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C H A P T E R T W O A Tale of Two Cultures Canada and the United States Who wants to live next to a giant, even if for the most part a friendly one who speaks your language, offers you movies, TV sitcoms, automobiles, and, to top it off, a huge market for your exports? But that same giant brings with it a culture capable of swamping yours. It has a history of hostility to government, an individualism that at times seems opposed to the very idea of human interdependence , an unparalleled love of the market, and a health care system that, for all of its objectionable qualities, has just enough intriguing experiments and fancy technologies to catch even the resistant eye. For its part, the giant does not reciprocate that last compliment. It has vaguely heard of its northern neighbor’s health care system, but mainly from some old rumors that the doctors don’t like it, that patients on waiting lists often die, and that desperate Canadians come in great numbers to the United States for their health care. Hardly anyone takes the trouble to check out those rumors, and in any case the Canadian system doesn’t count as a model, fatally flawed by its dependence on government financing. Canadians are far less uninterested in their neighbor and its health care system. On the contrary, they worry about becoming ‘‘Americanized,’’ facing a culture overwhelming in its sheer size and economic force and ignorantly indifferent to Canadian strengths, not the least of which is a notably successful health care system. A comparison of Canada and the United States in their response to market ideas and practices offers as fine an example as one could ask for of the way in which two countries apparently so much alike can go in opposite directions. That difference is the product of history broadly taken, a A T A L E O F T W O C U L T U R E S 53 different starting point some two centuries ago. But there is a history more narrowly taken, what Carolyn Hughes Tuohy has called the ‘‘accidental logics’’ of the development of health care in the two countries that, at critical junctures , led them down divergent paths.1 That broader history is one marked by the growth of the United States as a world power, fueled by an intense commercial drive (‘‘the business of the American people is business,’’ as President Calvin Coolidge once said), by a love of innovation and technological prowess, by a breakdown of community in many places, and by an embrace of the market that has now reached into nearly every sphere of American life, from athletics at one end of the alphabet to universities at the other. That broader history has been marked in Canada by a more reserved development , sharing many of the American traits, but in a quieter way, eager for business success, ready to accept the market in most spheres but not (for the most part) in health care, attracted to technological prowess, yet holding on to the idea of community and solidarity in the provision of welfare for its citizens. The narrower history of Canadian health care reflects those influences but, in its embrace of universal health care, diverged in an important way from traits and trends that were often enough otherwise similar between Canada and the United States. It is that narrower story of the two countries that we want to tell here, focusing on debates about the market, but which is usefully set as an introduction within the context of the broader story. THE EARLY CANADIAN BACKGROUND Many Americans are hardly aware that Canada is a younger nation by a century, coming into existence as a coherent state in 1867 with the establishment of the Canadian Confederation, uniting Ontario and Quebec, and gradually adding other provinces in the years to come. If it first had to throw off the influence of the French, who early colonized much of the country, it had later to deal with the British. But in the latter case the bond with Great Britain was to endure and, even if Canadians desired their independence, which finally came about in 1982, they maintain to this day a friendly postcolonial relationship with the mother country. The seeds of that bond were in part planted by British loyalists who fled to Canada during the American Revolution, and fertilized by a steady stream of British migrants. If...

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