Media speculation about the scope of proposals for health care reform in the United States have led many Americans to be “very concerned” that changes will limit their choices in the future (ABC news poll 6/24/09). Health care choices are made on three levels: insurance plans, sources of care (physicians and hospitals), and clinical decisions (diagnostic tests and treatments). In this Commentary, we discuss the extent to which Americans currently are able to exercise choices. For context, we will compare the U.S. environment with that in Canada, partly because its health system, with much greater government involvement, is often publicly-portrayed in the U.S. as limiting choice.