For decades, the political left in the United States has pushed for a single-payer health-care system. Various terms such as 'Medicare for all,' 'universal health care,' and 'public option' have been employed to describe this system. Regardless of the terminology, the proposed single-payer model would involve government oversight of health-care delivery, with decisions influenced by political factors and budgetary constraints. A recent commentary highlighted the concept of a universal public option, which would allow patients to enroll in the Medicare program. Proponents argue that this public option would compete with private insurance, theoretically providing more choices for patients. However, the reality suggests that competition with a government-run program is challenging. The government has unique financial advantages, such as the ability to tax and operate with a budget deficit, which private companies do not. Researchers have estimated that implementing a federal public option in the Affordable Care Act (ACA) exchanges could lead to an $800 billion deficit over a decade. To maintain budget neutrality, significant tax increases would be necessary. Thus, the financial implications of a public option raise concerns about its sustainability. The historical context of Medicare's introduction reveals the challenges posed by government programs. In 1966, when Medicare was established, there was a robust private insurance market for seniors. However, within a few years, private companies struggled to compete with Medicare, leading to a decline in available private options. As a result, Medicare has effectively become a government-run system with limited competition. A critical issue with single-payer systems is the imbalance between demand and supply, often resulting in rationing of medical care. For example, Canada, known for its universal health care, reported an average wait time of 30 weeks from seeing a primary care provider to receiving specialty treatment last year. Age and budgetary constraints are additional methods of rationing care. To control costs and improve quality, it is essential to empower patients to manage their own health-care dollars and make informed decisions. A single-payer system would hinder this objective by increasing government control over health care. Effective health-care reform requires respect for patient autonomy, including initiatives like provider price transparency, tax code adjustments, and reforms to existing programs. Allowing patients to access and compare health-care services in a competitive marketplace is vital. The experience of Canada illustrates the shortcomings of a single-payer model in meeting these goals.