Hi. I guess I’m 3 months late to this party, but this article didn’t show up in my Medium feed until today.

I have a few questions.

I probably have a skewed view of the situation as well, as I live in a fairly affluent region and the healthcare is therefore better.

One of the major concerns that conservatives have to a single-payer system is a fear of homogenization. The cynical interpretation is that these are people with good jobs and access to good healthcare, and they balk at the idea of poor people having access to the same level of healthcare that they do. The charitable interpretation is that they simply fear a diminishment in the quality of healthcare they receive, regardless of the cause.

But here, in just the second sentence of your article, you acknowledge that, even though rich and poor alike are on the same system, affluent regions still have access to better healthcare. So this homogenization fear seems to be at least partially a myth, doesn’t it?

The waiting lists can be horrendous, with hip replacement operations, transplants, heart surgery, and just about every type of surgical procedure having longer waiting lists than the average for a developed country of a comparable size.

Well, let’s talk about the reason why the waiting lists exist.

It’s kind of a supply and demand problem, right? The demand for surgeries outweighs the supply of surgeons available to perform them. And that problem only exists because the state is providing healthcare to people who otherwise wouldn’t be able to afford it.

What are the alternatives? Well, one alternative is to just not offer healthcare to people who can’t afford it. That would eliminate the waiting lists, but that’s not an ideal solution.

The only other alternative I can think of is what it sounds like you’re proposing. Allow those who can afford it to purchase private insurance, which somehow helps them circumvent the waiting list.

But how does that work? You didn’t really explain that. Is it through private hospitals? Which would only serve patients with private insurance, and turn away people with state-provided insurance?

I assume that’s what the model is. But is that fair?

Suppose there are two patients, Bob and Carol. Bob is a millionaire and Carol is a teacher. Carol slips on a patch of ice and injures her back. A month later, Bob falls while skiing and sustains a very similar injury. Both of them need a minor spinal surgery. Carol has already been on the waiting list for 4 weeks, but because Bob is rich, he’s able to go to a private hospital and circumvent that waiting list.

Should Bob be entitled to a different standard of healthcare just because he has more money?

Some might think it’s more than fair — after all, he has more money! If he can afford to hire a private surgeon, why shouldn’t Bob have the freedom to do so?

But I keep thinking about organ transplants. That’s one area of healthcare where we all seem to agree that it’s not fair for the rich to get privileged treatment. They go on a list, same as everyone else, and the only relevant factor in determining who gets the next heart or kidney is who needs it most. Income doesn’t matter.

So why shouldn’t that same standard apply to all healthcare?