Personally I feel that none of the current systems are ideal. A dear friend of mine with a cancer of the spine was receiving treatment based on a medical insurance. (if that's what you mean by the user payer system) During a phase of his treatment his insurance ran out and in no time at all he was catching the bus home - he was dependent on crutches and periodically a wheel chair - this made no difference. Now this was in New York.

He explained this account to me about ten years ago, so things may have changed there I don't know, or possibly it was a one off case of mismanagement - but to me it seems immoral to measure a person's health needs by their finances.

What matters like these show is that health care systems everywhere are struggling to cope.