Private insurance companies may lose the big market but they will continue to make a profit from offering to finance non-standardized care and expedited services. Any large-scale government health care system will require restrictions on access to services just as private insurance plans do today. They will simply be more obvious and prone to politically motivated interventions which will further disrupt the "market" for specialty care. Wealthier individuals will be able to opt out of the waiting line and you can bet that substantial numbers of the middle class will purchase insurance to gain similar access to "off-line" medical services. Canada has just this system today (its called "crossing the US border for elective surgery") as does the UK. Unions and high level executives will more than likely continue to receive subsidized access to these supplemental services. Moreover, the best and brightest physicians, nurses, dentists, and pharmacists will quickly migrate into centers which provide these services if only to avoid the inevitable dysfunction that develops whenever the government provides large scale services (Postal Service, VA, disaster relief). The political chicanery which will also arise as a universal government health system begin to negotiate with pharmaceutical companies and other suppliers should provide an additional incentive for wealthier individuals to avoid the "government hospital."