| Book Review | The American Historical Review, 105.1

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| Book Review | The American Historical Review, 105.1 | The History Cooperative

Book Review

Canada and the United States

Antonia Maioni. Parting at the Crossroads: The Emergence of Health Insurance in the United States and Canada. (Princeton Studies in American Politics.) Princeton: Princeton University Press. 1998. Pp. xiv, 205. $37.50.

Why did two countries as similar as Canada and the United States—similar especially in terms of health care services—end up with such different health insurance schemes? In addressing this question, Antonia Maioni rejects the argument that the difference is a product of an American value system based on "the synthesis of individualism and universalism, preference for limited government, and the emphasis on self-reliance" (p. 28) contrasted to the Canadian emphasis on "collective values and the positive role of governments" or a deference to elites and public authority (p. 29). Indeed, her careful analysis of documents from the 1930s and 1940s suggests that there was at least as much popular and even political elite support for a public health insurance system in the United States as there was in Canada. 1

For an explanation, Maioni looks at how institutions shape the politics of health reform. In particular, she shows how the the separation of powers in the United States, in contrast to the parliamentary system in Canada, makes it both more difficult to coordinate disparate reform agendas and easier for well-organized groups to influence legislators. Both countries have federal systems. Maioni argues, however, that the more decentralized power structure in Canada makes it easier for third parties to emerge in ways that influence national policies and for the federal government to become involved in provincial jurisdictions through its spending powers. . . .

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