In a recent Maine Voices piece, Alice Knapp makes the mistake many advocates of single-payer health care make: They think health care will be cheaper and better if someone else pays for it (“Universal health care is only fair,” March 9).

Knapp likes the publicly funded Canadian system, but even the Health Council of Canada acknowledges that waiting times for specialists, certain procedures and even primary care doctors have become a significant problem.

Every single-payer system that has made health care a “public good,” as Ms. Knapp recommends, is struggling with unsupportable costs, or access, or both.

The individual Ms. Knapp describes who has too much income for insurance subsidies and who may develop a health condition that results in bankruptcy is not a typical patient, and even socialist systems can’t prevent all cases of hardship and financial distress from every source.

We have had a single-payer system for decades in our Medicare and Medicaid programs. The quality of care is generally good, but access for Medicaid patients is a growing problem because of low reimbursement rates to providers, and the trustees of both programs warn each year that their long-term cost trajectories are unsustainable without benefit cuts or much higher taxes.

We will never be able to achieve an acceptable balance in quality, access and costs unless patients have more responsibility for their health care dollars in a way that gives them incentives to voluntarily constrain demand and to seek value – incentives that don’t exist in most single-payer systems.

Martin Jones