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Deeper Dissection #10: International Comparisons

Don't other countries have single payer?

Oct 06, 2025
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“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.

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