If you believe that health care is a public good to be guaranteed by the state, then a single-payer system is the next best alternative. Unfortunately, it is fiscally unsustainable without rationing.

Summary

This quote suggests that if one considers healthcare as a right provided by the government, a single-payer system is a viable option. However, the quote also acknowledges that this system can become financially untenable without implementing measures to limit and control the distribution of healthcare services. In other words, rationing would likely be necessary in order to sustain a single-payer healthcare system in the long run.

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