The very different methods of delivering health care allows citizens and politicians to look to the other side of the border for alternatives. In Canada, the United States is used as a model and as a warning against increasing private sector involvement in health care. In the United States, meanwhile, Canada's monopsonistic health system is seen by different sides of the ideological spectrum as either a model to be followed or avoided.

Government involvement

The two neighbours are a dramatic contrast. Canada has one of the world's most fully socialized health care systems (with the exception of services noted below) while the United States is one of only two OECD countries (with Mexico) to not have some form of guaranteed health insurance for all citizens.

The governments of both nations are closely involved in the delivery of health care. The central structural difference between the two is in health insurance. In Canada, the federal government is committed to providing funding support to its provincial governments for health care expenditures as long as the province in question abides by acessibility guarantees as set out in the Canada Health Act, which explicitly prohibits billing end users for procedures that are covered by Medicare. In the United States, federal and state government funding of health care needs of its citizens is limited to Medicare and Medicaid insurance programs for the eligible senior, very poor or disabled persons. Health insurance must be paid for privately, otherwise, and, in most cases is provided by a person’s employer. However, there are about 45 million Americans (although not all are citizens) who do not have health insurance.

Canada's universal health plan does not cover certain services. Dental care is covered for children up to the age of fourteen. Prescription drugs are not covered, and optometry is only covered in some provinces. Visits to many specialists may require an additional user fee. Also, some procedures are only covered under certain circumstances. For example, circumcision is not covered, and a fee is usually charged when a parent requests the procedure; however, if an infection or medical necessity arises, the procedure would be covered. When compared, the privately managed sectors of the health system have similar rates of participation and treatment in both countries.

Until the 1960s both countries had almost identical health care systems. The creation of Medicare in Canada in 1966 rapidly led to government funding of much of the health system. Since then, the American government has also become deeply involved in the delivery of health care, but has not created a system of universal government coverage. There are a number of explanations for this difference. Traditionally it has been ascribed to the more individualistic and free market nature of American society. However in several other areas of the economy, such as education, the American government is just as, or even more deeply, involved when compared with Canada. Even in some health areas, such as in placing restrictions of smoking, the United States has been faster to restrict freedoms than Canada. An alternate explanation is that during the period that Canada, and most other developed nations, introduced a publicly funded health system the American government was pouring a huge slice of its GDP into the military due to the Cold War and thus could simply not then afford to invest. By the time the Cold War had eased, the post-war consensus on government involvement in the economy had broken down throughout the west, so it was all but impossible to introduce new spending programs on the scale of a national health plan.

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