Interest groups, public opinion, and path dependence: how Canada and the U.S diverged on healthcare policy
de Laforcade, Marco Adreyan
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Despite being comparatively similar countries, the United States and Canada have taken very different historical tracks to developing their respective health care systems. While Canada incrementally developed a system of universal coverage through national public insurance, the United States repeatedly failed to achieve universal healthcare reform and infamously maintains its hybrid public-private system to this day. Scholars of comparative politics have produced numerous competing accounts of the conditions under which health care policy change occurs and explanations for the major factors that shaped policy divergence. However, there are few studies dedicated to explaining mechanisms for continued policy divergence and its impacts on public opinion. In this thesis, I comparatively examine the passage of Medicare in the United States in 1965 with the Canadian Medical Care Act of 1966 and present the results of a nationally representative U.S. public opinion survey. I find that a mechanism of path dependence, whereby interest groups and constituencies that participate in policy battles are strengthened or curtailed by their outcomes, weighed disproportionately on the power of the former in the United States. In Canada, path dependence created a stalemate in which early forms of policy entrepreneurship made healthcare expansion and reduction equally difficult to achieve. The contemporary survey reveals that U.S. public opinion largely favors healthcare reform on matters of principle rather than policy.