The Illusion of Infinite Care
All healthcare is rationed, the only question is by whom
There is no such thing as unlimited healthcare. This is a truth so obvious that it should not need repeating, yet it has become a political taboo to acknowledge it. The illusion that medical care can be offered freely and without limit is not only economically incoherent but morally corrosive. All systems must economize; the only question is how and by whom.
The political promise of unlimited care is a deliberate falsehood, crafted to make government control of healthcare seem humane and necessary. In the United States, where the healthcare system is only nominally private and deeply entangled with government mandates, subsidies, and regulation, many people experience high costs, surprise bills, and coverage denials. These real and painful failures are then used as political evidence in favor of an entirely government-run alternative. Americans are told that if we had single-payer healthcare, no one would ever be denied by an insurance company or forced to choose between medical care and housing or groceries. The implication is that the public system would be generous, frictionless, and inexhaustible.
This is a seductive promise, but it is built on an economic and moral sleight of hand. What is being offered is not actually infinite care. That does not exist. There is no system in which anyone can receive any treatment they want, at any time, with no limitations and no personal cost. The strategy behind socialized medicine, as with all collectivist systems, is to hide where the rationing happens. In a market, economizing is visible. Price signals reflect scarcity and demand. Patients are allowed to make trade-offs. They are free to choose how to spend their own money, and which priorities matter most to them. In a socialized system, prices are suppressed or distorted. Costs are obscured, dispersed, and shifted away from the individuals using services and onto taxpayers at large. The apparent generosity of such a system depends entirely on this concealment.
The fundamental lie behind universal government-run healthcare is not that there are no trade-offs, but that the individual will no longer be the one to make them. In reality, the trade-offs remain. The difference is that the individual is no longer in charge of the budget. The state is. The state’s budget is not infinite.
The promise of socialized healthcare creates the illusion that patients will be able to walk into any clinic or hospital and receive whatever care they want, whenever they need it, without cost. In reality, rationing still occurs, but not through price. It occurs through denial and delay. Instead of being told a treatment is unaffordable, patients are told it is unavailable, or at least unavailable to them. They wait not hours, but months or years, and they have no recourse.
In many countries with nationalized systems, age alone may disqualify a patient from receiving certain care, such as aggressive cancer treatment or surgical intervention. There is no appeal. There is no second opinion. If the algorithm has decided that your expected outcome does not justify the cost, your care, and possibly your life, ends there. In systems like the NHS, elderly patients may be denied curative treatment for breast or prostate cancer purely on actuarial grounds.1 In Canada, patients who need a hip or knee replacement often wait over a year, sometimes two, simply to reach the front of the queue.2 That wait is not negotiable, no matter the degree of pain or disability. The patient is not allowed to pay more to move faster. They are not allowed to pay at all. What’s more, instead of offering you the treatment you seek, some of these systems may helpfully suggest that you consider killing yourself under a state-sanctioned “medical assistance in dying” program.3
By contrast, in the United States, flawed as the system may be, patients retain the freedom to act. An elderly patient can choose to undergo chemotherapy should he so choose. A construction worker in chronic pain can get a knee replacement in weeks, not years. A family can seek second opinions, pursue experimental treatments, or access high-level specialty care if they are willing to bear the cost. Even though our system no longer resembles a free market, these decisions still belong primarily to the patient and not entirely to the system.
In a true free market, rationing occurs through price. That word, rationing, carries unfortunate emotional baggage, but it is merely the act of allocating finite resources in the face of demand that exceeds supply. When consumers are allowed to decide what care is worth to them, they retain agency over their choices. They are free to weigh their own values, priorities, and financial circumstances. They may decide to forego a service, seek a less expensive alternative, or pay a premium for expedited care. Healthcare proceeds via voluntary exchange, grounded in autonomy and mutual consent.
Contrast this with what happens in systems where price is suppressed or concealed. When patients do not face the cost of their care directly, they are not shielded from rationing. They are simply excluded from participating in the decision. The rationing still occurs, but it is hidden behind denial codes, waiting lists, coverage determinations, and bureaucratic reviews.
In government-run systems, it is administrators, not patients, who decide what care is “appropriate,” what counts as “necessary,” and what is “cost-effective.” That is not to say such systems are heartless by design, but they are inevitably heartless by necessity. A public system cannot offer everything to everyone. It must decide what to exclude. Those decisions are always subject to political influence, utilitarian logic, and cost-containment priorities.
This phenomenon is not limited to foreign single-payer models. It plays out every day in the American system as well, which is putatively “private” but in no way represents a free market. Insurance companies, particularly those managing public funds through Medicare Advantage or Medicaid contracts, act as gatekeepers. Physicians know this all too well. They may recommend a treatment or diagnostic test, only to be overruled by a clerk who has never seen the patient and may lack any clinical training. In the end, it is not the patient or the doctor who decides what care is “appropriate,” it is a distant, impersonal algorithm, accountable only to budgetary targets and compliance metrics.
The moral distinction is not between rationing and no rationing. That choice does not exist. The moral distinction lies in who holds the authority to decide. In a market-based system, that authority rests with the patient. In a centrally managed system, it rests with the state or its contracted proxies.
Some will argue that this is unfair, and that no one should be denied care simply because they cannot afford it. That is a sincere concern. The alternative, however, is to deny care because someone else decides that you are not worth the cost. When rationing is moved upstream to insurers or governments, it becomes less visible, but more arbitrary. It privileges conformity and statistical efficiency over individual needs and values. It replaces personal judgment with protocol. Most importantly, it disempowers the individual patient in making choices about their own lives, handing over the fate of each and every human life to the cold calculus of a bureaucratic spreadsheet.
Only a market can honor the infinite diversity of human wants and needs and restore the dignity of the individual. Only a system that allows price to play its role can accommodate both the scarcity of resources and the uniqueness of each patient. To pretend otherwise is not compassion, it is delusion.
There is no healthcare system without trade-offs. The only question is whether those trade-offs are made by patients and doctors acting together, or by bureaucrats managing spreadsheets. All care is rationed; the difference between these systems is who gets to make the choice.
Adams B. Ageism in NHS is stopping some older cancer patients getting the best treatment according to a survey of oncologists. PharmaTimes. December 21, 2012. https://pharmatimes.com/news/ageism_in_nhs_stopping_older_patients_treatment_975984/
Campbell D. NHS accused of age discrimination over lifesaving surgery. The Guardian. October 14, 2012. https://www.theguardian.com/society/2012/oct/15/nhs-cancer-joints-surgery-age-discrimination
Canadian Institute for Health Information. Wait times for priority procedures in Canada: hip and knee replacement surgeries within benchmark time frames. CIHI. June 2025. https://www.cihi.ca/en/wait-times-for-priority-procedures-in-canada-2022
Dawson E, Neufeld ME, Schemitsch E, John-Baptiste A. The impact of wait time on patient outcomes in knee and hip replacement surgery: a scoping review protocol. Syst Rev. 2022 Mar 4;11(1):38. doi: 10.1186/s13643-022-01909-4. PMID: 35246261; PMCID: PMC8895094. https://pmc.ncbi.nlm.nih.gov/articles/PMC8895094/
Fraser Institute. Waiting Your Turn 2022: Wait times for health care in Canada. Fraser Institute. December 15, 2022. https://www.fraserinstitute.org/sites/default/files/waiting-your-turn-2022.pdf
Government of Canada. Medical assistance in dying. Government of Canada. Updated March 27, 2024. Accessed August 7, 2025. https://www.canada.ca/en/health-canada/services/medical-assistance-dying.html