Solving the Health Care Problem

How Other Nations Succeeded and Why the United States Has Not

By Pamela Behan

Subjects: Health Care
Paperback : 9780791468388, 204 pages, June 2007
Hardcover : 9780791468371, 204 pages, August 2006

Alternative formats available from:

Table of contents


The Research Question
Explanations from the Literature
The Research Method
The Book

1. What Can This Approach Tell Us?
2. Canada

Historical Influences and Legacies
Canadian Health Care Reform Initiatives
Theoretical Explanations and Canadian Health Policy

3. Australia

Historical Influences and Legacies
Australian Health Care Reform Initiatives
Theoretical Explanations and Australian Health Policy

4. The United States

Historical Influences and Legacies
Division, Delay, and Private Entrenchment
U. S. Health Care Reform Initiatives
Theoretical Explanations and U. S. Health Policy

5. A Second, Systematic Approach

The Theoretical Implications of the Three National Studies
A Systematic Comparative Historical Method
The Qualitative Comparative Analysis

6. Conclusions

Theoretical Conclusions from the Traditional Study
What the Systematic Study Adds
So What?
Limitations to the Study
Directions for Future Research

Appendix A. The Selection of Cases
Appendix B. A Typology of Health Policy Outcomes
Appendix C. The Choice of Causal Factors
Appendix D. The Final Sixteen Factors and “Constants”
Appendix E. A Short Introduction to Qualitative Comparative Analysis
Appendix F. Tables used in the QCA

Examines Australia and Canada to help explain why the United States provides less health care protection than other democratic nations.


The United States is the only industrialized democracy that allows its citizens to go entirely without health care for lack of funds or to be bankrupted by medical bills. Author Pamela Behan was confronted by the effects of this policy failure during her previous career as a nurse, and with Solving the Health Care Problem, she examines how it can be corrected. Behan explores American health care policy failure by looking at how two other, similar nations—Canada and Australia—managed to adopt health care protections, and compares their stories with events in the United States. Behan's systematic comparison of all three nations shows that the factors responsible for these different results center on the responsiveness of each nation's political institutions to its voters. In particular, Australia's parliamentary system and labor party and Canada's constitutional flexibility and national-provincial dynamics proved central to each nation's adoption of national health insurance. In contrast, similar efforts in the United States became less frequent and less ambitious after they were repeatedly blocked without even coming to a vote. These dissimilarities reveal the institutional and class issues that must be addressed for the United States to successfully confront the health care problem.

Pamela Behan is Assistant Professor of Sociology at the University of Houston–Downtown.