That’s not the full story. Insurance companies today already ration care : they won’t pay for expensive brand-name medicines and they often won’t approve surger

That’s not the full story. Insurance companies today already ration care : they won’t pay for expensive brand-name medicines and they often won’t approve surgeries without requiring extensive pre-qualifications and alternate treatments. Which is mostly for the best. Single-payer would have other effects. One, by ensuring that everyone has access to preventive and non-emergency care, it would reduce the overall cost of care. Today, the uninsured wait until they are horribly ill to show up at the ER where they are treated as public charges. Those people are also not effective at their jobs, and die earlier, which is an added cost. Net-net, a healthier population will be less expensive to care for and will be more productive. Second, a single-payer system will replace hundreds of independent insurance companies that compete with each other with a single system, increasing efficiency, Third, a single-payer monopoly can negotiate with providers to reduce cost. When you represent all of the patients in the country, you can demand the lowest rates. The government already does this today with Medicare, which is why many people call this plan “Medicare for All.” There will undoubtedly be some care rationing, but I expect that as in the UK there will be the option to buy private insurance on the retail market, or to pay cash for procedures that you want but which aren’t covered - as it is today for cosmetic surgery. Insurers dont cover plastic surgery, but that business seems to be booming.