Opponents of the Affordable Care Act, which is also known as Obamacare, claim it is a disaster for the country, mainly because it gets government into the health insurance business.

They say it amounts to “socialism” in the United States, just as supposedly exists in Europe and other places that use government as the lone insurer. The system used in Canada, Europe and almost all other developed countries is not for us, they say, because government as the “single payer” displaces investor-owned insurance companies. We should not let “big government” provide health insurance. We should leave that to the private sector, just as we always have. And Americans should protect individual freedom not to have health insurance, they say.

The facts are somewhat different from the opposition’s claims.

It’s true that Americans have traditionally had the right not to buy health insurance. When they fall ill and use health facilities, the rest of us get to pay their costs in higher health insurance premiums. Health care grows more costly, because tens of millions remain outside the insurance system, most of them forced to do so.

The Affordable Care Act is not a single-payer system, and leaves private insurers in business. In fact, it produces more insurance buyers and relies on competition among insurers to keep costs down.

And it will not directly affect most people. The majority will continue to receive coverage through employer-sponsored plans, Medicare, Medicaid, the Veterans Administration and other existing plans.

Neighboring Canada has a national health plan, and nobody there thinks it is socialism. The current Conservative government has not tried to repeal or defund it.

It is worth comparing it with the Affordable Care Act, an exercise that was recently carried out by Antonia Maioni, a faculty member at McGill University in Montreal.

To start with, in Canada, government is the single payer, while in the U.S., there are many insurers.

In Canada, every legal resident is covered, Maioni notes. In the U.S., about 20 million people are expected to end up without coverage.

The Canadian system is truly national with coverage required to be the same across the country. In the U.S., because some states have refused to expand Medicaid, despite a massive federal subsidy, the health insurance system varies. Major differences also result from different insurers operating in each state.

To keep premiums low, especially for young people, the American system provides a variety of coverages. The more you spend, the better the coverage. In Canada, everybody is treated the same and nobody pays directly, because the system is financed by tax dollars. That provides “equal access,” which is not a feature of the U.S. approach.

The American law does little cost containment, especially when it comes to what Maioni calls “the administrative burden of multiple payers, providers and plans.”

In short, despite the charges made by its critics, the Affordable Care Act is far from the single-payer system of much of the rest of the world. And, with competing insurers, it also isn’t “socialism.”

The complex system created by Congress to avoid a single-payer system has contributed heavily to the current disastrous start-up and its inevitable costs. There is quite a bit wrong with the new health care law, so Congress, if both sides were willing, could make it work better.

When asked, not a single Republican senator thought the law could be repealed, so there’s a basis for serious talk about improvement.

One problem is uneven Medicaid coverage. Some states, including Maine, have opted out of expanding coverage, even with federal support, because of GOP opposition and worries about future state costs.

Recently, some conservatives have suggested that Medicaid should become a completely federal program. That would relieve states of a huge burden, though it risks being called “socialism.”

But wouldn’t that make the program even more costly? Of course, you cannot extend health insurance coverage to millions more people without it costing more. It has been an illusion to claim otherwise.

Though it’s difficult to predict the trade-off accurately, a comprehensive, tax-financed system would reduce insurance premiums at least in large states. In states like Maine, with few competitors, premiums remain relatively high.

Increasing Medicare and Medicaid spending is becoming a huge and burdensome part of federal outlays.

Competition would have to work, if costs are to be pushed down. That may be beginning to happen in large states, but not for prescription costs.

If government cannot control costs by being the single payer, like Canada, Europe and our own Veterans Administration, it may need something like the regulatory authority it now has over utilities.

— Gordon L. Weil is an author, publisher, consultant, and former official of international organizations and the U.S. and Maine governments.