National Identity and the Challenge of Health Reform in Canada

Health reform remains the most contentious policy issue in Canada. Medicare is subject to the same political forces that demand state retrenchment in other areas, but it has escaped wholesale reorganization because of the commitment of Canadians to the principles of medicare, because the provinces and the federal government remain locked in a battle about provincial autonomy, and because the existing system serves the interests of various professional groups including organized medicine. Nevertheless, reform and, especially, expansion of coverage is essential if the existing system is to be sustained. The most encouraging aspect of current debate is the recognition that we can look beyond the U.S. for reforms more consistent with the underlying values of Canadians than is the U.S. system.