Commentary on Canadian health insurance: lessons for the United States

The Government Accounting Office's comparatively favorable report on Canada's National Health Insurance program (Medicare) prompted a firestorm of reaction: criticism from the health insurance industry primarily and praise from advocates of single-payer models of American reform particularly. Congressional hearings aired this controversy, and this article is a revised version of the author's testimony to the Government Operations Committee, June 18, 1991. The author examines the legitimacy of cross-national comparison as a general analytic tool and the lessons to be learned from North American health care comparisons in particular. In the final section he critically discusses two sets of myths about Canada's experience with universal health insurance: those regarding the desirability of the Canadian system itself and those questioning the transplantability (adaptability) of the model to the United States.