WITHOUT A DOUBT, the biggest challenges facing U.S. President Barack Obama are found in his crusade to reform a health-care system that currently leaves nearly 50 million Americans without any insurance coverage and possibly 100 million others with only partial coverage and under the threat of losing it along with their jobs.

In anticipation of the anti-reform lobbies, Mr. Obama has been holding town hall meetings at which victims of the current system can express themselves and possibly counter the naysayers who have already convinced nearly half the U.S. population that the modest Obama scheme will leave them worse off.

The none-too-subtle campaign led by the private insurers includes a blitz of commercials that portray Canada's health care system as inferior to that in the U.S., with Canadians facing long waits for treatment of life-threatening diseases.

In an attempt to set the record straight, a non-profit, Web-based news service, The Real News Network (www.therealnews.com) sent a reporter to Toronto to get a random sampling of pedestrians who were asked to view one of the anti-Medicare commercials and compare our health care system with that in the U.S.

Not surprisingly, everyone responded that while our system has its flaws, it's far better than that to be found south of the border.

As we see it, the scheme envisioned by Mr. Obama falls far short of the type of universal medicare Canadians have enjoyed for more than 40 years. (Universality actually preceded the Oct. 1, 1969 founding of The Ontario Health Insurance Plan, the predecessor Ontario Medical Services Insurance Plan having been a similar scheme to what Mr. Obama has in mind, creation of a government sponsored alternative to private insurance.)

As probably every Canadian knows, the U.S. system provides excellent care for those who can afford it, but is the major single cause of personal bankruptcies.

Much less is known, however, about the inherent inefficiencies in the U.S. system that have led to Americans collectively paying more for health care while getting less.

In a bid to get that message across, the U.S. Department of Health and Human Services (HHS) recently released a report entitled Hidden Costs of Health Care: Why Americans are Paying More but Getting Less.

Released by HHS Secretary Kathleen Sebelius, the report documents the rising cost of deductibles, copayments and out-of-pocket expenses that are making it more difficult for families with insurance to receive the health care they need.

"It doesn't matter if you have insurance or not: when Americans go to the hospital or the doctor's office, they are paying more and getting less," Secretary Sebelius said. "Every year, co-pays, deductibles and other expenses are taking a bigger bite out of the family budget and the American people are demanding reform."

Among other things, the report found that:

• An American with employer-based coverage paid an average of $1,522 on health care (not including premiums) in 2006, compared with $1,260 in 2001. When the added burden of higher premiums were included, out-of-pocket costs rose even more sharply, with a 30 per cent increase from an average of $2,827 in 2001 to $3,744 in 2006.

• Employer-sponsored health insurance premiums have nearly doubled since 2000, a rate three times faster than wages. In 2008, the average premium for a family plan purchased through an employer was $12,680 — nearly the annual earnings of a full-time minimum wage job.

• For "preferred provider organization" (PPO) plans purchased through an employer, the average family deductible increased 30 per cent in two years, from $1,034 to $1,344. And for small firms, deductibles increased 64 per cent, to $2,367 from $1,439.

• In 2004, only one in five people with health insurance through an employer had a co-payment of more than $25, but by 2008 the number jumped to one in three.

"Millions of Americans don't have insurance, and millions more are still struggling to afford the care they need," Ms. Sebelius said. "We need to pass health reform this year to give these families the relief they need."

Perhaps the toughest challenge facing the President lies in the area of costs. Without a doubt, experience in Canada demonstrated that government health insurance plans that operate as alternatives to private plans soon find themselves saddled with the high-risk and low-income clientele, particularly when the private insurers are able to rid themselves of such individuals.

In the circumstances, the Canadian alternative of federal financial support for provincially operated health care plans would offer a more cost-effective solution to the mess in the U.S. than the current Obama scheme.

But no matter what form it takes, any universal health care system will be expensive and have to be supported financially, preferably at least in part through higher income tax rates for the wealthiest U.S. taxpayers.