By NextBestFitLonger waits if demand grows faster than capacity
When care becomes free and universal, use rises. If supply doesn't grow, people wait, as in Canada (median 28.6 weeks from referral to treatment) and the UK (7.4 million on the waiting list). People with good employer coverage today, who are seen fastest, notice most.
Evidence
- Canada median wait 28.6 weeks (2025).Sources: Fraser Institute (2025)
- NHS England waiting list about 7.4 million; 59% treated within 18 weeks.Sources: NHS England (2025)
Is it really a cost?
The arguments on each side, with sources. Whether it matters depends on whom you ask.
- Single-payer and tax-funded systems can have long waits: Canada's median from GP referral to treatment was 28.6 weeks in 2025, and England's waiting list was about 7.4 million.Sources: Fraser Institute (2025); NHS England (2025)
- In a 2016 survey of people who needed a specialist, 30% in Canada and 28% in Norway waited two months or more, against 6% in the U.S. and 3% in Germany.Sources: Commonwealth Fund (2020)
- People with private coverage get in fastest today: 96% of physicians took new privately insured patients, against 74% for Medicaid. One shared queue ends that advantage.
- Waits follow capacity, not only how care is paid for: Canada has 2.7 practising doctors per 1,000 people against an OECD average of 3.9, and 2.5 hospital beds against 4.2.Sources: OECD (2025)
- The U.S. is no better supplied: 2.7 doctors and 2.8 beds per 1,000 people. A U.S. single payer would need capacity to grow with coverage, which is a choice, not a given.Sources: OECD (2025)
- The U.S. already has waits: new-patient appointments in large metro areas average about a month.
Who's affected
- People with employer coverage: They are seen fastest today and would share one queue with everyone.
- People with ongoing or specialist care needs: They need specialists and procedures most often.
None identified.
Under your mix of paths
- Demand rises with coverage; supply grows slowly
- Budget caps on capacity
Related costs
Open questions
- How should waits be prevented: more capacity, small copays, wait-time guarantees, a private tier?
Caused or worsened by these paths
This problem only matters if one of these paths is chosen.
Care with no premiums or networks gets used more. Unless capacity grows too, waits get longer, and people seen fastest today notice most.
Free covered care increases use, placing more demand on care services.
Stepped care can leave patients waiting for higher-intensity mental health care.
Dentist capacity is limited, so covering dental care in the standard benefit is likely to create waits for dentists.
Banning private insurance for publicly covered services leaves patients without a private escape from waits.
Waits rise when annually set health budgets lag demand.
Removing copays increases use of care, adding demand to the system.
Solution paths (3)
Open a path for what it fixes, what it creates or worsens, who gains and who loses, precedents, and how it connects to other paths. See all paths as a decision tree.
If care isn't provided within a set time, patients may go to another provider, even abroad, at the payer's cost.
- +Longer waits if demand grows faster than capacity
- −Depends on other changes to work
- −Targets and quality metrics invite gaming
Expand workforce and facilities before universal coverage starts.
- +Longer waits if demand grows faster than capacity
- −Takes years, or money up front, before it pays off
Pay extra for procedures beyond baseline volume to cut queues.
- +Longer waits if demand grows faster than capacity
- −Raises spending or loosens control over it
- −Low-value care and overtreatment
Also addressed by paths for other problems
Additional residency positions increase physician supply, including primary care, psychiatry, and rural sites, to address capacity behind waits.
Expanding practice to the full extent of training quickly adds capacity for care.
Expanded roles within physician-supervised teams add capacity for care.
Retaining payment per service rewards productivity and supports shorter waits.
Expanding Medicaid home care ends waitlists for those services.
Private insurance lets patients bypass public queues, providing a relief valve for waits.
Adjusting budgets for changing demand helps prevent demand growth from producing queues.
Paying for additional procedures above a baseline rewards throughput and cuts queues.
A maximum-wait rule allows delayed patients to receive treatment elsewhere at the original hospital’s expense.