About the Author

Gregory P. Marchildon

Gregory P. Marchildon is a Canada Research Chair in Public Policy and Economic History at the Johnson-Shoyama Graduate School of Public Policy, University of Regina. He was executive director of the Royal Commission on the Future of Health Care in Canada (the Romanow Commission). His most recent books include Health Systems in Transition: Canada (2013) and Nunavut: A Health System Profile (2013).

Books by this Author
Making Medicare

Making Medicare

New Perspectives on the History of Medicare in Canada
also available: Paperback eBook
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Profits and Politics

Profits and Politics

Beaverbrook and the Gilded Age of Canadian Finance
also available: Hardcover eBook
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Is Two-Tier Health Care the Future?

“….overcoming the many barriers and interest groups opposed to universal medicare was a hard-won political war waged over many years, particularly with respect to medical associations who fought tooth and nail against the prospect of a public health care system and various politicians who were ideologically in favour of maintaining a significant role for private health insurance.  The melange of laws that exist across the provinces, and the Canada Health Act itself, are thus a product of the particular history and context of medicare, including political accommodations necessary to bring doctors into the public plan (for example, they are not public employees but independent contractors mostly paid on a fee-for-service basis with still relatively little governmental control over their clinical decision-making).”

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Universality and Social Policy in Canada

Introduction: Understanding Universality


Universal social programs such as medicare and Old Age Security (OAS) are major components of Canadian welfare states, provincially and federally. Widely popular, these programs are unique because they are universal, offering benefits to a population based on citizenship and residency, without any income or means test. Universal programs are accurately perceived as cornerstones of the modern welfare state in Canada and in other advanced industrial countries. Yet in recent decades, demographic, economic, and political challenges have created new pressures on universal programs, and scholars such as Neil Gilbert (2002) have pointed to the decline of universality. (For an overview of the universality debate, see Rice and Prince 2013.) In Canada, policy changes such as the dismantlement of universal family allowances in the late 1980s and early 1990s, and the termination of the Universal Child Care Benefit (UCCB) in 2016, seem to back this argument. In contrast, the early establishment and maintenance of universal elementary and secondary education, the resilience of Medicare and OAS in the face of significant ideological and political opposition, the creation of universal childcare in Quebec in the late 1990s, and the existence of the UCCB during the Harper years (2006–15) point to the enduring role of universality in Canadian social policy. Recent international and comparative research also points to the absence of any precipitous decline of universality in advanced industrial societies more generally (Béland, Blomqvist, et al. 2014).


Grounded in a historical and comparative perspective, this accessible volume explores the issues raised by social policy universality in Canada. These issues include the fiscal sustainability and social adequacy of existing education, health, and old age security programs; gender equality; and the full inclusion of Indigenous peoples, recent immigrants, and people with disabilities in core Canadian economic and social institutions.


Understanding universality


This volume aims to address several timely and important questions about public policy, citizenship, and politics. It does so through an analysis of social policy and program universality in Canada. The volume rests on three fundamental observations or propositions. The first is that, despite a sustained period of welfare state decline and retrenchment, the principle o universality as a policy tool or instrument of governing continues to underpin a significant proportion of social programs and state interventions. In key policy areas, the federal and provincial welfare states in Canada remain universal in character. The second observation is that social researchers and policy advocates are paying renewed attention to strategies of universalization as a reform agenda. There is also some government action in particular policy fields, including childcare and prescription drugs, if we take the examples of Quebec and British Columbia. The third, which clearly links to the other propositions, is that universalism goes to the very meaning of Canada as a political community and social structure often described as a sharing and caring country comprising diverse provinces; different linguistic, ethnic, and racial communities; multiple generations; a variety of family forms; and people with a range of abilities and disabilities. Canada is also a decentralized federation. Because most social policy is within the jurisdiction of provincial governments, the majority of universal social programs are provincial in nature. However, intergovernmental agreements and the occasional use of federal spending power have produced more pan-Canadian features in fields such as health care, which have become both symbolic and material aspects of what many people understand to be the Canadian identity.


To understand the contemporary nature and political implications of universality in Canadian social policy, we need to address basic questions about particular constituencies, including vulnerable sectors of society. What are the consequences of universal income benefits for gender equality? How do OAS benefits impact intergenerational relations and rates of poverty? In the context of Canadian federalism, what is the theory and practice of universalism in health care, immigration, and fiscal relations between the federal and provincial governments? At what point does the targeting of a particular subpopulation based on age (e.g., children or seniors), years of employment (e.g., the Canada Pension Plan), or status (e.g., Indigenous Canadians who are registered under the federal Indian Act) conflict with the principle of universality? What does universality mean in terms of the relationships between federal and provincial states and Indigenous peoples? Is universalism simply another form of centralization or assimilation? How does the inherent right to self-determination and Indigenous citizenship connect with practices of Canadian citizenship? For people with disabilities, what is the appropriate relationship between universal and selective approaches to policy design and service provision? This issue also includes the preferred balance between equality and equity and between mainstreaming and differentiation. All these questions, in one way or another, touch on dynamic tensions between unity and autonomy, social cohesion and difference, and the politics of inclusion and identity that are often at the heart of universal programs and policies.


