Politics & Policy

No to Single-Payer

Sen. Bernie Sanders introduces the “Medicare for All Act of 2017” on Capitol Hill, September 13, 2017. (Yuri Gripas/Reuters)

Fifteen Democratic senators have signed on to a universal-health-care bill introduced Wednesday by independent Bernie Sanders. Dubbed “Medicare for All,” the bill is light on specifics, but it constitutes an undisguised proposal to nationalize health care. The most important consideration is that single-payer is a bad idea that would cede control of one-sixth of the American economy to the government.

Senator Sanders’s arguments are heavy on populist bromides. He says the path toward single-payer ought to be straightforward, and sinister corporate interests are the only obstacles standing in the way. But the truth is that a plan like his would threaten people’s existing coverage. While insurance companies certainly want to stay in business, the fundamental roadblock to single-payer is not that politicians are beholden to them. It’s that many Americans are satisfied with their current coverage and would like to keep their doctors.

A true single-payer plan, one that replaces the panoply of available private insurance plans with just one offered by the government, would obviously infringe upon their liberty to choose their own health-care arrangements. President Obama sought to allow Americans to keep their existing plans with his Affordable Care Act and, infamously, failed. And Sanders’s plan represents a far more drastic assault on the market than Obamacare did. While Obamacare implemented onerous regulations on insurers and required citizens to purchase insurance, it did not in the end fundamentally transform the health-care system. “Medicare for All,” by contrast, would expand Medicare to cover people of all ages within four years, and effectively phase out private insurance by forbidding employer-based coverage to offer the same benefits as the government.

Weaker iterations of single-payer try to evade the problem by allowing people to keep their coverage, at least initially: Consumers can buy in to the public system if they so choose, but are not forced into it. But for the public plan to be workable, it would have to attract consumers. And to attract consumers, the system would have to be made attractive. That costs money.

Indeed, any single-payer plan, whether it forces citizens to participate or permits consumer choice, would be colossally costly. It’s no surprise, then, that Sanders’s plan is thin on details. The plan he introduced during the 2016 election would have inflated the federal budget by trillions of dollars, necessitating a massive tax hike — and not just on the rich. This time around, the senator is not willing to say how much he’d raise taxes. That’s for good reason.

Two of the country’s most liberal states make for instructive cases. California’s legislature, where Democrats have supermajorities in both houses, recently considered a single-payer plan only to balk when the price tag was calculated to be more than double the state budget. Vermont’s legislature actually passed a single-payer plan three years ago. The state abandoned Green Mountain Care, however, when it came time to actually appropriate funds for the program. Advocates of single-payer tout its supposed popularity among Americans, but these blue-state lawmakers, and properly designed polls, have found that it becomes less attractive when its realities are laid bare.

Nationalizing health insurance would have further destructive consequences, creating a system governed by political rather than market incentives. A single-payer system would devote resources to people who are mildly sick. It could well be popular, as many people would have positive experiences. But the investment of capital spurred by economic incentives has made the American health-care sector the most innovative in the world. While those innovations do not offer immediate political rewards, they benefit those with more-serious ailments, especially over a longer time horizon. Despite the rhetoric of its supporters, single-payer is not the more humanitarian approach.

That Democrats are moving in its direction is dispiriting, but predictable. Our health-care system was flawed when Obama came along, and Obamacare made it worse. People still can’t purchase cheap, renewable catastrophic coverage for themselves thanks to the law’s regulations, and there have been loud demands to fix the system.

Such a fix could be accomplished with reforms designed to cultivate a functioning marketplace, removing regulations on the types of plans companies can offer while keeping tax credits in place for Americans who need assistance. Democrats, however, prefer the alternative of direct government control. If we don’t move toward the first, we will continue to drift in the direction of the second. That would be unfortunate in the extreme.

    READ MORE:

    How the Dems Push for Single-Payer Could Get Trump Re-Elected

    Who’s Really Paying for Single-Payer

    How FDR’s Legacy Will Prevent Single-Payer

Most Popular

U.S.

The Coming Anti-COVID Restriction Backlash

The backlash is coming. It already seems clear that the first major political and cultural eruption of the Biden years will be a roiling populist backlash against the next round of COVID restrictions. We saw this sentiment play out in sporadic anti-lockdown demonstrations last spring, and it has driven ... Read More
U.S.

The Coming Anti-COVID Restriction Backlash

The backlash is coming. It already seems clear that the first major political and cultural eruption of the Biden years will be a roiling populist backlash against the next round of COVID restrictions. We saw this sentiment play out in sporadic anti-lockdown demonstrations last spring, and it has driven ... Read More

The Rural Way

Almost every national Election Night reveals the same old red/blue map. The country geographically is a sea of red. The coasts and small areas along the southern border and around the Great Lakes remain blue atolls. Yet when the maps are recalibrated for population rather than area, the blue areas blow up, ... Read More

The Rural Way

Almost every national Election Night reveals the same old red/blue map. The country geographically is a sea of red. The coasts and small areas along the southern border and around the Great Lakes remain blue atolls. Yet when the maps are recalibrated for population rather than area, the blue areas blow up, ... Read More
The Economy

Here Comes the Biden Blame Game

During the eight years that President Obama and his team managed the economy, Americans were regularly assured that the president’s Keynesian policies would deliver striking growth in the years ahead. The growth repeatedly failed to materialize, and what followed was a master class in blamesmanship. No matter ... Read More
The Economy

Here Comes the Biden Blame Game

During the eight years that President Obama and his team managed the economy, Americans were regularly assured that the president’s Keynesian policies would deliver striking growth in the years ahead. The growth repeatedly failed to materialize, and what followed was a master class in blamesmanship. No matter ... Read More
Elections

A Hard Look at Those Post-Election Legal Efforts

On the menu today: Michigan certifies its vote totals; the General Services Administration starts the transition; and it’s time for a hard, unflinching look at the president’s post-election legal efforts. What Did the President Get from His Legal Team? Michigan and Georgia have certified their election ... Read More
Elections

A Hard Look at Those Post-Election Legal Efforts

On the menu today: Michigan certifies its vote totals; the General Services Administration starts the transition; and it’s time for a hard, unflinching look at the president’s post-election legal efforts. What Did the President Get from His Legal Team? Michigan and Georgia have certified their election ... Read More
History

From Hate to Heroism

Welcome to “The Tuesday,” a weekly newsletter about language, culture, politics, and, lately, relentless book-hawking. To subscribe to “The Tuesday” and receive it in your inbox, please follow this link. From Hatred to Heroism Daniel Cordier, when he was young and getting started in life, did not seem ... Read More
History

From Hate to Heroism

Welcome to “The Tuesday,” a weekly newsletter about language, culture, politics, and, lately, relentless book-hawking. To subscribe to “The Tuesday” and receive it in your inbox, please follow this link. From Hatred to Heroism Daniel Cordier, when he was young and getting started in life, did not seem ... Read More