Canada is a lovely country, I used to live there for a few years and I love everything about it. your point about USA being bigger and more complicated is right, but on the other hand its economy is also the biggest in the world and they have far more resources than other countries. as for how to pay for it, I explained it in my earlier comments. it will be through taxes just like every other country that has single payer system. everyone will pay more in taxes , and of course people with higher income will pay more, but they will not pay premium, deductible and copayments anymore, therefore most people will end up saving in their health care costs.