Because single payer plans like the UKu2019s NHS and Canadau2019s national healthcare system are running into the same exploding financial problems that the United States is having due to the tremendous costs of new technologies and new expensive drugs. Those systems are not handling the growth in expenses well either.But they react differently. Instead of rapidly building new facilities and installing new high tech machines as occurs in every city in the United States, the UK and Canada slow things down with budget creep. They canu2019t commit political suicide with huge tax increases that would hurt their economies so they incrementally pass increases. That significantly delays but doesnu2019t prevent new technologies coming into play (Most cities in the US have more MRI and PET scanners than entire Canadian provinces.Itu2019s a form of government rationing because budget restrictions create a shortage for everyone in the system, resulting in waiting lists that some patients never get off. Their citizens mostly accept that for non-emergencies because fortunately, as in the US, most people donu2019t require sophisticated or advanced medical care. When they cannot accept it, they leave the system and fund their own private healthcare.Before Obamacare, more than 85% of Americans expressed approval of their healthcare. That number has fallen somewhat but still represents a sizable majority.Most Americans donu2019t want what a federally run program would entail. They donu2019t want their options reduced. They donu2019t want to be put on waiting lists. They donu2019t want to lose their choice of physicians and hospitals. They donu2019t want bureaucratic layer upon layer getting in the way of their healthcare. In short, they donu2019t want what Medicaid patients currently get. They also donu2019t want what weu2019ve been hearing that a significant number of Americanu2019s veterans get.Many Democrats say they want Medicare for all. Medicare simply doesnu2019t pay the bills of hospitals and doctors. Medicare exists at itu2019s current high level of care because a significant part of the care is cost shifted from the 170 million Americans who have employer based health insurance.Iu2019ve used Nobel Prize winning liberal economist Paul Krugmanu2019s response to Bernie Sandersu2022 Medicare-for-All plan time and time again. Krugman was a big supporter of Obamacare and also of Hillary Clintonu2019s candidacy. So here goes again:My column and Bernie Sandersu2022 plan crossed in the mail. But the Sanders plan in a way reinforces my point that calls for single-payer in America at this point are basically a distraction. Again, I say this as someone who favors single-payer u2022 but itu2019s just not going to happen anytime soon.Put it this way: for all the talk about being honest and upfront, even Sanders ended up delivering mostly smoke and mirrors u2022 or as Ezra Klein says, puppies and rainbows. Despite imposing large middle-class taxes, his u201cgesture toward a future planu201d, as Ezra puts it, relies on the assumption of huge cost savings. If you like, it involves a huge magic asterisk.Now, itu2019s true that single-payer systems in other advanced countries are much cheaper than our health care system. And some of that could be replicated via lower administrative costs and the generally lower prices Medicare pays. But to get costs down to, say, Canadian levels, weu2019d need to do what they do: say no to patients, telling them that they canu2019t always have the treatment they want.Saying no has two cost-saving effects: it saves money directly, and it also greatly enhances the governmentu2019s bargaining power, because it can say, for example, to drug producers that if they charge too much they wonu2019t be in the formulary.But itu2019s not something most Americans want to hear about, foreign single-payer systems are actually more like Medicaid than they are like Medicare.And Sanders isnu2019t coming clean on that u2022 heu2019s promising Medicaid-like costs while also promising no rationing. The reason, of course, is that being realistic either about the costs or about what the system would really be like would make it a political loser. But thatu2019s the point: single-payer just isnu2019t a political possibility starting from here. Itu2019s just a distraction from the real issues.Health Reform Is HardHospital waiting lists at seven-year high as 3.4m need treatment193,000 NHS patients a month waiting beyond target time for surgeryhttp://www.telegraph.co.uk/news/2017/03/30/hip-knee-surgery-waiting-lists-lengthen-nhs-focus-ae-cancer/Hip and knee surgery waiting lists to lengthen as NHS focus on A&E and cancer careNHS Health Check: Hospital op 'long waiters' rise by 163% - BBC NewsCanada lags G7 in cost-saving IR proceduresHealthcare wait times hit 20 weeks in 2022. reportWaiting Your Turn: Wait Times for Health Care in Canada, 2022 ReportCanadians increasingly come to US for healthcare: https://www.usnews.com/news/best...