Canada and the Netherlands: Rhetoric versus Reality in the Evolution of Solidarity Underpinning Universal Health Coverage

Since the mid-twentieth century, the shared goal of healthcare systems of Canada and the Netherlands has been to achieve broad healthcare access and coverage for citizens despite their health system differences. However, the rhetoric of "state" control in Canada and "market" control in the Netherlands belies very different realities in both countries. A longer historical perspective uncovers the discrepancies between the rhetoric and reality of solidarity that has emerged - and still exists - in both countries. In Canada, universal healthcare is historically seen as an important cultural cornerstone to be facilitated by the state as a public good in the context of institutional paralysis. In contrast, the Dutch system is historically predicated on an ideology of limited state control and healthcare provision by private parties. Yet the historical development of the system shows an ever-growing influence of the state in ensuring universal access to a continually broadening range of health services.