Is care the same in a single-payer system?

Architects and supporters of single-payer plans say quality health care would be available to everyone in such a program. They argue that today only those with premium coverage have such access, and often those with no insurance or too little insurance get inferior care or wait longer to see doctors. They say a single-payer system would not have levels of care, but simply the same type of care for all.

Opponents say quality could continue to depend on income or geography. Some argue that countries with universal care show the pitfalls: long wait times to see doctors, especially specialists, varying quality of care and options for those with more income to go outside the system. They worry that physicians would leave the system or leave California, and access to care could become a bigger issue than it is now, especially in areas that already lack enough providers.

In a recent report, the California Chamber of Commerce said single-payer models create the false impression that health care is free, which increases demand and strains the system. That requires care to be rationed, the report said, “which is why countries with a single-payer system, such as Canada, have a wait-time crisis on their hands.”