Biden officials threaten to jumpstart single-payer health care systems

Move over, Bidencare. Single-payer health care could be coming to the United States.

President-elect Joe Biden’s nominee to lead the Department of Health and Human Services, California Attorney General Xavier Becerra, is a longtime supporter of Medicare for All. If confirmed, he’ll have the power to approve waivers that would allow states to implement government-run, single-payer health care within their borders.

Those excited about this possibility ought to look at the latest research on wait times in Canada. Importing single-payer into the United States would force American patients to wait for months for low-quality care.

The Affordable Care Act empowers the secretary of Health and Human Services to grant states “innovation waivers” to experiment with new ways of providing access to care. For years, progressives have been intrigued by the possibility of using these waivers to implement state-level single-payer.

California Gov. Gavin Newsom campaigned on bringing single-payer to the Golden State. But that effort largely fizzled once he took office in 2019, thanks to hostility from the Trump administration, the high cost of single-payer, and the pandemic.

Becerra’s nomination has energized California lawmakers, including Canadian-born Assembly member Ash Kalra, D-San Jose, to put single-payer back on the state’s agenda.

New York could also send a waiver application Becerra’s way. In 2018, the state Assembly passed legislation that would have established single-payer in the Empire State. The bill did not gain traction in the then Republican-controlled state Senate. But a slew of progressive lawmakers elected this fall might breathe new life into the effort.


new report from the Fraser Institute, a Canadian think tank, should give them pause. In 2020, Canadian patients were collectively waiting for more than 1.2 million procedures, up roughly 15% from 2019.

The median wait for treatment following referral from a general practitioner was 22.6 weeks last year. This is the longest wait on record, up 143% since the Fraser Institute began keeping track in 1993.

In some parts of the country, the median wait exceeded 40 weeks. Orthopaedic surgery, ophthalmology, plastic surgery, and neurosurgery all have median waits of over 30 weeks.

Long waits understandably lead to worse health outcomes. For example, patients who delay cataract surgery more than 6 months experience increased vision loss, lower quality of life, and have more falls than those who don’t have to wait.

All that time on the shelf is bad for the Canadian economy, too. Fraser estimates that the value of the time patients spent waiting for care in 2019 was about CA$2.1 billion. That doesn’t consider the value of time outside the normal workday — or the value of caretakers’ time, who could be engaged in more productive work.

Joe Biden won the presidency in part by promising to govern as a moderate. By nominating Medicare for All fan Xavier Becerra to lead the Department of Health and Human Services, he’s doing just the opposite. The secretary-designate should take a long look at the long waits in Canada before even thinking about green-lighting state-level single-payer in the United States.

Sally C. Pipes is president, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her latest book is False Premise, False Promise: The Disastrous Reality of Medicare for All, Encounter Books, January 2020. Follow her on Twitter @sallypipes.

Nothing contained in this blog is to be construed as necessarily reflecting the views of the Pacific Research Institute or as an attempt to thwart or aid the passage of any legislation.

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