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The Health-Care Debate, From Up North

By Jonathan Malloy
Tuesday, September 15, 2009

Canadians love American health-care debates because it means you notice us. Much like Tennessee or North Dakota, we like just being mentioned. But your debates allow us to replay our own debates about health care and their relationship to national myths.

Consider a lunchtime conversation I had a few years ago with some American political scientists. Academics incapable of small talk, we began discussing why our similar countries had different health-care systems. I talked about political culture and national identity, which mystified the Americans a bit. They were interested in iron triangles; veto points; and the power of congressional committees, lobbyists and campaign donations. Those are important, yes, but I argued that health care was ultimately determined more by national identity and myths.

Ask a Canadian about differences between our country and the States, and you'll get a threefold answer: One, gun control. Enough on that. Two, much better Super Bowl commercials that are blocked out by Canadian cable regulators. (This is actually discussed seriously. The fact that we watch the Super Bowl religiously is not discussed.) Three, we have health care for all and you don't.

The reality of the two systems is of course much closer. But Canadians, who have a highly fragile and internationally ignored national identity, understand instinctively that health care says a lot about a country's heart and its understanding of itself.

Facts are remarkably unimportant in health-care debates, as every incoming Democratic president quickly learns, especially if he tries to put his government hands on Medicare. The same goes for Canada. Just as a disturbing number of Americans seem to believe we have "death panels" here, most Canadians are convinced that American emergency room defibrillators are activated by credit card swipe. ("Your health card, not your credit card" is a standard phrase in the Canadian political lexicon.) If it doesn't fit the national myth, it goes nowhere and is politically dangerous.

This, of course, works both ways. While Americans loudly proclaim their opposition to "socialist" health care, right-wing Canadian politicians are the quickest to pledge total opposition to privatization and "two-tier health care."

Once facts are put aside, the national myths reinforce themselves, even across borders. Every Republican fulmination against Canadian health care gets big play in the Canadian media, because it reinforces our sense of difference with the States. (When Democrats criticize our system, we're hurt but keep quiet.)

Perhaps you missed the "Americans for Prosperity" ads this summer featuring a Canadian woman's allegation that she would have died waiting for treatment in Canada. Canadians didn't -- the ads received national coverage and rebuttals and boosted our sense of difference with and superiority over the United States. "An admitting nurse doesn't check your credit card -- she checks your pulse" was the sort of line typical from our unimaginative politicians.

Now let's be clear -- you don't care about Canada (or North Dakota or Tennessee). But you do care about American health care and the outcome of the current process.

A year ago, America had a great appetite for change, and a catalyst in candidate Barack Obama, that might have been able to shift the national myth enough to transform American health care, much like Lyndon Johnson established Medicare so firmly that it now needs protection from government hands. But having used up his superpowers on the global recession, Obama is left to slug out the health-care debate with nothing but facts. He needs more than this to overcome a national myth that denies health care as a public good.

Good luck and watch out for those death panels.

The writer is a professor of political science at Carleton University in Ottawa.

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