Les partisans d'un système de santé publique font souvent valoir dans un tel régime, tous les patients sont traités équitablement sans égard à la taille de leur portefeuille.  Malheureusement pour eux c'est exactement l'inverse: les régimes privés sont plus équitables que les régimes publics:


« It is commonly supposed that a publicly funded single payer health care system will deliver better health outcomes, and distribute health resources more fairly than a multi-payer system with a large private component.

Health status is similar in both countries. But Canada has no more abolished the tendency for health status to improve with income than have other countries. Indeed, the health-income gradient is more prominent in Canada than it is in the U.S. The need to ration when care is delivered “free” ultimately leads to long waits or unavailable services and to unmet needs. In the U.S. costs are more often a source of unmet needs. But costs may be more easily overcome than the absence of services. »