Single Payer is Making Us the Stupid Party

The dramatic and stunning failure of the GOP’s Obamacare repeal efforts have sent single-payer advocates into a tizzy. Emboldened by public interest in new health care solutions, progressive activists have begun to loudly and aggressively demand that Democrats push for a single-payer system. Democratic politicians, eager to harness their enthusiasm, have being hopping on the bandwagon one after the other.

In all this excitement, though, we must stop and ask ourselves what we are actually supporting. Single payer, also called by its new focus-group-endorsed synonym “Medicare for all”, is the most extreme and challenging of the many health care options available. It is also the most politically unpalatable. This does not mean that we should not support it — if it was just a matter of courage and determination, I’d be 100% on board. But progressive activists frequently have difficulty defending single payer’s flaws, which are numerous and daunting, or explaining away its recent political defeats. They have charged full speed ahead in demanding single payer without stopping to think about the actual political and policy considerations required, or the enormous opportunity they are risking with this strategy. If the discussion carries on its current path, Democrats could be blowing a once-in-a-lifetime chance to solve health care in this country.

I have found in these discussions that many people see single payer as synonymous with “universal health care” and not only don’t understand the other paths to universal coverage, such as the public option or the multi-payer German system, but don’t even understand what single payer is. Here’s a crash course. The current flaw in Obamacare is that, while everyone can now get covered, that coverage must still come from private insurance companies (the “payers” for medical expenses), which often have inflated rates or poor coverage in certain regions. When Paul Ryan complains that many counties have no competition, this is what he’s talking about. One solution would be for the government to create a default medical insurance program (a “public option”) that’s universally available and competes with insurance companies to drive rates down. Another solution would be to get rid of all the insurance companies and have the government handle all medical payments (“single payer” because only the government pays for medical bills). These are just two of a diverse array of health care strategies that have been analyzed over the last few decades. Obamacare was one vote away from including a public option, with Joe Lieberman joining Republicans to cast the decisive “no” vote. Single payer has never been seriously attempted legislatively.

The rhetoric of progressives on single payer is heavy on applause lines and light on policy specifics. But policy specifics matter. A single-payer plan introduced in California would have cost $400 billion per year. A similar proposal in New York would have cost $200 billion a year. That’s more than we spent on the entire Department of Defense last year, and for just two states. The California plan would have been paid for by a 15% payroll tax increase. I don’t know about you, but I wouldn’t want to move to California if it meant paying 15% more in taxes for health coverage I already have for free through my employer. These are real consequences that voters will suffer under single payer.

Single-payer advocates have also failed to address long lines and rationing, key issues that plague other single payer nations. In Canada, for instance, patients must wait an average of 4.5 months to get treatment after referral to a specialist. Many Canadians in emergency situations come to the United States, where there is no wait. Another elephant in the room is the fact that the government in single-payer nations is often able to artificially reduce spending by setting mandatory prices for drugs. American companies, which discover more than half of all new drugs, must adhere to those prices if they want to enter the national market — and many choose not to, depriving citizens of those drugs. If the United States wanted to match the low costs of other nations, it would also have to set drug prices, at risk of stifling innovation, repelling drug companies, and depriving patients of needed medicine. And these complications are only the tip of the iceberg. What effects will eliminating the massive insurance industry have on our economy? How much health care will be permitted in expensive end-of-life situations? What if you are in an emergency and want to pay out of pocket for faster or experimental treatment? These are questions that demand serious policy answers, not simplistic campaign rhetoric.

Whether or not these arguments against single-payer are credible, though, is really beside the point. Regardless of whether the policy is adopted, such a debate would be very healthy for the country to have. The main problem, though, is that we are not having a debate. Instead, single-payer has been turned into a litmus test for Democrats. Progressives across the country are demanding that Democratic candidates pledge to support single-payer to earn their support, with all other universal health care options deemed unacceptable at best or evidence of corruption at worst. A common accusation is that pragmatism and caution on the part of Democratic politicians is really cowardice, or an attempt to appease wealthy donors. In Georgia, for instance, Jon Ossoff was crucified by progressives for advocating an incremental approach over a direct shift to single-payer.

“Sadly, thousands of progressives have given lots of money to someone who opposes a popular program central to progressives,” said Michael Lighty, the policy director of National Nurses United, on Ossoff’s rejection of a single-payer plan, calling it “another example of how corporate Democrats misread voters and align with the health care industry over patient.”

Supporters of single-payer also frequently engage in intellectual dishonesty by claiming a tremendous majority of Americans support single payer. They frequently achieve these numbers by conflating the popularity of universal coverage with popularity for single payer. When you give Americans the details of single payer, such as the degree of tax increases and government provisioning required, the policy’s popularity collapses. Recent proposals for statewide single payer systems in Vermont, California, and Colorado were overwhelmingly rejected by voters for being far too expensive. Claiming victory because Americans support a label but not its details is just as dishonest as when the GOP crows about Americans hating Obamacare while polls show them supporting its individual components. Such dishonesty is largely harmless in the context of an intraparty policy debate, but would quickly be met with devastating reality if the party ever tried to woo moderates and conservatives with single payer.

Democrats have a golden opportunity right now to make real improvements to Obamacare. Republicans are already turning to Democrats to craft real compromise-based policies to improve the system. The public is disillusioned with the GOP’s health care failures and turning to us for ideas. We need to leave campaign rhetoric at the door and have an honest, detailed and straightforward conversation with the public about different options for achieving universal health care. Let’s not squander this opportunity by making “single payer or bust” the hill we die on.