TORONTO -- Ask people in Canada what they make of American health care, and the answer typically falls between bewilderment and outrage.
Canada, after all, prides itself on a health system that guarantees government insurance for everyone. And many Canadians find it baffling that there's anybody in the United States who can't afford a visit to the doctor.
So even as Canadians throw shade at the American hodgepodge of public plans, private insurance, deductibles and copays, they hold in high esteem a little-known Affordable Care Act initiative: the federal Center for Medicare & Medicaid Innovation (CMMI).
It was a hot topic on a reporter's recent visit to Toronto to study the single-payer health care system.
Wonky as it seems, the center's mission -- testing innovations to hold down health care costs while increasing quality -- has gotten noticed. Researchers and clinicians talk about its potential to foster experimentation and how it has led the United States to think out of the box regarding payment and reimbursement models.
"It is gaining traction in many circles here," said Robert Reid, who researches health care quality at the University of Toronto.
"There have been some good efforts ... they have tried more things than we have," agreed Dr. Kaveh Shojania, a Toronto-based internist who studies health care quality and safety.
Despite the praise emanating from north of the border, the program doesn't get the same love on the home front.
Through the ACA, CMMI is armed with $10 billion each decade and sponsors on-the-ground experiments with doctors, health systems and payers. The idea is to devise and implement payment approaches that reward health care quality and efficiency, rather than the number of procedures performed.
Since taking office, though, President Donald Trump has rolled back its reach.