The confusion around health care in America is palpable. Just over a month ago, efforts to pass the AHCA imploded before the bill could even be brought to a vote. Now there is a real chance that it could come to fruition, transforming the landscape of American health care for the second time in a decade.

America is facing a growing threat to the health of its citizens. Last week, the U.S. House of Representatives voted to pass the American Health Care Act (AHCA). If the bill becomes law, it could leave millions in the U.S. without health care. And it could have an impact in Canada, too -- but not for the reasons you might expect.

U.S. President Donald Trump on May 4, 2017 at the White House in Washington, DC. The House has passed the American Health Care Act that will replace the Obama era's Affordable Healthcare Act with a vote of 217-213. (Photo: Alex Wong/Getty Images)

Why is the issue of health care in the U.S. so fraught? And is Canada immune to the social whiplash underway just south of us? As physicians observing from both sides of the border, we see two key reasons why this issue continues to polarize opinion in the U.S. -- but it is ultimately trade policy, not health policy, that will put Canadian medicare in the crosshairs.

First, unlike Canadians, Americans have not yet come to view health care as an expression of core national values, deserving of protection as a fundamental right of citizenship. In Canada, there is no serious doubt about whether or not the country should continue to have universal health coverage. Rather, the debate is mostly centered around how to expand public financing to broaden coverage (for example, to include prescription medicines and home care on a universal basis) and how improve systems of delivery to make care better and reduce wait times.

This is because the choice to offer universal health coverage is central to the Canadian identity. For Canadians, health care arose from a national determination to take care of each other during times of need. But the U.S. is still actively wrestling with the question of what it means to offer health care to citizens and where health care fits in the country's values system.

But Canadians should not feel smug.

Second, the U.S. lacks a structural component that has been at the core of Canadian health care for decades -- the federal requirement to provide insurance for all necessary doctor and hospital services, sustained through a single payer that guarantees coverage for essential services. In the U.S., there has been no such federal legislative push, and little talk of bringing health care under the umbrella of a single, accountable and democratically supported vision.

The existing health-care law in the U.S., the Affordable Care Act (ACA), is a patchwork of legislative compromises and deals struck between interest groups, administered by many different stakeholders. While the legislative architecture of Canadian health care has unified the system under the Canada Health Act and buffered it from multiple challenges, the more ad hoc nature of the ACA has left it vulnerable to the type of existential threat it now faces from the Republican Congress.

Until Americans decide that health care is a right that should be supported by the federal government as an extension of national values, and resolve to create a legislative structure with teeth to support that vision, the health-care debate cannot be resolved because it is not grounded in any public consensus.

But Canadians should not feel smug.