Medicare for All is struggling to gain traction at the national level. Some progressives are hoping that left-leaning states will instead be able to lead the way.
This month, California Democrat Rep. Ro Khanna introduced the “State-Based Universal Health Care Act,” a bill that would let states take all the healthcare money they get from the federal government—for Medicare, Medicaid, veterans care, Obamacare, and the like—as a block grant they could use to help pay for a single-payer system.
“This bill allows states with bold leadership to establish their own successful universal health care programs in order to prove how viable our movement is on the national level,” Rep. Khanna said.
The plan comes with a host of problems. For starters, several states have already ventured down the road to single-payer—and failed to get there.
In 2011, Vermont’s then-governor Peter Shumlin signed a state-based single-payer plan into law. The idea was to get waivers to pool federal funding into a government program that would cover everyone in the state.
Three years later, Gov. Shumlin abandoned the idea after concluding it would double Vermont’s budget and require massive new taxes that he said would pose “a risk of economic shock.”
Rep. Khanna’s home state of California has also tried to enact single-payer—and failed. In 2017, the state Senate approved a government takeover of the state’s health insurance sector. But even though Democrats controlled the governor’s mansion and both houses of the state legislature, the plan died in the Assembly without a vote. That’s because the proposal would have doubled the state budget—and required a $200 billion tax hike.
Nearly 80% of Colorado voters voted against a 2016 ballot initiative, Amendment 69, that would’ve put the state on the path to single-payer. Even the Democratic governor at the time, John Hickenlooper, urged people to vote against the initiative. Concerns about cost were a significant factor. The Colorado Health Institute analyzed the plan and found that funding would fall $8 billion short within ten years despite massive tax increases.
Rep. Khanna doesn’t think that these states’ experiences are relevant. Instead, he cites Canadian history to defend his plan. “Our neighbors in Canada established their own successful national health program by allowing the province of Saskatchewan to lead with a universal hospital care program in 1947,” he said.
In other words, ignore single-payer’s recent history in Vermont. And California. And Colorado. And look instead to Saskatchewan 70 years ago.
Canada’s healthcare system is not one the United States should wish to emulate. Consider the waits that Canadians must endure for care. The median wait time to receive treatment from a specialist following referral from a general practitioner is 19.8 weeks.
Getting to a doctor is also a tremendous challenge. More than one-third of Canadians must travel an hour or more to find a medical facility that can perform an angioplasty—a common procedure to restore blood flow through an artery—according to a 2010 study published in the journal Open Medicine. In the United States, fewer than 20% would have to go that far.
Even a trip to the emergency room in Canada doesn’t guarantee prompt care. One study found that 29% of Canadians waited four or more hours in the emergency room. In Quebec, more than half did.
In the United States, only 11% of patients had to deal with those sorts of waits.
These sorts of delays aren’t just dangerous for Canadians’ health—they’re costly. In 2018, waiting for treatment cost Canadians about $2.1 billion. And that’s only considering hours lost during the standard workday. Add on weekends and time typically spent outside the office, and the total economic cost of those waits is $6.3 billion, or more than $5,800 per person.
Canadians who can afford to opt out of those waits often do so by traveling abroad for care. In 2017 alone, patients made as many as 217,500 trips outside the country for health care, according to a report from SecondStreet.org, a Canadian think tank. They spent roughly $690 million out of pocket on care. That’s in addition, of course, to the thousands or even tens of thousands of dollars that the typical Canadian family pays in taxes to fund their country’s public healthcare system.
Rep. Khanna’s bid for state-level single-payer is unlikely to gain traction as long as Republicans control the Senate and White House. But there’s an election in less than a year that could change all that. Let’s hope Americans wake up to the fact that, they’d face long waits, rationed care, higher taxes, and a doctor shortage under single-payer.
Sally C. Pipes is president, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute.