Canada's medicare advantage – Opinion, Aug. 24.

A competitive health insurance market is the ideal for an efficient, quality health-care system and neither Canada nor the United States has it. Unfortunately, American and Canadian health systems are more alike than people realize, insofar as government bureaucracy has severely stunted both.

Each state burdens insurance plans with between six and 50 mandates that employers and patients shoulder through higher premiums.

Canadians must wait an average of 18 weeks between receiving a diagnosis from a general practitioner and receiving treatment from a specialist. They must wait a year or more for hip and knee replacements.

Robert Bell advocates a health-care system based on need rather than ability to pay, but last year's Supreme Court case, Chaoulli v. Quebec, revealed that Canada's law prohibiting payment for health care neglects patients' needs completely.

Fortunately, the majority of Canadian justices found that this law violates human rights.

The Canadian system should not be "protected" if it deserts the patients it is intended to help. It should be forced to compete, and thus, improve.

Ultimately, Canada and the U.S. should both ask the following question: Should health care be accountable to the government or the patients? The answer is patients and a single-payer government monopoly is not the solution.

Diana M. Ernst, Health-Care Policy Fellow, Pacific Research Institute, San Francisco, Calif.