U.S. has highest level research institutions. If you are rolling in the money, rich and powerful, you can afford the extra expenses of the American system. I'm not arguing that single payer is better for the 1% because it isn't, it's better for the rest of the country. The poor and middle class can't Perhaps the most darning (this is CB) statistic is GDP. Most of Western Europe/Canada spends 9-10% of GDP on healthcare. America spends 16% of GDP and gets poorer quality care. Independent agencies absolute rip apart the American system every year. WHEN change to a public option or single payer comes I do think it should be slow and conservative, but it's needed for sure. You can also use the French two-tier system. Frenchies don't come to the US for service as much because France has a public healthcare system available to everyone and allows for private institutions open to the wealthy. Your comment may be based on Donald Trump's last debate statement about Canadians coming across the border for surgery. 8% of Canadians think their healthcare system needs major reworking, in America that number is closer to half.