One reason single payer works in Canada is that each Province runs its own program. Federal involvement is limited. When comparing the US with Canada remember that we have very long wait times. This helps reduce costs but has only worked so far because we are so polite -- that may not last much longer. It will be very difficult to modernize, especially medication and dentistry. Supplementary services are only covered by private insurance and employers don't always make good partners. Canadians like to compare themselves with the US but we don't look so great compared to Europe and other developed countries. Some Canadian doctors are willing to work on a salary, which has some advantages but that would probably not be acceptable in the US.