible to the general public. Formal institutions were also recognised to play a pivotal role in
governing the political parties in their processes. She also elucidated on the role of health
reforms in Canada (CCF-NDP) and the Medicare for the Aged Act (MAA) in the United States
that restricted the federal age eligibility to the aged residents. Failure of organised labour to
effectively bargain for retiree health insurance resulted in the legalization of federal health
insurance for the elderly in 1965 (Maioni, 1997).
Convincing- Some of the points put forth by the author were convincing. This can be
accredited to the fact that in the US, healthcare plans are generally delivered through private
companies. US residents usually take care of their health system without any particular
assistance from the government. Conversely, the healthcare system in Canada is funded by a
single system. The coverage is publicly funded and funds are obtained from the provincial and
federal taxes. Another aspect that helped is that health insurance care is usually provided by
plans in Canada that have been created in each territory and province, in place of a unified single
federal health plan. Although the Canadian government is largely accountable for paying into the
health insurance plans, the province and territory also holds and accountability for taking this
money in order to create a system, under the guidelines that have been enforced by the Canadian
health act (CHA). Furthermore, her statements can also be considered convincing since the
Canadian healthcare system comprises of an estimated 10 autonomous provincial healthcare
system that have the duty of reporting to the provincial government and a unified federal system.
This factor results in the formation of a significant degree of variation in the coverage and
funding between the US and Canada. Accuracy of a statement can also be established by the fact
that the direct healthcare government funding in the US is restricted to Medicaid, Medicare, and

3ANALYSIS
State Children's Health Insurance Program (SCHIP) that usually covers senior citizens, the
disabled, poor people, and children who are eligible (Maioni, 1997).
On the other hand, the Canadian healthcare system has the role of providing coverage for
a plethora of private and public delivery, which is controlled by regional health authorities and
private boards, in place of the government. However, some of the facts presented by her are not
convincing, since she did not take into account the paradox of modern federalism that exists in
the United States. Centralization has resulted in an improvement in the capacity and
accountability of the local and the state government, in addition to the concomitant political
regulations that have made the government more effective and representative. The immediate
consequences for the policies related to increasing burden of unceasing and degenerative
disorders for also not taken into account. During the previous generation all the countries had
diversified their health policies in order to a code for increased priority, with the aim of reducing
or preventing the disabling impacts of chronic diseases. Thus, in addition to studying the
financing and organisation of medical services, relevant data allied with the health care policies
should also have been considered, for drawing the comparison (Maioni, 1997).
Take home message- In the article the author has traced the historical divergence of
methodology related to healthcare to the year 1944, when the social democratic party also
referred to as the Co-operative Commonwealth Federation (CCF) acquired public support in the
provinces, for pushing through a new form of health coverage that was called public medical
insurance. All the success of this particular public health care program was able to demonstrate
that presence of such an effective insurance program throughout the nation could prove
successful. Universal healthcare was rejected by the ruling liberal federal government. However,
continuous pressure from the CCF resulted in the adoption of national healthcare insurance

4ANALYSIS
coverage in the year 1966, which was accompanied by an increase in the liberal concerns. Health
reform issues played a pivotal role during the similar time frame in the politics of America,
where a universal healthcare system was introduced during the mid 1940, backed by support
from the public (Maioni, 1997).
However, divisions that were present in the Democratic Party, combined with strong
opposition from the American Medical Association resulted in restricting the legislative action.
Public support soon reduced for the idea that eventually resulted in the adoption of unlimited
healthcare program in 1965. This subsequently led to the formulation of a dual tiered system in
the United States, where the Medicaid program covers the poor and Medicare program the
insurance coverage to the elderly. This leaves the remaining population to get enrolled for
different forms of voluntary health insurance. Hence, the major difference exists in the
legislative and federal system between both the countries. While Canada is a federation that
contains an institutional categorisation of political powers, the federal government present in the
United States principally controls the healthcare program. The provincial government of Canada
emphasized more power over healthcare insurance, compared to their American counterparts.
This is principally in charge of the enforcement of policy innovations that directly target
administration of Healthcare services in the entire nation (Maioni, 1997).
Conclusion- Thus can be concluded that, there are differences in the political culture and
federalism between the two countries namely, United States and Canada. However, there was no
specific factor that predestined Canada to depart from the US, during the time period 1930-
1960s. There existed no fundamental difference between the morals and the values of the
Americans and Canadians that could be held responsible for such a stark divergence in the

5ANALYSIS
policies, related to social reforms. However, lack of adequate access to health insurance is a
persisting problem in both the countries.

6ANALYSIS
Bibliography
Maioni, A. (1997). Parting at the crossroads: The development of health insurance in Canada and
the United States, 1940-1965. Comparative Politics, 29(4), 411-431. DOI:
10.2307/422012