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Icon and taboo: single-payer politics in Canada and the US

Published online by Cambridge University Press:  09 March 2020

Carolyn Hughes Tuohy
Carolyn Hughes Tuohy*
Affiliation:
Munk School of Global Affairs and Public Policy, University of Toronto, Toronto, Canada
*
CONTACT Carolyn Hughes Tuohy c.tuohy@utoronto.ca
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Abstract

In 1965 and 1966, the United States and Canada adopted single-payer models of government insurance for physician and hospital services – universal in Canada, but restricted to certain population groups in the US. At the time, the American and Canadian political economies of health care and landscapes of public opinion were remarkably similar, and the different policy designs must be understood as products of the distinctive macro-level politics of the day. Subsequently, however, the different scopes of single-payer coverage would drive the two systems in different directions. In Canada, the single-payer system became entrenched in popular support and in the nexus of interest it created between the medical profession and the state. In the US, Medicare became similarly entrenched in popular support, but did so as part of the larger multi-payer private insurance system. In the process universal single-payer coverage became politically iconic in Canada and taboo in the US.

Keywords

Health policycomparative public policypolicy narrativessingle payer systems
Type
Research Article
Information
Journal of International and Comparative Social Policy , Volume 35 , Issue 1: SI: Recent Social Policy in Canada and the United States , February 2019 , pp. 5 - 24
Copyright
Copyright © 2018 Informa UK Limited, trading as Taylor & Francis Group

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