BOOKS

According to popular marketing mythology, the inclusion of the word 'Canada' in the title of a publication is enough to convince any potential purchaser that the content is boring beyond belief. But Unhealthy Times: political economy perspectives on health and care in Canada is an interesting and, for many politicians and health managers, provocative book.

The evolution of the world's second most expensive healthcare system, since its break in 1966 from the ruinously expensive US model, has important parallels and lessons for our NHS.

Canada's medicare system was not a nationalisation of healthcare, like the NHS. Instead, it was a tax-funded insurance scheme designed to cover the full cost of treatment in hospital or by a physician.Doctors (like British GPs) and hospitals were left as private providers.However, the narrow definition of healthcare to be funded has left today's evolving system vulnerable.A growing number of private clinics, nursing homes, and home-based services are charging fees not covered by the scheme.

Despite its popularity and high levels of government spending (50 per cent more per head was spent in Canada than in Britain in 1998), the Canadian system has faced cuts and struggled to cope.

And like the NHS, it has come under fire from the advocates of neo-liberal policies, including the expansion of private insurance and for-profit services.

Unhealthy Times seeks to explore this developing crisis from the standpoint of 'political economy', which is defined as flowing from 'both liberalism and Marxism'. The strengths of this complex and nuanced approach are that issues of class, national and international political context, economic policies, and gender can be incorporated into a tough, critical analysis that refuses to take statements at face value or see developments in isolation. Contradictions are explored and embraced - such as continued political support for Canada's tax-funded healthcare from major employers keen to avoid the overhead health insurance costs of their US rivals. And grim lessons are drawn for Canada from the private sector's inroads into the NHS.

The challenging method of approach should give food for thought to all those not yet lobotomised by the anodyne, promarket platitudes of New Labour and Milburn-speak.