 A public insurance plan was not included in the Affordable Care Act but some argue that it would have added to health care access choices, and others argue that the central issue is whether health care is rationed sensibly.Opponents of reform invoke the term socialized medicine because they say it will lead to health care rationing by denial of coverage, denial of access, and use of waiting lists, but often do so without acknowledging coverage denial, lack of access and waiting lists exist in the U.S. health care system currently or that waiting lists in the U.S. are sometimes longer than the waiting lists in countries with socialized medicine.Proponents of the reform proposal point out a public insurer is not akin to a socialized medicine system because it will have to negotiate rates with the medical industry just as other insurers do and cover its cost with premiums charged to policyholders just as other insurers do without any form of subsidy.