Over all OECD healthcare systems, we identify increasing similarities and common trends, especially with regard to the role of the state. Yet two countries, the USA and Canada, have ‘parted at the crossroads’ since the 1960s and therefore are quite frequently cited as examples for the opposite trend, i.e. for divergence. According to our position, it is far from evident that this trend has still been dominant in the past 15 years. In our contribution, we show that the USA and Canada have become more similar regarding the role of the state in financing, service provision and the regulation of healthcare systems. Furthermore, the article investigates potential explanations. We find that a most influential explanatory factor is the healthcare system itself, its deficiencies and functional requirements as reflected in the specific system type. As the system types of the USA and Canada vary, so too do their adaptive responses to problem pressure. By systematically acquiring non-system-specific elements, i.e. characteristics which were originally less developed or completely absent, the systems grow more similar and therefore converge.