单选题 For health insurance, the United States has taken the road less traveled. The United States is the only rich country without universal health insurance. People in the United States spend the most, rely heavily on the private sector, and obtain care from the world's most complicated delivery system. While some supporters have expressed satisfaction, if not pride, in these remarkable qualities, others contend that the United States faces unique limitations in reforming health care.
In her exceptional book, Parting at the Crossroads, Antonia Maioni compares the formation of the U.S. and Canadian health-care systems for the years 1930—1960. The United States and Canada are often considered the most similar of Western democracies. They share a common border, are wealthy, and have federal government. Their trade unions are only moderately powerful, and their populations are diverse and young. Nevertheless, their health-insurance systems are nearly opposite. The United States relies on a mix of government plans, targeted to the elderly and indigent, and employment-based plans, which the government indirectly supports. Canada offers public health insurance to all qualified residents, with the private sector providing supplementary services in some provinces.
Labor organizations became strong advocates for health-insurance reform in both countries. Their impact partially depended on political institutions and how other actors, particularly organized medicine, wielded them. Canada's governmental and electoral systems allowed labor to cooperate with a social democratic party in the Saskatchewan province, which established a universal program. The Saskatchewan program demonstrated universal insurance feasibility, spurring the dominant Liberals to introduce a national universal program. In contrast, the U.S. electoral system effectively precluded third-party formation, forcing organized labor to dilute its health-insurance goals because it was one of many interests represented by the Democratic Party.
Maioni suggests that economic vitality is important for the future of both countries' systems, but the prognosis is uncertain. Despite recent concerns about the Canadian government's budgetary health, Maioni contends that widespread support protects universal insurance. Conversely, Maioni seems pessimistic about options for U.S. universal health insurance. Despite economic buoyancy, dissension will likely prevent reforms. Although a devastating economic downturn would make health finance difficult in either country, the U.S. system seems especially vulnerable. Employment-based insurance and medicare both rely on labor market attachment. High, chronic unemployment could result in coverage loss and financial difficulties for employer insurance and medicare, swelling the uninsured pool. Such a crisis could provide an opening for universal health insurance. In any case, whether the United States relies on the public or private sector, escalating health expenditures figure into budgets of government, corporations, and families. The U.S. health care system's future may depend on Americans' willingness to devote more of their national income to health care.

单选题 From the first sentence we learn that the United States
[A] has gone astray about what it does with health insurance.
[B] has complicated its health insurance policy and confused its people.
[C] has reformed its health care to their average people's satisfaction.
[D] carries out a different health insurance policy from other Western countries.

单选题 Canadian health-care systems are different from those of the U.S. in that
[A] the federal government is directly responsible for them.
[B] private sectors in Canada play a more important role.
[C] the government only indirectly supports the employment-based plans.
[D] the trade unions in both countries are only moderately powerful in such matters.

单选题 The vulnerability of the U.S. insurance systems lies in
[A] its failure to extend its coverage to the poor and elderly.
[B] its excessive dependence on the labor market.
[C] Americans' willingness to buy insurance.
[D] the willingness of the government to invest in them.

单选题 The Saskatchewan program in Canada shows that
[A] the labor union of a country can play a positive role in health-insurance reform.
[B] universal health insurance is practicable in a federal government.
[C] a third party is needed to coordinate the efforts of the government and the labor union.
[D] the electoral system has a direct impact on the insurance plan.

单选题 The passage is most likely to be
[A] a summary of a government-sponsored program in health policy study.
[B] a review of a book in health-care system study.
[C] a survey of the influence of economic policies on the health-care system.
[D] a critical commentary on the U.S. health-care system.