Stalled in D.C., the Single-Payer Fantasy Makes Its Way to Blue States


Despite the best efforts of progressives such as Senator Bernie Sanders (D., Vt.) and Representative Pramila Jayapal (D., Wash.), Medicare for All is off the table in Congress — for now, at least.

But that doesn’t mean single-payer health care is dead. Like a zombie, the idea is being revived in blue-state capitals across the country.

In California last month, a bill to create the nation’s first state health-insurance monopoly was ratified by the state assembly’s Health and Appropriations Committees before dying without a vote on the Assembly floor. Progressive Democrats and the California Nurses Association are furious, and say that they’ll keep trying to ram the bill through.

In New York, where Democrats control the state assembly and senate, senior leaders have begun negotiations with public-sector unions and other special-interest groups in hopes of winning their support for a statewide single-payer plan.

Similar efforts are under way in at least 19 other states.

Single-payer advocates persist in the belief that their cause is not only a moral imperative but also popular. Their rhetoric is seductive. Health care is a right, they argue. A wealthy country such as ours should be able to provide universal health coverage to all its citizens, just as other developed nations do.

But single-payer health care’s track record is disastrous.

The closest thing the United States has to a single-payer system is the Veterans Health Administration, which is best known not for quality health care but for the 2014 scandal that exposed its long record of incompetence, negligence, and fraud. Wait times at VA clinics got so long that dozens of patients died before ever seeing a doctor.

The scandal was eerily similar to one that occurred a few years earlier in the United Kingdom, where National Health Service hospitals tried to improve their wait-time statistics by keeping patients waiting in ambulances rather than letting them inside and starting the clock. Officials today predict that one in five people in England could be on a waiting list for medical care by 2024.

In Canada’s single-payer system, only the government can provide care deemed “medically necessary.” The median wait last year for treatment from a specialist following referral by a general practitioner was more than 25 weeks — nearly half a year.

Single-payer advocates in the U.S. look at what doctors get paid abroad and conclude that there’s a lot of room to trim compensation here. The difference can be striking. One study pegged average doctor salaries in the United Kingdom at about one-third of those in the United States. Canadian doctors also make less than American ones.

That could explain why the United Kingdom and Canada are beset by large and growing doctor shortages. If a state actually implements a single-payer system and tries to reduce doctor compensation accordingly, you should expect its physicians to move elsewhere, take early retirement, or change professions.

The “free” care that single-payer proponents promise is actually quite costly to taxpayers. New York’s bid for single-payer would require $250 billion in new taxes — more than triple the Empire State’s total tax revenue in 2020. The proposal that just fizzled in California was projected to cost as much as $391 billion, 36 percent more than the entire state budget proposed by Governor Gavin Newsom for 2022–23. And the version of Medicare for All that Senator Sanders stumped for on the presidential-campaign trail would have cost at least $32 trillion over ten years.

There’s a reason that countries with single-payer health care tax their middle classes at much higher rates than we tax ours. The average Canadian family of four, for instance, pays more than $15,000 in taxes just to cover the cost of public health insurance.

Proposed taxes were the undoing of Vermont’s single-payer plan back in 2014. The state projected that it would have taken new 11.5 percent payroll and 9.5 percent income taxes to pay for state-run health insurance. After he saw those numbers, then-governor Peter Shumlin pulled the plug on the plan, admitting that the taxes would have crippled the state’s economy.

Enthusiasm for single-payer may be waning among Democrats in Congress. But their brethren in blue-state capitals are taking up the fight. Patients — both present and future — need to push back against this wave of single-payer enthusiasm, lest they lose the health-care system that they’ve come to count on.

SALLY C. PIPES is the president, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. @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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