In a surprising twist, debate on health care in Washington has pivoted from Republicans’ failed bid to repeal “Obamacare” to Democrats pushing the ultimate progressive program — single-payer health care. In a nutshell, that’s free health care, on the federal government’s tab. Think Medicare for everyone. In theory, it sounds great — who doesn’t like “free” stuff — except someone would end up paying for that massive program, and in the end, financial models show it’s not workable. Fact check: These are not Republican talking points, but critical remarks some prominent Democrats across the U.S. have made in dismissing the premise of single-payer care, mostly due to financial concerns. While President Donald Trump has vowed to veto any single-payer plan, here are several other reasons single-payer health care faces an uphill battle.
4. Vermont Dropped Single-Payer Proposal Due to Cost
In 2014, Vermont Gov. Peter Shumlin, a Democrat, announced he had abandoned his plan to enact single-payer care in the state. Shumlin said the plan, which would have levied tax increases on people and businesses, could create “economic disruption” and be “detrimental to Vermonters.”
“These are simply not tax rates that I can responsibly support or urge the Legislature to pass,” the governor said. “In my judgment, the potential economic disruption and risks would be too great to small businesses, working families and the state’s economy.” If one of the most liberal/progressive states in the nation can’t find the political will to enact single-payer care on a relatively small scale (Vermont has roughly 625,000 residents) that doesn’t bode well for its chances in a nation of more than 300 million people.
3. Poll: Americans Unsure About Single-Payer
A 2016 Gallup poll found that 52 percent of Americans say health-care coverage is a “government responsibility.” That’s consistent with other polls in recent years, with Democrats strongly in favor and Republicans opposed. But a Kaiser Family Foundation poll in 2017, which found 55 percent favored single-payer health care, showed almost 60 percent were opposed if they were told it would require Americans to pay more in taxes. Clearly, universal care is going to be a tough sell for many Americans who already have good health care plans through their employer or elsewhere.
2. Lawmaker Kills Single-Payer Plan in California
California lawmakers considered a bill this year that would offer universal health care coverage to all state residents. But critics pounced on the idea after a cost estimate for the bill reached $400 billion per year — more than twice the state’s annual budget of $180 billion. In July, California State Assembly speaker Anthony Rendon killed the bill, citing it as “woefully incomplete,” with no specific information on how the plan would be financed. His move drew harsh criticism, and even death threats, from liberals and progressives in the state. Supporters argue the plan could be done for significantly less, and that eliminating various layers of government and private bureaucracy could make the system even more cost effective Yet once again, if a state where progressives control the capitol can’t get a universal care deal done, and leaders are balking at the cost, that shows the concept has a hard road ahead in the U.S.
1. Canada’s Health Care System Beset by Problems
For years, progressives have pointed to Canada’s national health care plan as a shining model for U.S. single-payer care. But critics contend that country’s Canada Health Act system has many problems. The biggest issue is access to care, with citizens facing months-long waits to see a specialist, and further lengthy waits after those specialists recommend a procedure. This is not only an inconvenience: Forbes notes that one study estimated that between 25,456 and 63,090 Canadian women may have died because of increased wait times between 1993 and 2009.
For wealthier Canadians, that’s not a problem — they cross the border into the U.S. to Buffalo, Detroit, Cleveland, etc., to seek specialized care. One Canadian think tank estimated more than 52,000 Canadians got treatment outside the country in 2014. Other CHA woes are akin to problems facing Medicare in the U.S. An aging population is counting on younger workers to keep the system going. Costs continue to rise, with Canadian provinces spending around 40 percent of their budgets on health care. And the long-term cost projections are even scarier. In the end, even proponents of single-payer care in the U.S. have come to realize Canada’s system might not be the best example to follow.