The United States is once again embarking on a national debate about health-care reform, one that will engage both the states and Congress, and will likely influence the outcome of the 2008 presidential campaign.

The debate will include both facts and faith - a belief that somewhere, somehow, someone has figured out how to create a government-run health-care system that actually works.

It is an act of faith because a well-functioning government-run health-care system has never existed. Regardless of the country - Great Britain, France, Italy, Sweden or Canada - they all face limited funding, rationed care and restricted choices. Why should so many people think a government-run system is the solution? There are three basic reasons:

* First, a government-run health-care system guarantees universal coverage: There are no uninsured. But having a promise of universal access to care isn't the same thing as ensuring that everyone actually gets care.

Take England, for example, where the National Health Service is sometimes considered a model for the United States. Access to treatment often depends on whom you know, not what you have. A recent London Observer article, "Ex-NHS advisor slams cancer lottery," noted that, "The trust has refused the (prostate cancer) treatment to 11 out of the 12 men who have asked for it since April 2005."

The person who did get treatment is quoted as saying, "Because I was articulate and well-informed and also, I suspect, because I had connections with the Department of Health, I got the right to my treatment."

However, one of the men who didn't get treatment is quoted as saying: "The government talks about patient choice, but here the choice is being made for me by a panel of people who I'm not allowed to meet in person, and who are not cancer specialists. For an extra $1,300, I could have a therapy that will mean fewer side effects, but I suspect that many men are not even being told about it because it's rationed."

* Second, most other developed countries spend 8 percent to 12 percent of their GDP on health care, while the United States spends about 16 percent. Many people assume that lower spending is a sign of efficiency. It's not. In a single-payer system, health-care dollars must compete with other valid claims on government funds.

So the amount spent on health care is a political decision, not a medical one. And so some patients - usually the very old, young, sickest, poorest and the least powerful - don't get the care they need in a timely fashion.

* The third reason has to do with equality. Some complain that the United States has a two-tiered health-care system: People with health insurance get good care, while the nearly 47 million uninsured have to wait in long lines at a public hospital or free clinic, get fewer options when they do see a doctor or just go without care.

But consider that several years ago a Canadian newspaper ran an article about Greg Multon, who was in the midst of a thee-month wait for a hospital CT scan to find the reason for his excruciating headaches.

Yet, once the hospital's radiology department shut down for the day, it would start doing CT scans on dogs and cats in the evening for $300 each - with no waiting. Moulton was quoted as saying he would go any time or pay anything. But in Canada it's against the law to pay out of pocket for care the government is supposed to cover.

Similarly, the Washington Post ran a story a few years ago about a Canadian man who needed a CT scan but didn't want to wait for months. He checked into a veterinary hospital under the name of Fido. So Canada, considered a model for U.S. reform, also has a two-tiered system where people have difficulty getting care regardless of income, but dogs can.

Does the U.S. health-care system have problems? Yes. But it is silly to think that the single-payer countries have solved all the problems. We want to fix our problems without importing theirs.

(Originally printed in the Press-Enterprise of southern California)