the effectiveness and financing of canadian national health insurance (nhi) is analyzed to assist in determining the appropriateness of this system as a model for the u.s. discussion relates to organization and background of nhi, access to medical care, nhi effects on socioeconomic and geographical distribution of care, empirical testing of long-run access implications, a geometric model of provincial budgetary choice, statistical analysis of nhi programs, and social welfare reductions. it is concluded that while there may be some short-term redistribution of medical care away from high income groups to low income groups, the average citizen must finance the medical program both through taxes and time spent waiting for lower quality care, that in the long run the reimbursement scheme of canada may actually decrease care to low access groups because of geographical problems with physician distribution, and that hospital and medical care parts of the program have been paid for at the expense of other social welfare spending categories. it seems likely that an american nhi program would also redistribute funds away from the poor and provide little flexibility in social welfare spending. a bibliography, 15 tables, and two appendixes are included