with universal health care, the doctor charges the health care plan (or the hospital) for each procedure, much the same way a doctor charges procedures to an insurance company or directly to an uninsured patient in the private USA health care system...unlike the private system, there is no insurance company in the universal health care system so it isn't overburdened with paperwork and profiteering...i think the usa is the only country in the world where the health care system is dedicated to avoiding the provision of health care by denying insurance coverage, which probably has a lot to do with the poor US healthcare outcomes compared to universal health care systems in other countries