The Fate of National Health Insurance in Canada and the United States: A Multiple Streams Explanation

Abstract

This article uses the multiple streams lens to describe why Canada eventually adopted national health insurance in the 1960s, compared with the most recent attempt at adopting national health insurance in the United States. The analysis strengthens the lens by paying close attention to the impact of differing institutional frameworks on the streams. It is found that the lens provides a useful description of the complexity of policymaking, pointing out critical elements in the process that are often overlooked.

Delphic oracles: ambiguity, institutions, and multiple streams

“…The milieu refers to organizational structures in (USA) state governments, such as the governor's formal powers and what they term legislative professionalism. Blankenau (2001) adds to this argument the link between institutional milieu and policy windows. He maintains that greater numbers of veto points necessitate a longer policy window in order to adopt a particular policy in light of the number and magnitude of compromises that need to be made.…”

“…Nevertheless, it was institutional ambiguity in the form of overlap, the conflation of partisan and executive/official roles, which prompted problem overload and ultimately closed the window for reform. By linking incomplete and uneven implementation to policy windows, the authors get back to the argument by Blankenau (2001) through a different mechanism: The size of reforms (and by implication the number of potential veto players) at time t affects the duration of the policy window at time t ? 1.…”

Montagem de Agenda no Comitê Itajaí: Uma Aplicação do Modelo de Kingdon

“…Existem, conforme Blankenau (2001), soluções justapostas aos problemas, identificadas e apresentadas por analistas de políticas, líderes políticos e pesquisadores, que devem ser aceitáveis para a comunidade e tecnicamente possíveis, bem como enquadrarem-se nos valores do sistema político. Essas questões e soluções são discutidas dentro dessas comunidades e divulgadas para o governo e população em geral por diferentes canais, de modo a influenciar a discussão geral sobre políticas públicas a serem adotadas em cada questão da agenda.…”

“…A janela de oportunidade se abriu quando do impasse em relação à aprovação do Plano: ao se decidir aprovar a ideia de implantar a cobrança, mas com a promessa de rediscutir a fórmula para acomodar os interesses dos usuários, abriu-se uma chance deste grupo de empreendedores de política de influenciar os rumos do instrumento e defini-lo dentro de seus interesses e necessidades, agindo, assim, como advocates no sentido definido por Kingdon (2003). A proposta era viável, dentro da formulação de Blankenau (2001), já que uma solução alternativa, proveniente dos usuários, estava de acordo com o fato de estes terem desempenhado historicamente um papel importante na gestão do Comitê.…”

Comparing How Ghana and Canada Succeeded in the adoption of the National Health Insurance (NHI): A Multiple Streams Approach

“…My main argument is that, in spite of the institutional differences of both countries, they succeeded in adopting the NHI policy, thus, changes in the problem, policy, and politics streams, as well as their confluence by policy entrepreneurs, accounted for a significant shift in Ghana and Canada"s health policy in 2003 and 1966, respectively. Existing literature on Canada"s comparative health care policy is mostly on the United States, New Zealand, the United Kingdom, Australia, and other industrialized countries (Blankenau, 2001, Boothe, 2011Marmor et al, 2010;Maioni, 1997;Tenbensel, 2008). There is little or no work on developing countries like Ghana.…”