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The debate about health-care reform in the United States is really heating up and, with any luck, some of that heat will radiate north across the border.

In Canada, we take our health system largely for granted. Sure, we moan about a lot of the system's failings, big and small, but when push comes to shove, the tendency is to forgive all in a patriotic fervour.

Medicare, we are told, is what defines us as Canadians. It is an embodiment of Canadian values such as fairness and compassion.

This is largely nonsense.

Medicare is an insurance program or, more precisely, the name we have given to a series of loosely connected provincial and territorial insurance programs across the country.

This is not to suggest culture does not have a profound influence on the shape of a health system. Of course it does.

Canadians, for historical reasons, are open to pooling resources and they are stoic. This agrarian philosophy shaped the medicare program that emerged from Saskatchewan under Tommy Douglas.

Similarly, the U.S. culture of individual freedom and pioneering spirit has shaped that country's every-man-for-himself health system.

Or, more precisely, it has ensured that they don't really have a system, but rather a market for health-care delivery.

The upshot is that - to generalize more than a little - Americans think Canada has an evil socialist system that ensures inefficiency, waiting and contempt for the patient; Canadians see the U.S. model as commodifying health for profit and catering to the rich at the expense of the poor.

What is required, though, is that we set aside these stereotypes - and the rhetoric that flows from them - and dispassionately examine what Canada and the U.S. do well, and not so well, in health-care delivery.

(There are those who will say the debate is a sterile one, that European countries have much better health systems. That may well be true, but the reality is that the U.S. and Canada are neighbours and the comparisons are inevitable and the issues current.)

The Canadian system has three principal strengths:

Universality: Under the publicly financed insurance program, everyone is ensured basic health-care coverage. Insurance is also mandatory. There is no opting out, meaning that risks (read: costs) are more broadly distributed.

Public administration: The single-payer system makes the accounting easy, so administrative costs are very low in Canada compared to the U.S. The downside is that the administrators are largely anonymous and there is little accountability.

Rationing: Centralized decision-making means that Canada can limit everything from the number of medical school graduates to the number of surgical procedures performed. This keeps costs down, but leads to waits and shortages.

The U.S. non-system also has some distinct advantages:

Rapid care: Waits are largely unheard of for people with insurance. But the only way to ensure instant care is over-capacity, and that is very costly.

Customer service: Health-care facilities, both for-profit and not-for-profit, compete for business and they do so with nicer facilities and good customer relations. In Canada, health-care facilities are remarkable for their neo-Stalinist architecture and the unwillingness of staff to look patients and visitors in the eye.

Innovation: When new surgical procedures, medical equipment and prescription drugs hit the market, they are available almost immediately.

And for all our bickering about who does health care best, the reality is that we have some gigantic problems in common: a phenomenally expensive focus on sickness care rather than keeping people healthy; lack of electronic health records; abysmal health-care resource planning, and a failure to recognize that the principal factors that ensure good health have nothing to do with doctors and hospitals - they are a stable income, an education and a roof over one's head.

The challenge for the U.S. in reforming health care is to incorporate some of the Canadian advantages.

Namely, there is a need to create bigger, more diverse pools of insured citizens. Right now, HMOs (health management organizations) practise cream-skimming, vying for young, healthy customers. This leaves the sickest (read: most expensive) to publicly funded plans, leaving the false impression that public plans are far more expensive than private ones.

The U.S. also needs to find a way of reducing the costs of bureaucracy and, paradoxically, the way to do so is more government involvement. A single-payer system is a non-starter, but seemingly simple measures such as standardized insurance forms, drug formularies and price lists could save billions and they will only come about through regulation.

The administrators of the Canadian health system(s) also need to get off their high horses and incorporate some successful measures from the U.S.

First and foremost, Canadian health-care institutions would benefit from some forms of competition. As our facilities are almost exclusively not-for-profit, there need to be rewards other than dividends to shareholders.

For example, hospitals with good customer satisfaction ratings could receive additional budget allocations, or a portion of each patient visit could go directly to the hospital as an incentive.

The strength of medicare is providing care to all. But quality and timeliness of care are also important.

Similarly, providing quick, excellent care to those who can afford it cannot override the right all citizens should have to the provision of basic health care, which is the case in the U.S. presently.

Between us, the Canada and the U.S. have all the elements to provide superb health care to all. But doing so will require some compromise, some vision, and a recognition that our neighbours actually have some ideas worth emulating.