(MONEY Magazine) – Although President Clinton appears to be ignoring Canada's universal health insurance system as he pushes for medical reform, Congress need not make the same mistake. After all, our neighbors to the north spend less on health care than we do and yet get better results than we and most other countries do. When Canada first implemented government-sponsored coverage for all residents 21 years ago, it devoted about as much of its GDP -- 7% -- to medical care as we did. Today, we spend the most in the world (12.4%, or $2,566 per person per year), yet 17% of Americans under age 65 lack insurance. By contrast, Canada expends only 9% of its GDP on medicine and spends just $1,730 per person a year. Canadians enjoy better health for their money too. They boast the eighth highest life expectancy in the world, 77.03 years, while Americans, at 75.22 years, rank 33rd, behind even Jamaicans and Dominicans. Canada's infant mortality rate of 7.9 per 1,000 live births is the 10th lowest in the world; our rate of 10 per 1,000 births ranks 21st. The Canadian system, which is regionally, not nationally, controlled, also seems particularly adaptable to our nation of 50 states. Canada's 10 provinces and two territories make their own rules within a broad, national framework. Most cover mental health services and prescription drugs for hospital patients, welfare recipients and anyone over age 65. Private insurance, which most Canadians have through their jobs, covers only items that government plans exclude, such as private hospital rooms, outpatient drugs, and dental and vision care. Under this so-called single-payer system, the government -- not hundreds of private insurance companies -- pays for health care with dollars raised by federal and local taxes. The provinces, which actually send checks to doctors and hospitals, also negotiate fee schedules with provincial medical associations to hold down costs. Although physicians are Canada's highest-paid professionals, they earn an average of only $87,000 a year, vs. $170,000 for American doctors. And hospitals must obtain provincial approval to buy expensive, high-tech equipment. One result is that such gear is scarcer: The U.S. has nearly eight times more magnetic resonance imaging (MRI) and radiation therapy units per capita than Canada, for example. Medical researchers have yet to show, however, that lots of high-tech wizardry improves our health. Canadians admit that they sometimes have to wait for nonemergency heart surgery, organ transplants, radiation therapy and the like. But they rarely queue up for run-of-the-mill services. In fact, a 1991 survey of 11,924 people by Statistics Canada, the government's statistical branch, found that 95% get the care they need within 24 hours (see the profile at left).

When there is a waiting list, a patient's spot on it is determined by doctors' ongoing evaluation of his condition. Delays vary by province and procedure, but to cite one example, there are usually 100 to 120 patients awaiting heart surgery in Ontario's central-west region (which includes Hamilton), where one cardiac surgery unit serves 1.8 million people. Waits average eight to 10 weeks, and some patients have to travel as far as 90 miles to the hospital. Americans with health insurance, by contrast, can shop for a doctor who will schedule them for tests or surgery immediately. But Americans who lack insurance often delay treatment until their deteriorating condition finally lands them in either the emergency room or the morgue. Clearly, Canadians who have to wait for treatment are inconvenienced. But are they harmed? Research is scanty, but a 1992 study by doctors at the University of Manitoba and Dartmouth Medical School in New Hampshire reported mixed results. When the researchers compared postsurgical mortality rates in Manitoba and New England, they found that the immediate outcomes varied little for low- and moderate-risk procedures but that the survival rate after three years was better in Manitoba. For high-risk procedures, short-term results were better in New England, but the survival rate three years after surgery was similar. Contrary to what many Americans believe, few Canadians cross the border to get care they would have to line up for at home. Of 7,654 Ontario residents having heart surgery in 1990 and 1991, for example, only 533 -- or 7% -- went to the U.S. or other nations. And most (59%) of those who did were emergency patients who were stricken abroad and wouldn't have had to wait in Canada anyway. Would Americans trade our system, which rations care based on ability to pay, for a Canadian-style plan where medical necessity is what counts? They might, but only if they understood that they wouldn't have to fill out another insurance claim form nor have limits placed on their choice of doctors, as happens under the increasingly popular managed-care plans in the U.S. Replacing our 1,300-company health insurance industry with a Canadian-style, single-payer system could even save as much as $3 billion a year, according to a 1991 report by the U.S. General Accounting Office. Up till now, fervent opposition by doctors and health insurers -- who stand to earn less under a Canadian-style system -- seems to have quashed public discussion of that option. But some health-care experts believe it's time to reopen the debate.

CHART: NOT AVAILABLE CREDIT: ORGANIZATION FOR ECONOMIC CO-OPERATION AND DEVELOPMENT CAPTION: PERCENTAGE OF GROSS DOMESTIC PRODUCT SPENT ON HEALTH CARE: CANADA 9% U.S. 12.4%