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In Sickness and in Health, In Good Times and in Bad: A Comparative Analysis of the Ideologies Governing Health Care Reform in Canada and the United States, 1962–1974 Michael A. Todt This study explores the ideology of health care reform in Canada and the United States from 1962 to 1974. During that time, Canada enacted Medicare, which provided a universal physician services program designed by the provinces and supported financially by the federal government. Rejecting a private-sector approach and Quebec’s desire for complete autonomy in the program design, the joint federal-provincial program supported the Canadian values of government responsibility for health care (paternal statism) and the belief that Canadians have a responsibility to care for each other (collectivism). From 1970 to 1974, the U.S. Congress failed to enact any national health insurance (NHI) program, even though NHI had the support of two presidents, Congress, and a large variety of organizations. Key ideological differences that explain the failure of the U.S. to enact an NHI program arose during controversies about maintaining the pluralistic system versus creating a federally run program, upholding the individual choice to participate versus mandating participation (individualism), and guaranteeing the right to access health care versus the inherent right to health care. These differences were impossible to overcome, and they remain at the heart of current debates about the recently enacted Patient Protection and Affordability Act of 2010, including challenges regarding its constitutionality.

In Sickness and in Health, In Good Times and in Bad: A Comparative Analysis of the Ideologies Governing Health Care Reform in Canada and the United States, 1962--1974