Cultural forms underlying health-related discourses in the United States and Canada:a historical-comparative study of the two countries\u27 editorials from 1965-1999

摘要

This paper investigates cultural reasons for differences between the U.S. health care system and its Canadian counterpart. The U.S. health care system is an entrepreneurial system based upon free market principles, while the Canadian health care system is a welfare-oriented system based upon governmental responsibilities. Differences in health care systems may reflect differences between two cultures. This paper is based upon Roberts\u27 theoretical framework on modalities. The basic assumption is that social systems can be understood through the discursive use of modal statements (sentences in which actors declare what is possible, impossible, inevitable, or contingent for each other) and their associated rationales. In an analysis of U.S and Canadian editorials during the period from 1965 to 1999, evidence is found that editorialists in both countries tended to use economic rationales when accounting for people\u27s possibilities and welfare-related rationales when accounting for people\u27s inevitabilities. Data in this study also suggest that whereas Canadian editorialists tended to use welfare-related rationales, U.S. editorialists tended to use economic ones. In addition, despite the fact that during the study period three important laws were passed that established Canada\u27s universal health care system, there is no evidence of simultaneous changes in Canada\u27s health-related modal discourse. The findings suggest that Canadians\u27 rhetoric of social responsibility (via mentions of inevitability for welfare reasons) was likely a fertile context for rather than a passive consequence of their developing system of universal health care.