If GOP Fails To Repeal And Replace Obamacare, Single-Payer Could Be Next
It's no secret that the cost of failure in the GOP healthcare reform effort will be that Obamacare remains on the books indefinitely.
Last week, Senate Majority Leader Mitch McConnell hinted that he might be willing to pay that cost. He said that Republicans would work with Democrats to produce a bill that would "fix" Obamacare's exchanges if they're unable to agree on a repeal-and-replace plan.
But if Sen. Bernie Sanders, I-Vt., is to be believed, the stakes may be even higher. In an interview out last week, Sanders said that he would be waiting in the wings with a single-payer proposal of his own, if the Senate GOP's healthcare reform bid falls apart.
Single-payer systems have endangered lives and reduced access to quality care everywhere they've been implemented. If Republicans needed any additional motivation for repealing and replacing Obamacare, Sanders's single-payer threat ought to do the trick.
Proponents of single-payer assume that patients would be better off if government bureaucrats controlled all of our nation's healthcare resources. They'd ensure that everyone had insurance coverage. They'd dictate spending levels and pay healthcare providers. And they'd eliminate all the supposedly wasteful spending that insurance companies devote to administration and marketing.
That would be a herculean task. Health care amounts to one-sixth of the U.S. economy. Managing it without the aid of market mechanisms like price signals would require bureaucrats to properly allocate trillions of dollars in resources and the labor of millions of American workers. Indeed, the estimated cost of the single-payer proposal Sanders offered in the 2016 election campaign was a whopping $32 trillion over 10 years.
It's far easier to just declare a global budget for health spending, and then ration care to ensure that spending stays below that ceiling. That's exactly what every other single-payer system does -- and how nations with single-payer systems can keep health spending lower than the United States does.
Take Great Britain's beleaguered National Health Service. In Scotland's NHS hospitals, an average of more than 19 operations were canceled each day between January and May due to overcrowding or insufficient staff.
Wait times for vital care are so long throughout the United Kingdom that the British Red Cross described the NHS as a "humanitarian crisis" earlier this year. That pronouncement came shortly after two patients at Worcestershire Royal hospital died after lying on gurneys for hours waiting for urgent care in the facility's hallway.
According to a new survey, more than half of NHS mental-health administrators admit that they are unable to cope with the demand for treating children and young people. This news comes nearly a year and a half after U.K. leaders committed more than £1 billion in new funding for mental health.
Only a single-payer system could subject patients in the world's fifth-largest economy to such deplorable care.
The situation isn't much better in Canada. Under the country's single-payer system, the median wait time for receiving treatment from a specialist after referral from a general practitioner is an astonishing 20 weeks -- more than double the 9.3 weeks recorded in 1993. The median patient waits nearly a year -- 46.9 weeks -- for treatment from a neurosurgeon following referral from a general practitioner.
Canadians who need an MRI can expect a median wait of more than 11 weeks.
Rather than wait for care in their home country, many Canadians head elsewhere. More than 63,400 residents received non-emergency treatment outside Canada last year, according to a report from the Fraser Institute, a Canadian think tank. That's up from fewer than 46,000 in 2015.
Government-run systems also struggle to hold employees accountable for even the most severe instances of negligence, incompetence, and fraud.
Consider the single-payer healthcare system run here in the United States by the federal Department of Veterans Affairs. In 2014, administrators at a VA hospital in Phoenix were caught covering up the excessive wait times endured by local veterans. The scandal led to the deaths of dozens of VA patients, sparking national outrage and a high-profile reform effort in Congress.
But neither public shaming nor a vigorous legislative overhaul has led to real change at the VA. A report released last October by the agency's inspector general found that hundreds of patients died while waiting for care at that same Phoenix hospital in the months following the scandal.
Wait-time fraud was not limited to Phoenix. According to a 2016 analysis of more than 70 separate investigations, workers at 40 different VA hospitals regularly doctored scheduling data to cover up chronic delays.
Of course, champions of single-payer rarely acknowledge the real-world consequences of their dream policy. In touting his own "Medicare-for-All" proposal, Sanders promises that "single-payer health care means comprehensive coverage for all Americans" -- a prospect that many voters would jump at.
But a government-issued insurance card is little consolation for patients who have to wait months for necessary surgery or languish in the hallways of an understaffed hospital. As Beverley McLachlin, chief justice of the Canadian Supreme Court wrote in a 2005 case challenging the prohibition of private insurance in Quebec, "access to a waiting list is not access to health care."
True, Sanders's proposed single-payer bill has little hope of passing in the Republican-controlled Senate this year. But Democrats could regain control of Congress in next fall's elections -- and make single-payer the linchpin of their legislative agenda through the next presidential election.
Indeed, if Republicans fail to enact a genuine alternative to Obamacare -- or worse, if they settle for a watered-down, Obamacare-Lite bill -- they will have sullied the name of conservative health policy. And if the health insurance market collapses on the GOP's watch, single-payer will seem to many Americans like the most reasonable option for saving our healthcare system.
This is a future that Sanders is preparing for. His Democratic allies in many state legislatures are introducing single-payer legislation themselves. The only way to stop them is for Republican lawmakers to show Americans what true free-market healthcare reform looks like.