Barack Obama just hopped aboard the single-payer bandwagon. During a speech at the University of Illinois at Urbana-Champaign earlier this month, the former president praised Democratic candidates for “running on good new ideas like Medicare for all.”
His endorsement of single-payer represents a bit of an about-face. As commander-in-chief, he opposed the idea. Politically, he recognized that a government takeover of the healthcare system would alienate the moderate voters that Democrats need to win elections. More importantly, he admitted that it would disrupt the care of millions of Americans — and not for the better.
Now that he’s out of office, President Obama can call for the government to seize control of one-sixth of the economy without worrying about what the two-thirds of Americans who aren’t Democrats think. But single-payer remains as ill-conceived today as it was during his presidency.
Obama used to downplay the feasibility of Medicare for All. In 2008, while campaigning for the presidency, he rejected the idea of replacing America’s health system with a government-run alternative, since “(m)aking that transition in a rapid way would be very difficult.”
A year later, after taking office, he explained to the American Medical Association that when opponents “claim that I’m trying to bring about government-run health care, know this — they are not telling the truth.” And just two months later, during a town-hall meeting in New Hampshire, he reiterated that “a transition to a (single-payer system) . . . would be too disruptive.”
Obama’s Secret Support
President Obama knew that single-payer would leave patients and taxpayers worse off. He didn’t want to be held responsible for the fallout.
What’s changed? Well, he’s no longer responsible for implementing policy. So he can endorse pie-in-the-sky proposals that motivate the Democratic base — and leave the hard questions about how to cover the trillions of dollars they’d cost to others.
In fact, he was a fan of single-payer before the political realities of the presidency got in the way. Back in 2003, when he was an Illinois state senator, Obama said, “I happen to be a proponent of a single-payer universal health care program.”
Single-payer also polls better now than it did a decade ago. From 2008 to 2009, support for government-run health care hovered around 46%. But according to an August 2018 Reuters/Ipsos poll, 70% of Americans — and 85% of Democrats — approve of single-payer.
That support wanes, though, once people learn about its specifics. Nineteen percent of those who favor single-payer switch their allegiance after hearing it will require higher taxes.
Fatal Delays In Treatment
Many Americans also don’t understand what Medicare for All would entail. Nearly half who currently get their insurance through their employers believe that a new national health plan would allow them to keep their plans. That’s not true — at least, not under S. 1804, the Medicare for All bill introduced by Sen. Bernie Sanders and co-sponsored by 16 Senate Democrats, including many with presidential aspirations in 2020.
Other countries’ experiences with government-run health care should further erode support for the idea.
Consider the United Kingdom’s National Health Service, which rations care to control costs. At present, more than 21% of cancer patients must wait over two months before starting treatment — a record high. During a heat wave this summer, overwhelmed hospitals turned patients away from emergency rooms.
Treatment delays often prove fatal. The number of British patients who die while waiting for care each year now totals nearly 30,000 — up from less than 19,000 five years ago.
Single-Payer: Limiting Access
NHS bureaucrats also limit access to medicines to keep spending down. In September, the agency announced it would not cover a new drug, ocrelizumab. The therapy can prevent patients with a degenerative form of multiple sclerosis from needing wheelchairs for up to seven years. Dozens of other medicines are similarly off-limits or heavily restricted.
The single-payer system in my native Canada is plagued by long wait times, too. Last year, patients seeking specialist care waited a median of more than 21 weeks between referral from a general practitioner to receipt of treatment from a specialist. Delays for some procedures are even longer. The median wait for orthopedic surgery is roughly ten months.
President Obama’s flip-flop on single-payer may represent an astute reading of today’s political winds. But those winds may shift after the public realizes that Medicare for All would consign patients to long waits for care and exacerbate the nation’s doctor shortage by driving physicians from the profession — all for a cool $32 trillion over its first decade.