After World War II, the United States and Canada, two countries that were very similar in many ways, struck out on radically divergent paths to public health insurance. Canada developed a universal single-payer system of national health care, while the United States opted for a dual system that combines public health insurance for low-income and senior residents with private, primarily employer-provided health insurance—or no insurance—for everyone else. In National Health Insurance in the United States and Canada, Gerard W. Boychuk probes the historical development of health care in each country, honing in on the most distinctive social and political aspects of each country—the politics of race in the U.S. and territorial politics in Canada, especially the tensions between the national government and the province of Quebec. In addition to the politics of race and territory, Boychuk sifts through the numerous factors shaping health policy, including national values, political culture and institutions, the power of special interests, and the impact of strategic choices made at critical junctures. Drawing on historical archives, oral histories, and public opinion data, he presents a nuanced and thoughtful analysis of the evolution of the two systems, compares them as they exist today, and reflects on how each is poised to meet the challenges of the future.

During the last 25 years, life expectancy at age 50 in the United States has been rising, but at a slower pace than in many other high-income countries, such as Japan and Australia. This difference is particularly notable given that the United States spends more on health care than any other nation. Concerned about this divergence, the National Institute on Aging asked the National Research Council to examine evidence on its possible causes. According to Explaining Divergent Levels of Longevity in High-Income Countries, the nation's history of heavy smoking is a major reason why lifespans in the United States fall short of those in many other high-income nations. Evidence suggests that current obesity levels play a substantial part as well. The book reports that lack of universal access to health care in the U.S. also has increased mortality and reduced life expectancy, though this is a less significant factor for those over age 65 because of Medicare access. For the main causes of death at older ages-cancer and cardiovascular disease-available indicators do not suggest that the U.S. health care system is failing to prevent deaths that would be averted elsewhere. In fact, cancer detection and survival appear to be better in the U.S. than in most other high-income nations, and survival rates following a heart attack also are favorable. Explaining Divergent Levels of Longevity in High-Income Countries identifies many gaps in research. For instance, while lung cancer deaths are a reliable marker of the damage from smoking, no clear-cut marker exists for obesity, physical inactivity, social integration, or other risks considered in this book. Moreover, evaluation of these risk factors is based on observational studies, which-unlike randomized controlled trials-are subject to many biases.

A valuable contribution to the health care debate.

Lives at Risk identifies 20 myths about health care as delivered in countries that have national health insurance. These myths have gained the status of fact in both the United States and abroad, even though the evidence shows a far different reality. The authors also explore the political and economic climate of the health care system and offer alternatives to the current health care public policies.

As almost all newspaper or magazine readers know, Canada figured prominently in the turbulent U.S. debates over health care reform in the early Clinton presidency. Furthermore, future news analysts and policymakers will undoubtedly again use Canada to cite the "good" and the "bad" aspects of single-payer national health insurance. Beyond the debate about the desirability of Canadian-style health care reforms, Antonia Maioni sees another question: Why did the United States and Canada, alike in so many ways, part "at the crossroads" to produce such different systems of health insurance? She answers this previously neglected query so interestingly that her book will hold the attention of anyone concerned with health care in either country or both. The author explores the development of health insurance in the United States and Canada, from the emergence of health care as a political issue in the 1930s to the passage of federal health insurance legislation in the 1960s. Focusing on how political institutions influence policy development, she shows that Canada's federal structure and its parliamentary institutions encouraged a social-democratic third party that became pivotal in demonstrating the feasibility of universal, public health insurance. Meanwhile, the constraints of the U.S. political system forced health care reformers to temper their own ideas to appeal to a wide coalition within the Democratic party. Even readers previously unfamiliar with Canadian politics will find in this book important clues about the "realm of the possible" in the uncertain future of U.S. health care.

The United States is among the wealthiest nations in the world, but it is far from the healthiest. Although life expectancy and survival rates in the United States have improved dramatically over the past century, Americans live shorter lives and experience more injuries and illnesses than people in other high-income countries. The U.S. health disadvantage cannot be attributed solely to the adverse health status of racial or ethnic minorities or poor people: even highly advantaged Americans are in worse health than their counterparts in other, "peer" countries. In light of the new and growing evidence about the U.S. health disadvantage, the National Institutes of Health asked the National Research Council (NRC) and the Institute of Medicine (IOM) to convene a panel of experts to study the issue. The Panel on Understanding Cross-National Health Differences Among High-Income Countries examined whether the U.S. health disadvantage exists across the life span, considered potential explanations, and assessed the larger implications of the findings. U.S. Health in International Perspective presents detailed evidence on the issue, explores the possible explanations for the shorter and less healthy lives of Americans than those of people in comparable countries, and recommends actions by both government and nongovernment agencies and organizations to address the U.S. health disadvantage.

This comparison of the American health care system with that of five other countries offers a valuable learning experience from which to model our own system. Health of Nations examines the relationships between the political, economic, and cultural influences that shaped each system and discusses how certain aspects of foreign systems might conform more easily than others to U.S. political, economic, and cultural realities. Graig scrutinizes the organization, financing, and implementation of health care systems in the United States, Canada, Germany, Japan, the United Kingdom, and the Netherlands.