Deeper Dissection #10: International Comparisons

Don't other countries have single payer?

“Doctors in other countries can just do what they want because they have single payer.”

An attending physician colleague once said that to me.

It perfectly captures a common American misunderstanding about how other countries actually ration care

and about what “single payer” even means.

Almost no country truly has a single-payer system. And in no country can doctors “do whatever they want” without regard to cost. Every nation faces the same basic constraint: scarcity. As Thomas Sowell reminds us, “The first lesson of economics is scarcity: there is never enough of anything to satisfy all those who want it.”

So the question isn’t whether care is rationed. It’s how it’s rationed — and by whom. Every system uses some form of central planning, its own version of our villain: CMS. The difference lies in where the planning happens, how rationing occurs, and who bears the transaction costs.