The clueless market universal healthcare as a right: free at the point of use, available to all. In reality, when price is removed and budgets constrain supply, care is rationed by time. Patients wait. Disease progresses. Productivity evaporates. And in the extreme, some systems offer an exit when treatment does not arrive.
If something constitutes a right, it means someone is compelled to render it. Doctors said no. I’ll take my time and education and play golf. You can take your time and spend it waiting for appointments.
Canada illustrates the pattern clearly. In 2025, the median wait from family-doctor referral to treatment reached 28.6 weeks. Triple the figure recorded in the early 1990s. Orthopedic and neurosurgery patients often waited nearly a year. Those delays cost Canadians more than $4.2 billion in lost wages and productivity in a single year, roughly $3,000 per person among the 1.4 million waiting. Pain, anxiety, and irreversible progression of disease are not captured in the dollar figure.
When timely care is unavailable, another option appears. About one in twenty of all Canadian deaths in 2024 were from Canada’s medical assistance in dying program. A substantial share involved people living with disabilities. Official reports emphasize grievous suffering; critics and disability advocates note that isolation, inadequate supports, and inability to obtain needed care often form part of that suffering.
A system that cannot deliver a joint replacement or specialist consult within months can still deliver a lethal injection with relative efficiency. That is not the compassion originally promised; it is the endpoint of monopoly rationing. The physician side of the ledger is equally revealing. In the United States, administrative burden — documentation, prior authorization, coding, quality reporting — consumes a large fraction of physicians’ time. Recent research shows doctors leaving clinical practice at a mean age of 48, roughly nine years earlier than a comparable cohort from 2008. Nearly half of those who left cited the “hassle factor” of bureaucracy as a leading reason, nearly equal to the share who described the work as too stressful. For many it is not classic emotional burnout. It is a straightforward calculation: after the unpaid paperwork, the residual clinical work no longer justifies the hours, the malpractice insurance cost, or the compensation.
Experienced clinicians reduce hours, sell practices, or retire early. Access shrinks further.
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The monetary cost of American medicine is high and well known. The cost of the alternative — care rationed by queue — is measured in years of diminished function, lost earnings, progressive disease, and a workforce that quietly exits because the job has been hollowed out by non-clinical demands. Rationing by price is imperfect. Rationing by waiting list is also imperfect, and often slower, more opaque, and more corrosive to both patients and the people trained to treat them.
Patients still pay. They pay with time, with function, with hope, and, in the most extreme cases, with their lives. Pretending the invoice never arrives at the bedside does not change the arithmetic of scarcity.
Michael Breeden is a retired Air Force chief master sergeant with 29 years of service as a combat controller in special operations. He writes on sovereignty, culture, and institutional accountability.