In the end, the United States, with a more limited view of the social contract, leaves its people to rely on the purchase of medical care as the main lever for attaining or improving health.

In both cases, providers and patients are working toward their own self-interest given the health care choices they face. Health care providers are trying to make the best living possible by structuring days to see a maximum number of patients, in light of the demands that administrative and paperwork place on their time. Patients and their familie

As a result, the Canadian health system now relies on a patchwork of provincial plans, population-specific federal plans, private supplemental insurance plans, and out-of-pocket payments to cover outpatient pharmaceuticals and other services not deemed medically necessary.