The Medicare system in the United States approximates the workings of a single-payer system. Using that program as evidence, critics say that expanding that program to cover all Americans “would give us all the compassion of the Internal Revenue Service and the efficiency of the postal service at Pentagon prices” (Constance Horner, HHS official under Bush, quoted in Stout, 1992). Proponents of a single-payer system point to our northern neighbors, whose Canadian version of Medicare works reasonably well. Although the Canadian system is not perfect, most citizens are satisfied with their medical care, which is available regardless of social or economic status. What is the evidence?