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This being the Fourth of July, thoughts naturally turn to our American neighbours, who are now in the final legislative stages of altering their health-care system, with Canada, once again, being held up as the example of what not to do.

It always happens when the Americans debate health care. Canada usually isn't on anyone's radar screen in the U.S., but when it comes to health care, everyone seems to have an opinion about our system.

The Republican Party to a person, the doctors' lobby, the private insurance industry and the large number of Americans content with the status quo mock the Canadian system. For them, it has no virtues, just long lineups for care, crumbling technology, patients who are given no choice of physicians, and doctors and nurses who flee Canada for the United States. Something must be rotten up there, they argue, if all those practitioners are heading south.

What passes for the left wing in the U.S. - people who read The Nation and The New York Review of Books, labour unions and some progressive Democrats - actually praise the Canadian system, and wish something akin for their country.

Then there are those, of whom Hillary Clinton and perhaps President Barack Obama might be included, who know something about the Canadian system and understand its strengths and weaknesses. On balance, they might like a “single payer” system in the U.S. but believe getting one would be politically impossible.

So they advance a myriad of schemes to patch the gaping holes in the existing system - including the lack of insurance for almost 50 million people and the system's skyrocketing costs.

Mr. Obama has made “health-care reform” a defining objective of his administration, perhaps the defining objective. He proceeded in a curious way, outlining some broad objectives, then passing the issue to Congress, where two Senate and three House committees have been labouring, with a deadline for a concrete result being the end of July.

Now he is taking his case for reform directly to the people, assuring audiences that, no, he is not suggesting a Canadian-style single-payer system. Instead, it would appear he favours expansion of the public system, now restricted to the elderly and the poor, that would compete with the private system.

From competition, and a variety of other cost-saving measures, the President believes he can find the money to cover all Americans. No one knows for certain what that cost might be, but the Congressional Budget Office suggests perhaps as much as $1-trillion.

How to square this circle - extend coverage without driving up the already massive federal deficit - has plenty of senators and House members worried. One step would be to eliminate the taxable benefit offered to those with company health plans - except that Mr. Obama opposed this sensible suggestion made by his campaign opponent, Senator John McCain.

At an earlier stage of debate, Mr. Obama had thought he could get hundreds of billions of dollars by auctioning carbon credits. No luck there, since the House bill on clean energy is giving away 85 per cent of those credits in the early years of the cap-and-trade system.

A few brave souls have even suggested a national sales tax to pay for health care, but the majority of Americans who now receive private coverage would revolt against the idea of taxing all to extend coverage to a minority.

Where this health-care debate will end remains unknown. A reasonable guess suggests wider coverage, an expanded public plan, with costs that will almost certainly exceed whatever revenue-raising schemes are devised. The twin results will be to end the anomaly/disgrace of America's being the only advanced industrial country in the world without universal coverage, and probably to put more pressure on an already overburdened federal budget.

The U.S. will thereby be “saved” from the Canadian system - the one that, critics should note, eats up about 10 per cent of Canada's national income compared with 16 per cent for the U.S. system, whose aggregate health results are comparable and whose patients can, in fact, choose their doctors (provided they can find one).

But if the U.S. can somehow extend coverage to all, where will that leave the unreconstructed defenders of the Canadian status quo?

For so many years, they have frightened Canadians by warning that the slightest change would propel Canada down the slippery slope to U.S.-style medicine where, as Jean Chrétien used to say in a gross exaggeration, “they check your wallet before your pulse.”

Just as defenders of the U.S. system have scared Americans with distorted images of the Canadian system, so defenders of the Canadian system have reflexively scared their fellow citizens with horror tales of U.S. health care.

The result has been to reinforce the status quo on both sides of the border, a status quo that is now being adjusted in the U.S. but that remains immovable in Canada.