Universal care is inevitably limited—increases inequality by forcing the government to pick who gets care & overwhelmed systems turn the pandemics impact.

Universal access to coverage is not the same as universal access to care. If health care is a legal right—a government entitlement free at the point of service—then it is what economists call a free good. The demand for a free goods unlimited. Unlimited demand, at any given point in time, must collide with limited supply; access to care is not, and cannot, therefore, be universal. Rationing, of course, occurs in all systems. Rationing decisions in single-payer systems are primarily budgetary, bureaucratic, or political meaning that government officials must, in some way or another, establish a scheme for determining who gets care, as well as how, when, and under what circumstances they get care.

Waiting lists are the primary rationing mechanisms. A team of researchers writing for the Journal of the American Medical Association reported in 2018 that 39% of patients in Canada, which is a single-payer system, and 19% of patients in Britain, the oldest model of a single-payer system, had to wait more than two months to see a medical specialist compared to only 6% of patients in the United States. British patients must often wait for hours in Britain’s overcrowded and understaffed emergency departments. By the end of 2020, with British hospitals and other medical facilities trying to cope with the pandemic, British waiting lists could approach nearly 10 million patients. In normal times, British waiting lists are routinely scandalous. In 2017, there were 4.1 million British patients on the waiting lists of the National Health Service (NHS), including waiting lists for cancer surgery. Nor do British patients get timely access to breakthrough medications.