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May 8, 1996

Health Care for Older PeopleA Look Across a Frontier

JAMA. 1996;275(18):1449-1450. doi:10.1001/jama.1996.03530420077042

The United States and Canada are 2 federal nations separated geographically by an arbitrary line of latitude but culturally by 200 years of history. The ancestry of their institutions lies respectively, albeit remotely, in the anarchy of frontiers and the order of empire. Different assumptions about the natural way to organize society emerge in the pattern of their health services. The United States presents to the world a vision of rampant entrepreneurialism bridled by the enlightened self-interest of citizens and spurred by sporadic pricks of compassion. Canada's more collectivist tradition emerges in a concern that its health services should make sense in the context of equity and the public health, an ideal that has yet to be fully realized.1 It has, however, retained the tradition of the physician as a fee-paid professional, and only in the salaried medical staff of some primary health care centers in Quebec does one