Perspective: Interpreting Canada: Models, Mind-Sets, And Myths

Abstract

The past three years have seen an extraordinary leap in American interest in the Canadian health care system. Why this sudden explosion of interest? We interpret the process as follows: First, the U.S. system is uniquely unsatisfactory and is continuing to deteriorate in objective, easily observable terms. The broad outlines of this situation are well known to the readers of Health Affairs – increasing numbers of unand underinsured, uncontrollable cost escalation, failure of the “competitive” strategies of the 1980s, increasing third-party intrusion into the practice of medicine, growing documentation of excessive and inappropriate medical care, and rapid growth of the already large “overhead” costs of an unproductive private-sector health bureaucracy. To quote Alain Enthoven: “It would be, quite frankly, ridiculous . . . to suggest that we have achieved a satisfactory system that our European friends would be wise to emulate”-or Arnold Relman: “Our health-care system is inequitable, inefficient, and too expensive.” Second, as the saying goes, “You cannot fool all of the people all of the time,” and Americans are becoming increasingly aware of their predicament. Their satisfaction with their system was the lowest among ten Western nations in a recent Harris poll. After an analysis of a wide range of polling data, Robert Blendon and Jennifer Edwards recently concluded that “citizens of this country have decided that fundamental change in our health care system is needed.” More significant for the debate over Canada, however, is the fact that a substantial majority of Americans have repeatedly indicated that they would favor a national health insurance plan financed through taxation. Third, the traditional alliance between private insurers and physicians