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Dr. Eric Lullove , wrote this article and Blue Amp Media is publishing it here with permission.
by Dr. Eric Lullove
The Single-Payer Paradox: Efficiency, Equity, and the Myth of the Perfect System
We have a habit in the U.S. of discussing healthcare as if it’s a choice between a “free market” and “the gulag.” It’s a binary that serves politicians well but does a massive disservice to the actual data sitting in our medical journals.
If we look at the democratic socialist models—the ones that treat a doctor’s visit more like a library book than a luxury purchase—we find a reality that is far more nuanced than the talking heads suggest. It’s not a utopia, but it’s also not the disaster some claim.
Let’s look at what the clinical literature actually tells us about the countries that decided to de-commodify human health.
The “Amenable Mortality” Gap
The most damning metric for the American model is amenable mortality. This is a clinical way of saying: people dying from things we already know how to fix. When you look at The Lancet or JAMA rankings, countries with Universal Healthcare (UHC)—whether it’s the single-payer system in Canada or the social insurance model in Germany—consistently beat us. Why? Because the barrier to entry is zero. When a patient doesn’t have to weigh the cost of a co-pay against the severity of a chest pain, they show up at the clinic earlier.
In democratic socialist medicine, the “win” isn’t just in the flashy, high-tech surgeries; it’s in the boring, consistent management of hypertension and diabetes. By making primary care a universal right, these nations have effectively slashed preventable hospitalizations. They keep people out of the ER because they caught the problem six months ago in a neighborhood clinic.
The Equity Argument: Social Solidarity vs. Individual Risk
Democratic socialism in medicine is built on a single, heavy pillar: Social Solidarity. In our current system, health is an individual risk. If you get a rare cancer, that’s your financial burden to carry. In a single-payer system, that risk is socialized. The data shows that this leads to vastly superior health equity. In the UK or Taiwan, your zip code and your income level are significantly less likely to determine whether you survive a myocardial infarction.
The medical literature is clear: UHC systems virtually eliminate medical bankruptcy. In most of these countries, the “medical bill” isn’t just lower—it doesn’t exist.
The Honest Trade-Off: Triage is Not Magic
Here is where we have to be intellectually honest: You cannot remove the price barrier without creating a different kind of bottleneck.
In a market system, we ration by wealth. If you can’t pay, you don’t get the care.
In a single-payer system, we ration by time and clinical urgency.
This is the “Wait Time” problem that critics love to highlight, and they aren’t entirely wrong. If you need a hip replacement in a single-payer system, and it’s not life-threatening, you are going to wait. You are in a queue behind people whose needs are more acute. The system is designed for the collective good, which sometimes means the individual’s convenience takes a backseat.
Furthermore, these systems are perpetually at the mercy of the state budget. If the government decides to lean into austerity, the “front line”—the nurses, the specialists, the clinic wait times—feels the squeeze immediately.
Is the Trade Worth It?
If we look at the population health metrics, the answer from the medical community is a cautious but firm “yes.”
Longevity: UHC nations live longer.
Infant Mortality: Their babies survive at higher rates.
Cost: They do all of this while spending roughly half of what we do per capita.
The “money” in these systems is spent on outcomes rather than administration. While the U.S. spends a staggering amount of its healthcare dollar on the bureaucracy of billing and insurance denial, single-payer systems funnel that cash into actual clinical care.
The Bottom Line
Democratic socialism in medicine isn’t about getting “free stuff.” It’s a fundamental shift in how a society values its members. It trades the “premium” experience of the wealthy for the “baseline” security of the many.
It’s a system where you might wait longer for a scan, but you’ll never have to decide between a chemotherapy treatment and your mortgage. In the clinical world, that’s a trade-off that saves lives—millions of them.
References
1.Political and Economic Aspects of the Transition to Universal Health Coverage. [ [link removed] ] Lancet. 2012. Savedoff WD, de Ferranti D, Smith AL, Fan V.
2. Lessons for the United States From Single-Payer Systems. [ [link removed] ] American Journal of Public Health. 2019. Greer SL, Jarman H, Donnelly PD.
3.How Single-Payer Stacks Up: Evaluating Different Models of Universal Health Coverage on Cost, Access, and Quality. [ [link removed] ] International Journal of Health Services : Planning, Administration, Evaluation. 2018. Fox A, Poirier R.
4. The Politics of Universal Health Coverage. [ [link removed] ] Lancet. 2022. Ho CJ, Khalid H, Skead K, Wong J.
5. Canada’s Universal Health-Care System: Achieving Its Potential. [ [link removed] ] Lancet. 2018. Martin D, Miller AP, Quesnel-Vallée A, et al.
Eric J. Lullove, DPM CWSP DABLES APWH(c) FFPM RCPS (Glasg)

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