What's race got to do with it?

A startling new analysis of the difference between Canadian and US healthcare funding

Gregory P. Marchildon, LRC: While the concept of race lacks a biological basis, categorization by race continues to shape relations within societies, particularly in those countries where slavery was a central institution for centuries, or where settlement involved the displacement of large numbers of indigenous peoples. For example, because of the legacy of slavery, the racial division between African Americans and white Americans is the single most important theme in the national narrative of the United States...

In his new book, National Health Insurance in the United States and Canada: Race, Territory and the Roots of Difference, Gerard Boychuk explains why the politics of race prevented the introduction of universal health care in the United States. He also introduces a bold new hypothesis as to why Canada did the opposite...

The different paths taken by the two countries have fascinated and perplexed commentators and social scientists on both sides of the 49th parallel for decades... Canadians increasingly perceived health care as a collective right rather than an individual benefit, a social service rather than a commodity to be bought and sold on the marketplace. This policy divergence produced a different way of viewing the world, a difference reflected in everyday language -- health care is generally described as an industry by Americans and as social policy by Canadians. However, the consequences of this policy divergence go beyond the philosophic...

In the United States, opposition to universality went well beyond an ideological preference for the market and hostility to the state... The more deep-rooted issue was the threat by health reform proposals to segregated health services. Southern congressional representatives, the majority of whom were Democrats, were viscerally opposed to reforms that might have required white people to be treated in hospitals, nursing homes and medical clinics alongside black patients. Segregationalist sentiment was also a pronounced feature of organized labour, and the unions worked with conservative Democrats as well as the most vocal opponent of universal health care, organized medicine. The American Medical Association was itself a segregated organization and opposed universal health care for racial as well as political and economic reasons in the 1940s and '50s.

It was only after the Civil Rights Act of 1964 forced the desegregation of all public programs funded by the American government that the racial objections to universality receded and the political and economic objections to universality and government intervention took priority...

Health care has become one of the key differences between the two countries... Canada continues to be influenced by a set of social democratic values that are very much in the minority south of the border... A more collectivist approach to health care in the US seems to fly in the face of the more highly individualistic ethos that underpins both major political parties as well as civil society. On the other hand, the American emphasis on individual rights combined with the legacy of the civil rights movement may lead to health care being declared a fundamental right by the courts. This would strengthen the hand of those political leaders who feel that it is time, finally, for all Americans to have universal access to essential health care. Race once prevented this from occurring, and now, the intersection of race and rights may allow it to happen.

Image source here.