Understanding the Political Economy of the Evolution and Future of Single-Payer Public Health Insurance in Canada (Technical Paper)
AbstractSurprisingly little attention has been paid to how we pay for health care affects how much we spend on health care. In this paper, the author discusses how non-contributory finance and effective subsidization of public health care spending with federal cost sharing crowded out demand for private insurance as voters opted for high levels of public health spending.
Banting, Keith, and Robin Boadway. 2004. “Defining the Sharing Community: The Federal Role in Health Care.” In Money, Politics and Health Care: Reconstructing the FederalProvincial Partnership, edited by Harvey Lazar and France St-Hilaire. Montreal: Institute for Research on Public Policy.
Bégin, Monique. 2002. “Revisiting the Canada Health Act (1984): What Are the Impediments to Change?” Speech to the Institute for Research on Public Policy 30th Anniversary Conference, National Arts Centre, Ottawa, 20 February.
Bohn, Henning. 1999. “Will Social Security and Medicare Remain Viable as the U.S. Population Is Aging?” Carnegie-Rochester Conference Series on Public Policy 50 (1): 1-53.
Boychuk, Gerard W. 2008a. “The Regulation of Private Health Funding and Insurance in Alberta under the Canada Health Act: A Comparative Cross-Provincial Perspective.” SPS Research Paper: The Health Series 1. Calgary: University of Calgary, School of Policy Studies. December.
———. 2008b. National Health Insurance in the United States and Canada. Washington, DC: Georgetown University Press.
Brennan, Brian. 2008. The Good Steward: The Ernest C. Manning Story. Calgary: Fifth House. Bundorf, M. Kate, and Mark V. Pauly. 2006. “Is Health Insurance Affordable for the Uninsured?” Journal of Health Economics 25 (4): 650-673.
Chung, Jennifer, and Ronald D. Kneebone. 2004. “Where Did the Debt Come from?” In Is the Debt War Over? Dispatches from Canada’s Fiscal Frontline, edited by Christopher Ragan and William Watson. Montreal: Institute for Research on Public Policy.
Courchene, Thomas J. 2004. “Confiscatory Equalization: The Intriguing Case of Saskatchewan’s Vanishing Energy Revenues.” IRPP Choices, March.
Deber, Raisa, Evelyn L. Forget, and Leslie L. Roos. 2004. “Medical Savings Accounts in a Universal System: Wishful Thinking Meets Evidence.” Health Policy 70 (1): 49-66.
Donato, R., and R. Scotton. 1998. “The Australian Health Care System.” In Economics and Australian Health Policy, edited by G. Mooney and R. Scotton. Sydney: Allen and Unwin.
Dyck, Dagmar. 2003. “Fiscal Redistribution in Canada, 1994-2000.” Working Paper 2003-22. Ottawa: Department of Finance.
Emery, J.C. Herbert. 2010. “‘Un-American’ or Unnecessary? America’s Rejection of Compulsory Government Insurance in the Progressive Era.” Explorations in Economic History.
Emery, J.C. Herbert, and Kevin Gerrits. 2006. “The Demand for Private Health Insurance in Alberta in the Presence of a Public Alternative.” In Health Services Restructuring: New Evidence and New Directions, edited by C. Beach et al. Kingston, ON: John Deutsch Institute for the Study of Economic Policy, Queen’s University.
Emery, J.C. Herbert, and Ian Rongve. 1999. “Much Ado about Nothing: Demographic Bulges, the Productivity Puzzle and Social Security Reform.” Contemporary Economic Policy 17 (1): 69-79.
Evans, Robert G. 2003. “Political Wolves and Economic Sheep: The Sustainability of Public Health Insurance in Canada.” Centre for Health Services and Policy Research Working Papers CHSPR 03:16W. Vancouver: University of British Columbia. December.
