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Why Canadians and Americans will never agree on health care

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For Americans, Canada is generally a frozen, canoe-laden outpost with a socialized health system. For Canadians, Americans are hard-working, gun-loving people who prefer expensive health care. But why and how we formed these views about each others' health systems is less clear.

So the University of Michigan's Stuart Soroka investigated. After running the most comprehensive study on the subject (a survey of more than 7,000 North Americans) and co-authoring the book Health Care Policy and Opinion in the United States and Canada, Vox talked to him about how health care differs in the two countries, why debates around health are more ideologically driven in the US, and what we can learn from each other.

Julia Belluz: So, do they really have "socialized medicine" in Canada?

Stuart Soroka: Canada has a health-care system where more of it is paid for by the state through taxes. So if that's the condition for socialized medicine, then yes I guess they do. Socialized medicine has become a catch phrase, though, a tool: the word 'socialized' sounds like socialism.

But in reality, Canada is closer to what political scientists would call a "social democratic model," as in more money flows into government and government does more of the buying, though it's actually relatively liberal because there is some privatization in Canada. There are also things in Canada that you pay for, like prescription drugs. Meanwhile there are other systems — like in Scandinavia — where any prescribed drug is free or covered by government.

JB: What do Americans most misunderstand about the Canadian system, and vice versa?

SS: What some Canadians and some Americans have are overstated views of the others' system. We talk about socialized medicine in the US: Canada certainly has a public health-care system and the States doesn't. So in that sense it's more socialized. But again, in the grand scheme of things, there are lots of countries that are much further along the spectrum than Canada. Canadians view of the States is that it's a fend for yourself system where it costs a fortune to do anything and where lots of Americans can't get health care.

JB: And yet you found that people generally want the same thing out of their health system on both sides of the border.

SS: When you ask the question about what people want from their health system, there's not a big difference between Canadians and Americans. What everyone wants is ready access to good health care. The form that takes in the Canadian case is concern about wait lists, whereas in the States, the concern about access is financial: can I get health insurance?

JB: If everybody wants the same thing, why is it that the debate about health care so different in the two countries?

SS: Part of it is the policy context: debate here is happening in the context of a primarily private system, and in Canada, it's primarily public. But also, in the States, partisanship plays a much more important role in the debate than it does in Canada. That's related to the fact that American parties have mobilized on either side of the public-private line in health care and Democrats and Republicans have clear and opposing positions. In Canada, that's not the case. There, for the most part, all parties are on one side of that divide. Even the Conservative party is on the public health care side, so there's no party that clearly enunciates an anti-public health-care system in Canada.


A 2011 protest about health care in New York City. (Photo: Spencer Platt/Getty Images)

JB: Basically, it seems discussion of the two health systems is reflected by our national governance principles: "Life, liberty, and the pursuit of happiness" in the US and "Peace, order and good government" in Canada.

SS: Those lines capture very well the differences in the two countries, and they reflect a difference in the way in which political debates and policies unfold.

Canada is somewhere in between the US and Europe in a range of policy domains. The health system isn't as conditioned by some of the more libertarian beliefs or beliefs in individual freedoms that have  been such a prominent feature of American politics since America started. Think about it: the US is a country founded by people who wanted to separate from Europe, and Canada is a country where people who wanted to stay with Europe went, the Loyalists went to Canada. So ideas that have been central to American politics have been less so in Canada. And this plays itself out in health.