Health care was one of the major issues in the recent midterm elections.

With the Democratic victory in the House, Republican efforts to repeal and replace or to make major changes to the Affordable Care Act are no longer achievable. Rather, look for a debate between Democrats’ liberal and moderate wings over whether to tweak the Affordable Care Act or to embrace a wide-ranging, more comprehensive expansion of insurance.

In the coming months, look for some people supporting “Medicare for all” to point to Canada as a model to study. On the other hand, expect detractors to reference Canada as a classic example of “socialized medicine.” Let’s take a closer look.

In Canada, everyone is covered by health insurance from birth to death. In the U.S. under the ACA, 28 million (9 percent) are uninsured and 85 million (26 percent) are underinsured.

In Canada, health care is viewed as a public service. In the U.S., most health care is dependent on your job and income. Lose either and you may lose your coverage. In Canada, you choose your doctors and hospital. Unlike the U.S. you are not limited to “in-network” providers, nor incur extra charges for going “out of network.” In the U.S., health-insurance bills are complex. In Canada, you get a card at birth to use when receiving hospital or doctor services. You don’t usually see a bill, since you are already covered and there are no deductibles or co-insurance at the time of service.

As for “socialized medicine,” doctors in neither country work for the state. Like U.S. doctors, Canadian doctors run their own private practices and are paid on a fee-for-service basis. The difference is that Canadian doctors deal with one insurer — the provincial government — not hundreds as in the U.S. Not surprisingly, due to its complexity and overhead, estimates are that administrative costs account for about 30 percent of U.S. health-care expenses, about twice as much as Canada.

In Canada, as in many other countries with universal access, cost are more controlled. U.S. per capita health cost in 2017 was $10,729, while per capita cost in Canada was $4,826. Canada spends 10.9 percent of its Gross National Product for the health-care system while the U.S. spends 17.9 percent, even though millions remain uninsured or underinsured. In the U.S., inability to pay for health care is the number-one reason for personal bankruptcy. In Canada, it is a nonissue.

Health statistics are no contest. Canadians live longer and have a lower infant mortality rate. Drug prices in Canada are negotiated by the government and are more affordable. In the U.S., Congress made it illegal for the government to negotiate drug prices for volume purchases.

Canada views health care as a right and the health-care system as a source of national pride . For most Americans, health care is not a right, with different systems for rich and poor and millions either left out or with greatly limited benefits.

Do the Canadians have it all right? Not by any means. Like other industrial countries, Canada has challenges due to rising costs, an older and sicker population and medical advances in technology and procedures. However, no one in the U.S. should feel sorry or shed a tear. Rather, most in the U.S. would be far better off by considering some elements of the Canadian system and adapting them to the U.S.

Thomas O’Rourke Ph.D./MPH is a University of Illinois professor emeritus of community health. He lives in Tucson in the winter. Contact him at