The Corner

Health Care

Single Payer Has Two Big Problems

Over the last few weeks, one of the problems with Medicare for All has gotten a fair amount of attention: its price tag. But that’s not actually the biggest political liability the idea has. An even larger obstacle is that it would entail upending the existing health-insurance arrangements of scores of millions of people, most of whom express satisfaction with those arrangements. As I wrote at Bloomberg Opinion recently, Democrats designed Obamacare the way they did in large part to avoid causing such disruption — and suffered politically to the extent they did not succeed. Democrats have also exploited fear of disruption to great political effect against Republicans, as in 2008 and 2017.

Ryan Cooper, writing for The Week, does not think Democrats should be concerned that the prospect of disruption will doom their policy ambitions. Medicare for All, he notes, would radically reduce the amount of disruption in health-care arrangements: People would no longer have to switch plans because they switched jobs, or have their employer change their insurer, or find that their insurer is no longer participating in an Obamacare exchange.

I think he is underestimating the political difficulty, which is rooted in a widespread conservative sentiment, albeit a conservative sentiment that sometimes stymies free-market health-policy changes. Most people have their complaints about the health-care status quo, but they are skeptical of promises that things will be better if the government remakes the system. Whether conservatives or liberals are telling them that a brand new system will let them pay less and have just as high a level of quality, they’re going to be a hard sell on giving up what they already have. I suspect that when people tell pollsters that they are satisfied with their insurance — as most respondents do — what a lot of them mean is, Please don’t screw around with it. Telling them that once they’re in the new system they won’t be able to leave is probably not going to allay their anxiety.

Ramesh Ponnuru — Ramesh Ponnuru is a senior editor for National Review, a columnist for Bloomberg Opinion, a visiting fellow at the American Enterprise Institute, and a senior fellow at the National Review Institute.

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