Canadian expatriates gathered in Bloomington on July 1 to celebrate Canada Day. MPR Photo/Curtis Gilbert

Republicans use it as a cautionary tale.

"If you like government-run health care programs, I suggest you go to Canada or England, or some of the other countries that do before you embrace that proposal," presumptive Republican presidential nominee John McCain said at a forum in St. Paul this June.

"To those who want a Canadian-style, single payer national health program, please show us the Mayo Clinic or the Medtronic of Canada. They do not exist," U.S. Sen. Norm Coleman, R-Minn., said in his acceptance speech at the state Republican Convention.

Canada's system is called "single payer," because the government provides health insurance for everyone. It is like one big insurance company that covers everybody's medical bills. All the money comes from taxes.

And to be clear: neither Coleman's opponent, DFL candidate Al Franken, nor McCain's opponent, Sen. Barack Obama, D-Ill., is proposing a system like Canada's single payer system.

Both support the idea in principle, but they say it is not where the U.S. is headed.

"I never said that we should try to go ahead and get single payer," Obama said in a Jan. 21 debate. "What I said was that if I were starting from scratch, if we didn't have a system in which employers had typically provided health care, I would probably go with a single payer system."

"We're not going to get national, single payer health care with this Congress, or even with a Congress that has anything less than 60 Democrats," Al Franken said in an appearance on Minnesota Public Radio's Midday program.

Both Obama and Franken want to reduce or eliminate the number of Americans without insurance, and both envision greatly increasing government's role in the health care system. But neither of them proposes eliminating private insurance.

Gordon Buchanan, 49, has had good experiences as a patient in both the U.S. and Canada. He is currently waiting for a liver transplant in the U.S. and is too sick to work. He is grateful he can fall back on Canada's universal health care system when his U.S. insurance runs out in two years. MPR Photo/Curtis Gilbert

Yet, Canada keeps popping up in the American health care debate. So how are things going up there?

It shouldn't be hard to find out. You don't even have to cross the border to find people with experience in both systems.

The Web site CanadaToTwinCities.com has an e-mail list of 450 expatriates.

One of them is Gordon Buchanan, 49, who has spent lots of time in hospitals on both sides of the border.

Eighteen years ago, Buchanan's liver and kidneys stopped working. His doctors still don't know why. He got a transplant in Ontario, Canada, which cost him nothing and changed his life.

But then, two years ago, Buchanan got sick again. This time he was living in the U.S.

"All my skin turned yellow, and my kidney function was dropping," Buchanan said.

Buchanan needs another liver transplant. He's on the list, here, waiting for one. And he's too sick to work. For now, he has insurance through his job, but that won't last forever.

"I think I have about two more years," Buchanan said, "at which point if I haven't had a transplant, and I'm not back working, then I have to go back to Canada."

Buchanan has had good experiences as a patient in Canada and the U.S., including at the Mayo Clinic. He wants to stay in Minnesota, because he has a daughter in school, a house and a life here. But he still prefers the Canadian system.

Michael and Jen Ifill moved to the Twin Cities from Canada seven years ago and never want to move back. One of the big reasons is the U.S. health care system. MPR Photo/Curtis Gilbert

"Can you imagine never, ever having to worry about going to see a doctor?" Buchanan asked. "No matter what your money situation, job situation, you never, ever see a bill. The level of tension in everyone is just that much less, just because of that one issue."

But not all the Canadian Twin Cities transplants have such fond feelings for Canada's system.

Four months after moving to the U.S. in 2001, Michael Ifill tore his Achilles' tendon. He was amazed to get an MRI within a week. He probably would have waited months back in Winnipeg. He had surgery and a complete recovery.

Meanwhile, back in Canada, one of his cousins tore her Achilles', as well.

"There, they steered her away from the surgery, and through some complications of things that could have been picked up on she developed a blood clot and ended up dying," Ifill said.

Ifill and his wife Jen never want to move back to Canada, and health care is the main reason. She's only 37 years old, but she's already had her hip replaced here in the U.S. That is another one of those operations people have to wait for in Canada.

She says at the time she left Winnipeg, the wait stood at 18 months.

"That would have been 18 months probably after I could no longer work," Jen Ifill said.

If you have a medical emergency in Canada, there are no waiting lists. The waits are for procedures the government deems to be non-necessary ones.

But Jen Ifill points out: When you need a hip replacement, it sure feels necessary.

"I couldn't really walk," she said. "I mean, I could walk from one point to another, but grocery shopping, going to the park, I couldn't do any of that."

That's why Michael Ifill doesn't want to see the U.S. move toward a Canadian-style system.

"Crime, violence, things like that doesn't scare me, but universal health care -- that's the one thing that scares me," Ifill said.

On a number of key health indicators, Canada actually does better than the U.S.

It has a higher average life expectancy and lower infant mortality rate. But the U.S. does better on other measures, like the percentage of people who survive after they're diagnosed with cancer.

"If you have something seriously, seriously wrong with you and really need the entire panoply of high-tech medicine, it's probably better to be in the United States," said Johns Hopkins professor Gerard Anderson, who has studied both health insurance systems. "If, on the other hand, you have a chronic condition, or you're basically just healthy, you're probably better off in Canada."

Anderson says Canada is way ahead of the U.S. in controlling the cost of health care.

"In the 1970's we spent about the same amount as Canada did," he said. "Now we're spending about twice as much as Canada is spending on health care."

According to a survey from the U.S. based Commonwealth fund, Canadians are more satisfied with their health care system than Americans are. Only 12 percent of Canadians think their system needs a total overhaul. In the U.S., that number jumps to 34 percent, the percentage of Americans think our health care system is broken.

But there is a growing movement for health care reform in Canada.

"We have a situation now where we are ranked 24th in the world in the number of doctors per-population, and we used to be ranked, in the early '70s, fourth in the world," said Dr. Brian Day, President of the Canadian Medical Association. "So, things are not going well in Canada, and change is about to happen."

Day wants the government to change the way it pays hospitals, and he wants to see a private health care system flourish alongside Canada's public one. He says that is the only way to fix a system that's dealing with a shortage of doctors, money and medical equipment.

"We are not a model for the United States. That's for sure," said Day.

But Dr. Day adds, the U.S., with 47 million uninsured, isn't a good model, either.