What is universality?


To better analyse universal social policy, we introduce three core concepts—namely, universalism, universality, and universalization. These concepts relate to important political ideas, prominent policy instruments, and social processes of change in program design and service delivery. Associated with each of these concepts are a number of complementary notions as well as counter-ideas that together constitute the normative and ideological context of the universal in the contemporary welfare state. Universalism is associated with, among other ideas, the corresponding notions of equality and solidarity alongside the contending ideas of diversity and particularism; universality with the complementary notions of accessibility and social rights (i.e., that benefits and services should be available unconditionally as a matter of citizenship or residency) plus the competing ideas of selectivity and deservingness; and, universalization with congenial concepts of belonging and decommodification in opposition to the concepts of separating, categorizing, and privatizing.


Universalism, like other “isms,” is a system of public beliefs. It refers to sets of attitudes, principles, ideas, arguments, normative theories, and frameworks of values expressed by specific individuals, groups, and movements. From the academic literature and from public discourse, three dimensions to universalism can be identified. These are universalism as: (1) a vision of preferred relations between citizens, governments, communities, and markets; (2) political claims for and against universal approaches in social policymaking and public services; and (3) a body of academic concepts and theories on social policy and the welfare state.


Universalism articulates explicit conceptions on the state, civil society, families, the market economy, and social policy that can be understood as beliefs regarding a desired mix of responsibilities between and among state and non-state actors in social policy and program provision. Favoured ideas in universalism include communal responsibility, equity, and sharing; equality of opportunity and status for all; and the importance of social inclusion and integration. Other connected “isms” include social democratic versions of collectivism, egalitarianism, and nationalism. In liberal welfare states such as Canada, the United States, and the United Kingdom, strong counter-isms to universalism include economic liberalism, market individualism, traditional familism, and neo-conservatism. More specifically in the Canadian context, beliefs about preferred arrangements between state and society link up to ideas of constitutionalism, federalism, and the division of powers; inter-regional redistribution; and the equal treatment of citizens across the country with regard to uniform rules on eligibility, benefit amounts, and benefit duration.


Academic theories about social policy that are traditionally supportive of universalism include relative conceptions of poverty measures rather than absolute measures; social rights as integral components of modern citizenship regimes (Esping-Andersen 1990; Prince 2009); and institutional and redistributive welfare models rather than a residual model for addressing individual and community needs (Rice and Prince 2013). More recently, from political theorists, feminist scholars, and policy analysts come the concepts of false universalism, differentiated universalism, and interactive universalism (Lister 2003; Young 1990). These concepts interrogate assumptions about the disembodied and autonomous citizen (and reveal this image to be an artificial universalism); question the supposed impartiality of the universal, with a focus on who is included and who is excluded; and, in our age of identity politics and equality rights in a multinational state, suggest a synthesis between the universal and the plural that seeks to embrace equality and diversity through notions of equity, self-determination, dignity, and inclusion. We return later in this chapter to this theme in relation to the paradox of diversity and universality.


Universality as a distinctive governing instrument in social policy refers to public provisions in the form of benefits, services, or general rules anchored in legislation instead of discretionary public sector programming or provisions in the private sector, the domestic sector, or the voluntary sector, including charitable measures. Accessibility rests on citizenship or residency irrespective of financial need or income, and the benefit or service or rule is applicable to the general population (or a particular age group, such as children or older people) of a political jurisdiction. The operating principle for universal provision is of equal benefits or equal access. A further expression of this general sense of political community is that financing universal programs is wholly or primarily through general revenue sources. This points to the direct link between general taxation and universality because, in contrast to social insurance programs such as Employment Insurance and the Canada Pension Plan, which are typically financed through dedicated payroll contributions, universal programs depend on the flow of general fiscal revenues associated with income and sales taxes. These programs are central to fiscal trade-offs inherent in the budgetary process and the politics of taxation. For instance, cuts in sales taxes or corporate and personal incomes taxes could lead to a reduction in fiscal revenues that may affect universal programs indirectly, as they alter the broad fiscal context in which these programs operate (Pierson, 1994). Finally, as far as provincial universal programs are concerned, federal fiscal transfers to the provinces such as the equalization program and the Canada Health Transfer are central to the politics of universality, because these transfers are instrumental in the capacity of the provinces, especially less well-off ones, to keep running universal programs over time (Béland, Lecours, et al. 2017; this issue is discussed further in chapter 2).

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