We have single payer, but not single provider:

Our governments are hell-bent on:

• Selling off the profitable part of the system (cosmetic surgery, simple testing)
• If a part of the system isn't profitable, contract it out to a buddy at two to three times the cost it would cost to do so publicly. Nursing, for example: why pay a nurse via payroll at $x when you can contract nursing to am agency who will charge the government three times $x.
• If there's no way to make the service profitable, just let it rot. Family medicine? Cancer screening? Screw'em.