———. 2004. “Financing Health Care: Options, Consequences, and Objectives.” In The Fiscal Sustainability of Health Care in Canada, Romanow Papers, vol. 1, edited by Gregory P. Marchildon, Tom McIntosh, and Pierre-Gerlier Forest. Toronto: University of Toronto Press.
Evans, R.G., et al. 2001. “Apocalypse No: Population Aging and the Future of Health Care Systems.” Canadian Journal on Aging 20 (suppl.1): 160-191.
Gagan, David, and Rosemary Gagan. 2002. For Patients of Moderate Means: A Social History of the Voluntary Public General Hospital in Canada, 1890-1950. Montreal; Kingston, ON: McGill-Queen’s University Press.
Glied, Sherry A. 2008a. “Health Care Financing, Efficiency, and Equity.” NBER Working Paper 13881. Cambridge, MA: National Bureau of Economic Research. March.
———. 2008b. “Universal Public Health Insurance and Private Coverage: Externalities in Health Care Consumption.” Canadian Public Policy 34 (3): 345-357.
Gouveia, Miguel. 1997. “Majority Rule and the Public Provision of a Private Good.” Public Choice 93 (3-4): 221-244.
Hogan, Seamus, and Sarah Hogan. 2004. “How an Ageing Population Will Affect Health Care.” In The Fiscal Sustainability of Health Care in Canada, Romanow Papers, vol. 1, edited by Gregory P. Marchildon, Tom McIntosh, and Pierre-Gerlier Forest. Toronto: University of Toronto Press.
Kifmann, Mathias. 2005. “Health Insurance in a Democracy: Why Is It Public and Why Are Premiums Income Related?” Public Choice 124 (3): 283-308.
Mansell, Robert L., and Ronald Schlenker. 1995. “The Provincial Distribution of Federal Fiscal Balances.” Canadian Business Economics 3 (2): 3-22.
Martineau, Patrice. 2005. “Federal Personal Income Tax: Slicing the Pie.” Cat. 11-621-MIE – No. 024. Ottawa: Statistics Canada. April.
McGrail, Kimberlyn. 2007. “Medicare Financing and Redistribution in British Columbia, 1992 and 2002.” Healthcare Policy 2 (4): 123-137.
Parry, Ian W.H. 2005. “Comparing the Welfare Effects of Public and Private Health Care Subsidies in the United Kingdom.” Journal of Health Economics 24 (6): 1191-1209.
Robson, William B.P. 2001. “Will the Baby Boomers Bust the Health Budget? Demographic Change and Health Care Financing Reform.” C.D. Howe Institute Commentary 148. Toronto: C.D. Howe Institute.
———. 2007. “Time and Money: The Challenge of Demographic Change and Government Finances in Canada.” C.D. Howe Institute Backgrounder 109. Toronto: C.D. Howe Institute.
Romanow, Roy J. 2004. Building on Values: The Future of Health Care in Canada, Final Report. Ottawa: Government of Canada.
Ruggeri, G.C., D. Van Wart, and R. Howard. 1995. “Fiscal Incidence as an Indicator of Voter Preference.” Canadian Business Economics 3 (2): 42-53.
Saez, Emmanuel, and Michael R. Veall. 2005. “The Evolution of High Incomes in Northern America: Lessons from Canadian Evidence.” American Economic Review 95 (3): 831-849.
Shiell, Alan, and Janelle Seymour. “Preference for Public Health Insurance: Egotism or Altruism?” International Journal of Social Economics 29 (5-6): 356-369.
Taylor, Malcolm G. 1978. Health Insurance and Canadian Public Policy: The Seven Decisions that Created the Canadian Health Insurance System. Montreal; Kingston, ON: McGillQueen’s University Press.
Tuohy, Carolyn Hughes, Colleen M. Flood, and Mark Stabile. 2004. “How Does Private Finance Affect Public Health Care Systems? Marshaling the Evidence from OECD Nations.” Journal of Health Politics, Policy and Law 29 (3): 359-396.
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