This fall, the Canada Program turned its attention to one of the thorniest issues in policy studies—the reform of health care—by launching a seminar series on Healthy Comparisons. Over the course of seven weeks, with nine guest speakers, the series examined health care systems in Canada and the United States. The series was also part of the core curriculum for GOV 2114, “The Politics of Health Care,” offered by the current William Lyon Mackenzie King Visiting Professor, Antonia Maioni from McGill University.
The challenges to health care are many, on both sides of the border, from access to coverage to financing. Even though Canada and the US have different health care systems, persistent problems exist in both countries. For Canada’s single-payer system, equitable access to care is still evident, as are gaps in coverage such as pharmacare. In the US, the complexity of health care systems, coupled with phenomenal costs, make this issue one of the most salient on the political agenda.
The series began by asking whether social values could explain differences between Canadians and Americans. Michael Adams, founder of the Environics polling firm, reviewed public opinion trends over the past generation to demonstrate that, while we tend to be alike in many respects, political polarization, race, and gender provide much sharper points of divergence in the US than in Canada. This suggests a different social environment for solidarity and the kinds of values that could support a commitment to publicly funded health care.
The series also turned to the expertise of health care practitioners themselves to ask how their experiences can shed light on cross-national differences. Drs. Marion Dove (McGill) and Aaron Hoffman (Harvard) were asked which country offered better access to primary care. While the answer was “it depends,” their conversation did reveal important nuances—how Canada’s “universalist” system ensures health insurance access without regard to the ability to pay, while in the US, the labyrinth of coverage and costs has led to a “bimodal” reality in terms of access to care and health outcomes. In a further cross-national conversation, Tim Evans (McGill) and Lisa Berkman (Harvard) revealed how these differences had a stark impact on responses to COVID-19 and the different health outcomes across the Canada-US border.
Jane Philpott—a former minister of health in the Government of Canada—argued that Canada needs to build more capacity in the health care workforce, especially in family medicine and primary care. And, she insisted, political vision and leadership are necessary for real change to occur. But how? Alika Lafontaine, past president of the Canadian Medical Association and an advocate in Indigenous health, revealed that an essential problem in all health care systems is falling back on “mental models” that are entrenched as solutions, even though this leads to higher costs and lower efficiencies. And Laurent Duvernay-Tardif, a former NFL Super Bowl champion and medical resident, echoed this sentiment, as well as revealing how the reality of health professionals in the system can be just as challenging as the pressure of facing the game on the football field.
The last words of the series came from political scientist and renowned health care expert Ted Marmor (Yale). Marmor reminded us that there are many misconceptions about Canada’s health care system in the US, but a careful comparative analysis of political institutions and interests can illuminate why countries differ in their approach to health care and contribute to meaningful health reform.
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Left to right: Daniel Manulak, Helen Clayton, and Antonia Maioni of the Canada Program. Credit: Bethany Versoy