Wolfe S, Badgley R F
Columbia University School of Public Health.
Health PAC Bull. 1992 Fall;22(3):29-35.
Health/PAC readers will remember Samuel Wolfe's previous Bulletin article about Canada's national health care system ("Importing Health Care Reform? Issues in Transposing Canada's Health Care System to the United States," Summer 1990), in which he described the uniqueness of our northern neighbor's experience. At that time, Wolfe expressed doubt that a Canadian-like model could find sufficient political and social momentum to be propelled south. In this latest article, Wolfe is joined by his long-time colleague, Robin Badgley, to discuss the inequity and inequality they believe still exists within the Canadian system. Wolfe and Badgley's insightful analysis of what they see as shortcomings of the Canadian model and suggestions for their remedy are especially welcome given the questionable validity of most criticism of the Canadian system that Americans hear. Their work helps us understand the real problems that remain in the still-evolving Canadian system. As Americans discuss the various possibilities for progressive single-payer reform, many envision of state-based system. Wolfe and Badgley point out that demographically rooted inequalities and the lingering health burdens of social class may interfere with truly national universal access. They also alert us to the dangers that federal retreat from adequate levels of support would pose to such a state strategy. Samuel Wolfe has a unique background as a country doctor, psychiatrist, and public health official who attended the difficult birth of Saskatchewan's provincial health plan--the prototype for Canada's national health insurance. A respected teacher, researcher, and community health activist, Wolfe has taught in the United States for more than 25 years. He will soon move back to Canada and the welcome security of its universal health care system.
《健康/政治行动委员会》的读者可能还记得塞缪尔·沃尔夫之前在该杂志上发表的关于加拿大国家医疗保健系统的文章（《引入医疗保健改革？将加拿大医疗保健系统移植到美国的问题》，1990年夏季刊），他在文中描述了我们北方邻国这一经历的独特之处。当时，沃尔夫怀疑类似加拿大的模式能否获得足够的政治和社会动力从而向南推进。在这篇最新文章中，沃尔夫与他的长期同事罗宾·巴杰利共同探讨了他们认为加拿大医疗系统中仍然存在的不公平和不平等现象。鉴于美国人听到的对加拿大医疗系统的大多数批评的有效性存疑，沃尔夫和巴杰利对他们所认为的加拿大模式的缺点进行的深刻分析以及补救建议尤其值得欢迎。他们的工作有助于我们理解在仍在不断发展的加拿大医疗系统中依然存在的实际问题。当美国人讨论渐进式单一支付者改革的各种可能性时，许多人设想建立一个基于州的系统。沃尔夫和巴杰利指出，基于人口统计学的不平等以及社会阶层长期存在的健康负担可能会干扰真正的全国性全民医保。他们还提醒我们注意联邦政府减少足够水平的支持对这样一个州战略可能带来的危险。塞缪尔·沃尔夫有着独特的背景，他既是乡村医生、精神科医生，也是公共卫生官员，见证了萨斯喀彻温省省级医疗计划——加拿大国家医疗保险的雏形——的艰难诞生。作为一位受人尊敬的教师、研究员和社区健康活动家，沃尔夫在美国任教超过25年。他很快将回到加拿大，享受其全民医保系统带来的令人安心的保障。
