Prison, the armed services, Medicare and Medicaid are single payer healthcare systems- the government collects the taxes, sets the payment amounts and "reimburses" providers. The stated objective is to provide a health care yet the end result is rationing.
Government is automatically an inefficient way to pay providers- first because it is inflexible, only able to pay according to regulations and schedules, and secondly because the collection of taxes, the accounting for funds, and the allocation and distribution of funds is a leaky bucket- each step has a cost in time and money, and each dollar taken in taxes is one less dollar that is available to citizens for their own use.
As this leaky bucket attempts, through heavily regulated systems, managed by bureaucrats with no requirement for compassion or timely action, the providers of health care services are continually having to choose between the medicine, machines and costs of providing medical care and the ability to care for those coming in under the single payer government system.
Rural hospitals are especially vulnerable to the reduction in income that is created when MediCare and MedicAid cover more people than private insurance- the income is simply insufficient to support the hospitals- and they close, or lose personal, equipment does not get serviced, or replaced, nurses are overloaded and tired, and the quality and availability of healthcare is compromised.
This is not the fault of the hospital systems- this is the consequence of a costly system promising health care that it cannot afford to pay for.In order to sustain hospitals at the efficiency rate of private insurance, governments, because of their costs of collecting and distributing funds, would have to charge at least double in taxes what they take now.
Although European governments are held up as a great example of what we could have in the US and in Wyoming, if you look at their failure to either help people suffering from COVID or even obtain and offer vaccines, it is obvious that healthcare is rationed under their systems. These failings are immediately obvious with term health problems like hip replacement or pituitary tumor operations. In the UK, average wait times of 18 to 22 months for those without privileged access, cash or massive supplemental policies (a thriving business in Britain!). While the US healthcare system is far from perfect- transparency in pricing, published success rates for procedures, and the ability to buy healthcare across state lines is needed, it is far far better than any single payer government system in the world in terms of quality of care and services.
Expansion of single payer government healthcare is the rationing of health care by another name that degrades the physician/patient relationship, wedging a layer of government between the patient and the care provider.When the government is the only payer, patients and providers take a back seat.This limits the resources available, and painful decisions are made about who lives, who suffers and who dies. Is this the kind of medical care we want?