Since Singer's main point seems to be the true -- obviously true -- point that ANY system "rations" care by one means or another, I'm not entirely sure what you wanted us to take away. He even argues *against* a system that outlaws private top-up insurance or that forbids people to pay out of pocket for non-covered treatments.

If your point was to try to argue that we don't have rationing now in the US, well, good luck. As one small example I was looking over my wife's old policy, Blue Cross in a West Coast state.

On their drug formulary, they provide zero coverage for any diabetes medications that are not generic. Pretty much any diabetes drug invented in the last 10 years, you can't have. If generics don't control your blood sugar, then your option is generic insulin. Given the amazing developments in diabetes meds in the last decades that would be terrible (trust me, I'm very familiar with the condition). But, hey, it's not rationing! No one getting between me and my doctor, right!