As the U.S. presidential campaigns begin to heat up, health care increasingly is becoming one of the key issues of the national debate.

Ask the candidates about the fact that more than 40 million Americans today lack the insurance coverage they need to gain full access to the health-care system and they’ll all tell you that is unacceptable. But when it comes to making improvements, their ideas differ widely.

Top Republican candidates, including front-runner George W. Bush, John McCain and Steve Forbes, for the most part would focus on changes they claim would increase access while building upon the strengths of the current system.

Democrats Al Gore and Bill Bradley, on the other hand, would greatly increase the role of government and the use of public funds in providing health care for Americans, with Bradley touting an out-and-out universal health-care system and Gore not far behind him.

All of the candidates would do well to examine the Canadian system that is so often touted by proponents of universal health care as a model that ought to be embraced by this country.

Washington Post reporter Steven Pearlstein took a close look at Canadian health care recently and found a system in turmoil—not enough hospital beds; not enough doctors and nurses; not enough advanced medical equipment; and no consensus on what to do about it.

According to Pearlstein’s report, a recent poll revealed that 75 percent of Canadians believe their health-care system is in crisis, and the federal minister of health says the need for fundamental changes in the system is "beyond debate."

Some observers say the problem is that nobody really coordinates or manages the Canadian system. Canadian consumers of health care are not confronted with deductibles to pay nor must they negotiate with managed plans. As a result, their demands on the system are limited only by the availability of facilities and personnel. And there is clear and compelling evidence that the decline in available services—even critical care, in some cases—is of growing concern to Canadian consumers and providers alike.

In Quebec alone, according to Pearlstein, more than 250 cancer patients have been sent across the border to the United States for treatment this year, and another 350 have waited more than eight weeks for radiation or chemotherapy.

As the Canadian experience shows, the demands placed on a publicly funded health-care system—especially one without strong incentives to hold down costs—inevitably will overtake the willingness or the ability of taxpayers to pay for them.

Both in this country and in Canada, expensive technology, longer lifespans despite often unhealthy lifestyles, and an expectation by consumers that they’ll receive the best treatment available for every illness or ailment are driving the cost of health care higher and higher. Ultimately, in any system, people will have to choose between what they want and what they can afford.