I am friendly with a doctor of a certain age who has, for many years, been a fixture of a small-town practice and a rural hospital with their economically challenged clientele. He was born, raised and trained in Canada, but came to this country to practice medicine.

He believed the Canadian system was overly bureaucratic and constrictive whereas the United States allowed doctors to practice with fewer fetters and with greater opportunities, and he has both served his patients well and prospered here as an American citizen.

But a funny thing happened on the way to retirement age. He now thinks the Canadian system may be superior in some important ways. It has loosened up and now permits patients more choice through optional insurance plans, rather like the Supplemental or Advantage plans that Medicare recipients can opt for.

I don’t want to put words in my friend’s mouth, but it seems clear form our conversations that part of his uneasiness with our present system is that it leaves too many people out in the cold, including many of the less than affluent people in his neighborhood. Neither the Rube Goldberg complexity of Obamacare nor the heartless cruelty of Republican alternatives has seemed like a solution to what ails the system.

Though he once thought the Canadian system concentrated too much power over medical practice om the hands of government bureaucrats, at least they had the health of patients in mind. Our system concentrates power in insurance companies whose motives are mixed at best – patient welfare perhaps, but their own profits for sure.

He believes everyone has a right to medical care and believes the Canadian system’s method for achieving it is comparatively sensible and straightforward, by means of a VAT, or national sales tax, whose proceeds are dedicated to funding healthcare for all.

At one stroke, this eliminates the tethering of employment to health care and unemployment to peril. The yoking health and jobs looks increasingly problematic in a shifting economy where lifetime employment is extinct, benefits are often unavailable, and many must eke out a living in a gig economy.

A single payer system, that substitutes a dedicated consumption tax for a payroll tax on workers or a deductible business expense for employers, might therefore be expected to allow companies to charge lower prices or increase wages, and could help protect the health of workers health from unpredictable economic ups and downs

A healthcare system for all also gets the expensive insurance bureaucracy out of the middle. The overhead for running Medicare is about 3% while the insurance companies can eat up as much as 18% of health dollars. Furthermore, the huge purchasing power of a single payer system explains why pharmaceuticals, invented and manufactured in America, often cost less in Canada, France, Germany or Sweden.

Of course, the odds of such a change taking place here are slim to none. Patients might welcome it, and so might providers who can be squeezed or micromanaged by insurers. But those who profit under the present patchwork mess – insurers, pharma and so on – have got a lot of clout.

And the party in power objects to any solution to any problem, other than war, that relies on bigger government or higher taxes. A system that is good for big business is fine with them even if it is bad for small patients.

This was on vivid display when wheelchair-bound protesters, fearful of losing healthcare, were dragged out of a congressional hearing and placed under arrest. This doesn’t happen in the rest of the developed world. Perhaps we are not as developed as we like to think.