Ifyou ask a Canadian if they like their single-payer health caresystem, you'll usually get a strong “Yes!” followed by a detaileddescription of how it's better than America's system. (Image:Shutterstock)

When was the last time you went to Canada? A trip north of the49th parallel is a fantastic excursion. You'll likely find yourselfthinking or saying at least a few of the following:

• These people are so friendly!
• Canada is like America's attic — there's some cool stuff uphere.
• Other than this colorful money, the metric system and French ontheir signs, Canadians aren't that different from us.
• It's like Canada is the 51st state! (You might think this is acompliment, but Canadians hate this one.)

Similar, but different

It's easy to think Canadians are just Americans without (asmany) handguns. But socially, they are significantly different. Andif we're looking for Canadian lessons to apply to the Americanhealth care system, recognizing these differences reallymatters.

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Let's start with some basics about the population:

• Canada's land mass is larger than that of the U.S. (Seriously,check out a globe.)
• Canada has only 36 million people. That's about 9 percent ofthe U.S. population (comparable to the population ofCalifornia).
• 90 percent of Canadians live within 100 miles of the U.S.border.
• Canadian culture is extremely influenced by American TV,magazines, companies, social media, etc.

Why does this matter? It means Canadians are much more educatedabout our American affairs than we are about theirs. And living inAmerica's shadow breeds a touch of “little brother syndrome.”They're ready to compete with you, and you don't even realizethey're in the running.Therefore, if you ask a Canadian if theylike their single-payer health care system, you'll usually get astrong “Yes!” followed by a detailed description of how it's betterthan America's system. Boom, they won. And you didn't even know itwas a competition.

Freedom vs. fairness

A more telling question to ask is: “What does it mean to be aCanadian?” You'll likely get some form of this answer: “Well, we'renot like Americans. We care more about our people than you do. Forexample, our health care system.”

Think about that. Canadians define who they are by contrastingthemselves with Americans, and they bring up health care to do it!Americans wouldn't do either. Even those of us who work in thehealth care system wouldn't think of “health care” when definingour national pride. Instead, I bet your answer would include theword “freedom.”

What insight does this give us? As strongly as Americans valuefreedom, Canadians value fairness. This is the critical socialdifference.

I see this playing out in three specific ways:

1. They're willing to pay more in taxes as long as thegovernment “looks after me when the time comes.”

2. They're willing to wait their turn.

3. They trust in government, believing someone smarter islooking out for their best interests.

As a Canadian who has now lived in the USA for 28 years (and isnow a citizen), I've yet to meet an American who matchesthese three statements!

Here's why: In all parts of America, and at all socio-economiclevels, one foundational value reigns supreme: freedom of choice.Americans won't blindly do what we're told. We don't want to waitmonths for “our turn” to receive non-emergency health services. Andwe really don't believe someone is looking out for our interests inany way close to the way we'd look out for ourselves—especially notthe government!

It's not that simple

So, although a Canadian will tell you they love theirsingle-payer system, I don't believe that same system would fly inAmerica. The next time a politician claims that single-payer is asimple solution, we need to dive into the details of their planalongside the values of American people.

What lessons can we learn from the Canadian system? Why do thearguments for single-payer sound so convincing? What questionsshould we ask politicians who are convinced “Medicare for All” willmake everyone happy? What should we, as an industry, be doing toeducate ourselves and our clients?

We need to ask good questions: Exactly how will your planned“Medicare for All” system work like it does in Canada? Since nocountry in the world pays for all health care (there is unlimiteddemand and limited supply), how does your plan allocate resources?Are there better solutions to stabilize the industry, i.e. providehelp for the uninsured versus the entire population?

As industry insiders, we need to keep learning and studying theissue and proposed solutions. We need to learn enough about othersystems so we can guide the conversation more intelligently. Weneed to ensure our future health care system is built upon afoundation of values that work for Americans.

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