Ideas and the Limits on Program Expansion: The Failure of Nationwide Pharmacare in Canada Since 1944
Bibliographic record
Abstract
Abstract.This article investigates the limits that ideas place on the scope of policy expansion though an empirical puzzle. Canada lacks a nationwide, universal pharmaceutical insurance program, which contrasts with the experience of most mature welfare states and Canada's own broad public hospital and medical insurance. The article find that ideas matter in policy development because of the mechanisms put in place by the pace of change. A slower, incremental process of policy development leads to restricted policy ideas that limit opportunities for program expansion. The article finds evidence of a reciprocal relationship between policy ideas and public expectations in four proposals for nationwide pharmaceutical insurance in Canada between 1944 and 2002. Résumé.Cet article examine les limites qu'imposent les idées à la portée du déploiement des politiques publiques, et ce à partir d'un paradoxe empirique : le Canada n'a aucun programme national et universel d'assurance-médicaments, ce qui tranche avec la situation de la plupart des États-providence établis ainsi qu'avec son propre système public d'assurance maladie et hospitalisation. L'article montre que les idées influencent le développement des politiques publiques en raison des mécanismes qu'induit le rythme des réformes. Un processus de développement lent et graduel entraîne la formation d'idées restrictives, qui limitent les opportunités d'expansion des programmes. La constatation y est également faite d'une relation de réciprocité entre les idées et les attentes du public dans le cadre de quatre propositions d'établissement d'une assurance-médicaments nationale au Canada, entre 1944 et 2002.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.022 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.014 | 0.019 |
| Scholarly communication | 0.009 | 0.003 |
| Open science | 0.002 | 0.005 |
| Research integrity | 0.003 | 0.005 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".