Obamacare – Possible Lessons from Canada

Cambria Press is proud to announce that The Political and Economic Sustainability of Health Care in Canada by Howard A. Palley, Marie-Pascale Pomey, and Owen B. Adams is now available. This is an especially welcome resource as the world watches how Obamacare will transform the American political landscape and business environment.

Former Canadian Minister of National Health and Welfare, The Honorable Monique Bégin, praises the book, stating that “The American public views the Canadian healthcare system either as a socialist NHS or at best–an unending challenge to square a circle. In fact, this original universal health care system embodies the difference between political cultures of two otherwise similar countries. Through three case studies–Ontario, Quebec and Alberta–this remarkable comparative analysis sheds light on how the Canadian ‘medicare’, as people call it, copes with the pressures of financial sustainability. Fascinating is the discussion of how varied provincial political leaders promote an increased role for the private sector within the historical parameters of the Canada Health Act (1984), and the difficulty for Canadians to remain “objective” in discussing the private sector in health care.  This publication is an authoritative study of interest for readers on both sides of the 49th parallel.”

Cambria Press is pleased to present a taped interview with Professor Howard Palley on his book.

In addition, the following is a transcript for the Q&A session Professor Palley kindly provided for Cambria Press.

QUESTION: Why did you and your coauthors decide to write this book?

RESPONSE: While  globally the mix of private and public sector involvement in health care delivery is a focus of political and public policy concern, little has been written about “the how and why” public policy develops in this area. We decided that a comparative case analysis of this development comparing the delivery of health care in three Canadian provinces: Alberta, Ontario and Quebec would shed light on such developing “public/private” partnerships.


QUESTION: Can you describe the Canadian health care system briefly?

RESPONSE: Canada has a complex health care delivery system which is a conglomeration of 13 public plans––10 provincial and three territorial, as well as a number of federally-administered plans serving special populations such as aboriginal groups and veterans.  Under the Canada Health Act all citizens and long-term residents are provided full coverage for most hospital and physician services as well as other coverages for many health care services.  Other than physician and hospital coverages, other coverages vary among different plans.

QUESTION: Why is this study important?

RESPONSE: The importance of this study is that examines how the public/private relationship in health care delivery––particularly that of the for-profit sector––has developed both historically and in recent years, in three subnational provincial jurisdictions within the federal system––Alberta, Ontario and Quebec. Our study examines both similarities and differences in this development. These provinces are highly distinct in their political culture and the political history affecting health care delivery.

Ontario and Quebec are Canada’s most populous provinces and Alberta is an increasingly populous prairie state. Alberta is unique in its long-time governance by the Progressive Conservative Party and its predecessor, the Social Credit Party. Ontario has had a more variable political history with periods of Progressive conservative, New Democratic Party and Liberal leadership and in recent years Quebec governance has shifted between the Party Québecois and the Liberal Party.  In our study, one dimension that we examine are political dispositions to act regarding public/private initiatives in health care delivery and how this affects health care delivery in these provinces.

QUESTION: Are there any national constraints on the actions of the provinces with respect to the delivery of health care services?

RESPONSE:  Provincial and territorial medical and hospital plans are constrained by the Canada Health Act of 1984. For necessary medical and hospital services there are no “extra billing” or charges. Also, provinces and territories must adhere to the Act’s five principles of public administration, comprehensiveness, universality, portability and accessibility in order to receive full federal funding for insured services. However for other health care and health care-related services, there are federal contributions that are not constrained by these principles — although they are subject to reporting obligations. Another factor providing some flexibility in provincial Medicare plans is that necessary hospital and medical services are not enumerated in the Canada Health Act. This has allowed some “delisting” of services which is discussed in the case studies.

QUESTION: What is unique about the book?

RESPONSE:  In the provincial case studies, we examine how the federal/provincial dynamic has “worked out” in the three provinces with respect to similarities and differences regarding involvement of the for-profit sector both within and outside the three provincial Medicare systems. We also examine how the national and provincial fiscal setting has affected both economic and political sustainability pressures leading to private commercial initiatives in the three case provinces.  In addition, we also note that these initiatives occur both within and external to the Canadian provincial Medicare systems and that there is a need that such initiatives are held to a standard of public accountability in order to meet equity and adequacy goals.

QUESTION: What other research do you believe is needed on this topic?

RESPONSE:  Other subnational health policy studies in federal states such as Germany, Australia and India are needed.

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Recommend this book to your library! Librarians can order the book directly from Cambria Press or they can order through their preferred academic book wholesaler (Cambria Press is on the approval list of premier wholesalers like YBP).

Be sure to check out the Cambria Press Desk Copy Plus Program for course adoptions whereby professors receive a FREE hardcover and students get FREE e-book access of the title when the library purchases the Platinum E-book edition!

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