Single-payer is back on the docket in California. Late last month, Assembly Speaker Anthony Rendon announced that he’d formed a special committee “to develop plans for achieving universal health care in California.”
Rendon has been under pressure from progressive activists all summer, ever since he shelved SB 562, a bill passed by the state Senate on June 1 that would put all the state’s residents into a new, state-run single-payer healthcare system. At the time, he deemed it “woefully incomplete.” SB 562 did not specify how, exactly, the state would pay for single-payer.
The state Senate passed a bare-bones bill for a reason. They know that support will crumble once people learn about the ugly reality of single-payer.
Single-payer’s partisans point out that the idea has never been more popular. According to a recent Quinnipiac University poll, 51 percent of American voters support it. The Pew Research Center found that even 12 percent of Republicans favor single-payer, up from 7 percent just three years ago. And per an IBD/TIPP poll, 57 percent of those who are following the healthcare debate closely back single-payer.
Even doctors — who should know better — are warming to single-payer. A survey by physician recruitment firm Merritt Hawkins found that 56 percent support the idea. In 2008, 58 percent of doctors opposed it.
Single-payer is popular because its backers talk solely about its feel-good aspects — namely, “free” health care for everyone. Who could oppose that?
Sen. Bernie Sanders, I-Vt., who spent more than a year on the campaign trail touting “Medicare for All,” is only now promising to fill in some of the details. But not too many. Sanders and his followers want to “start the debate over whether health care should be considered a right, and then work out the details later,” according to an Axios story.
That’s good enough for California Sen. Kamala Harris, who last week announced that she would co-sponsor Sanders’s not-yet-existent single-payer bill.
The version of “Medicare for All” advocated by Rep. John Conyers, D-Mich., and 115 Democratic co-sponsors contains few specifics about how it would be paid for: a “modest” new payroll tax, a “modest” tax on unearned income, a “small” tax on stock and bond transactions and an unspecified tax hike on the “top 5 percent.”
When Nevada proposed to let people buy into Medicaid as a way to get closer to universal coverage, the bill the state’s governor ended up vetoing was just four pages long.
What happens when the details come out?
Sanders’s home state of Vermont was well on its way to a single-payer plan until its governor pulled the plug. The details doomed the plan. Then-Gov. Peter Shumlin, a Democrat, argued that an 11.5 percent payroll tax plus premiums of up to 9.5 percent of income “might hurt our economy.”
Coloradans had the chance to vote for single-payer last November. But when they saw the price tag — which included a $25 billion payroll tax — 80 percent voted against it.
Even liberals who embrace the notion of single-payer start to get nervous when they take an honest look at the nuts and bolts.
In a lengthy article published in The Nation — the self-proclaimed “flagship of the political Left” — Joshua Holland wrote that the “Medicare for All” proposals proposed thus far “may be virtually impossible to enact.”
He noted that single-payer would be hugely disruptive to the vast majority of Americans who already have health plans they like. That includes the 33 percent of seniors on Medicare Advantage, the increasingly popular option that lets them pick a privately administered health plan. The Obama administration repeatedly put off cuts to this program to avoid a huge political backlash.
Olga Khazan, writing in The Atlantic, pointed out that a single-payer system would likely push doctors out of practice, cause many hospitals to close, create longer waits for treatments, and lead to rationed care and fewer blockbuster drugs.
Real-world experience with single-payer systems shows that this is exactly what happens under single-payer.
For example, the Veterans Health Administration has been plagued by chronic and deadly delays, corruption, and massive amounts of waste.
In the United Kingdom, the National Health Service is suffering from a shortage of general practitioners so severe it’s planning to lower its standards for gaining entry to the profession. Trainees, for example, will be allowed to fail their exams five times and still practice medicine.
According to The Daily Mail, doctor morale is so low that 40 percent of general practitioners plan to retire within the next five years.
Day after day, British papers report on chronic delays in treatment. Earlier this year, for example, the NHS abandoned its goal of having non-urgent operations — including things like hip replacement and hernia repair — performed within 18 weeks because so few hospitals were meeting the target. The NHS also started denying surgeries that the government deemed of “limited clinical value.”
In Canada, delays continue to mount. The latest report from the Vancouver-based Fraser Institute shows that the median wait time to see a specialist is now 20 weeks — more than double the wait in 1993. Canadians wait nearly a month before getting a CT scan or an ultrasound, and almost three months for an MRI.
These aren’t chance occurrences. Shortages, overspending, waste, bureaucratic inertia, constant budget battles, and lack of innovation are endemic to government-run health care.
That’s why some single-payer advocates are pushing for single-payer in steps. There’s talk of lowering the eligibility age for Medicare, for example, or letting people “buy into” Medicaid. Anything to get a larger share of the public on government-run health programs — until they’re all that’s left.
No matter how it’s achieved, single-payer is a disaster.