Throughout the 1990s, opponents of the Canadian system gained considerable political traction in the United States by pointing to Canada’s methods of rationing, its facility shortages, and its waiting lists for certain services. These same opponents also argued that "refugees" of Canada’s single-payer system routinely came across the border seeking necessary medical care not available at home because of either lack of resources or prohibitively long queues.

This paper by Steven Katz and colleagues depicts this popular perception as more myth than reality, as the number of Canadians routinely coming across the border seeking health care appears to be relatively small, indeed infinitesimal when compared with the amount of care provided by their own system.

The project was inspired by the national debate surrounding the proposed federal Employee Free Choice Act. Corporate allegations that the national law will allow employees to be coerced into signing “card’ or “petitions” motivated LER to conduct an objective assessment of how Illinois’ law is working. The results of the study unambiguously revealed that the majority sign-up provision was used extensively without hint of union
or employer abuse.