Antonia Maioni’s goal is to explain the development of health insurance in Canada and United States of America. She goes on to elaborate why the United States and Canada have different healthcare insurance systems even though these two countries are majorly similar in almost all other aspects for example they share the same economic, political and social attributes (Maioni, 1997 p. 411). She offers that the major contributing factor to this contrast is the fact that health reform was fostered by political institutions. In this respect, they shaped party systems in the two countries whereby, the major difference in the two countries was the existence of the social democratic third party in Canada.
She advances the school of thought on how formal rules implemented the third party in Canada and not in the United States and how it was able to influence the development of health policy. Maioni evidenced this by stating that the decentralized nature of the Canadian federalism and the policy areas including the health policy considered to be the responsibility of the provinces make the election of third parties in the provinces enable significant influence for policy innovations (Maioni, 1997 p. 413), influence of choice and elaboration of policy alternatives. Which is very unlike the United States of American system whereby state-level parties although had some impact on major parties; their implications were limited by the encroachment of federal government in social policy and general ability of their protests to be absorbed by national parties.
In Canada, during the 1940s the third party (CCF) helped in sparking the interest of the government in health reform. This was so, because their policy on universal health insurance was gaining popularity and the Liberal and Conservative official parties feared that CFF may undermine their electoral support. The Liberal party even went ahead and absorbed the third parties social reform platform and ended up winning the election. The CCF government proceeded to make sure that the health reform did not slip out of the political agenda. The CFF’s presence in the House of Commons limited the Liberal’s margin to change policies as they insisted the government made good the promises made on the reforms. A new third party was created in 1961, The New Democratic Party whose main objective was the public demand for medical insurance. This new party was the majority in the House of Commons and it exerted pressure to the government to make legislature that would please the NDP. The health reforms were not easy to implement and we see that the presence of the third party actually furthered the medical reform in the country (Green & Rowell, 2013).
In United States of America, senior officials in government had a politicized attitude to health unlike their counterparts in Canada. When President Truman came into power, he vehemently supported a national health insurance system although he was severally blocked from implementing this by the conservative coalition formed by southern Democrats and Republicans. During the modification of the health reform a strategy was developed to replace the national health insurance system and they came up with one that focused on the aged. This was majorly because the aged were mostly shut out of the private insurance market (Maioni, 1997 p. 420). Unlike in Canada, the US had a precedent for the ages whereas Canada focused on the universal idea by the CCF. Hence in United States of America the idea of national health insurance was erased. A Medicare bill was proposed and passed after a hearty debate in which incremental health reform is possible in the United States but also it highlights institutional constraints that limit the reform. The main advantage of Medicare was that even though the proposed health legislation was limited in scope it could be changed before final passage (Beik, 2013).
In the US compromises taken on the health reform reflected how parties had to appeal to the right however, in Canada, the party in power was forced to consider the third party as a political force to reckon with in federal legislature. It is clearly seen that in United States of America a modified reform strategy was undertaken whereby government programs were specific to a group of clienteles whereas in Canada universal access in health insurance programs (Maioni, 1997 p. 431).
The failure of President Truman discouraged further attempts in introducing national health insurance in the US whereas in Canada such reform was very possible. Maioni in her argument on the reasons for the contrasts in the two health insurance systems is very convincing as the historical events cited evidence exactly how the political parties directly influenced these two systems in separate paths.
In Canada, due to the acceptance of the influential social democratic third party, caused the universal type of health insurance very possible as the party in power (The Liberals) was forced to take into consideration the third parties policy demands and in United States of America the lack of influential third parties led them to the dual-tiered health insurance system that focused on the aged and the poor.
Maioni, A. (1997). Parting at the Crossroads: The Emergence of Health Insurance in
the United States and Canada. Comparative Politics, 29(4), 411-431.
Beik, J. I. (2013). Health insurance today: A practical approach. St. Louis, Mo: Elsevier.
Green, M. A., & Rowell, J. A. C. (2013). Understanding health insurance: A guide to billing and reimbursement. Clifton Park, NY: Delmar Cengage Learning.