The Willful Ignorance of Single-Payer Advocates

 

• Medicare for All proposals ignore the baseline reality that 92% of Americans already have health coverage, and most of the uninsured are eligible for assistance.
• Single-payer systems come with major tradeoffs, including higher taxes, fewer drug options, and potential hospital closures, especially in vulnerable communities.
• Advocates like PESP sidestep these consequences, promoting slogans over substance and offering misleading analysis to advance their agenda.

The most important question when evaluating a policy change is often: “Compared to what?” Policies can look very different when considered relative to the status quo or a counterfactual. When considering the budgetary effects of policy changes, this counterfactual matters a great deal – it is the yardstick against which costs are measured. When policymakers celebrate expanding programs or deride cuts to spending, those observations are relative to some alternative, but it’s important to understand what that alternative looks like. There is perhaps no policy debate more bereft of this type of analysis than that related to health care, particularly surrounding single-payer health systems.

The U.S. Health Care System in Perspective

For advocates of single-payer health care in the U.S., such as those supporting its most recent incarnation known as Medicare For All, there is likely a deliberate unwillingness to grapple with the realities of the U.S. health care system, while looking longingly to utopian visions of “free” and abundant access to care. The reality of the U.S. health care system is that the vast majority – 92 percent – of Americans already have health coverage, most of which is provided by employers. Smaller shares are covered by existing government programs or non-group providers. Of the remaining 8 percent that are uninsured, most are eligible for public assistance. It is unclear how much Medicare For All would further close this gap.

Blind Faith and Willful Ignorance

Advocates don’t necessarily want to grapple with these realities – the slogans are too catchy. Senator Bernie Sanders is perhaps the most conspicuous of the health care utopians, characterizing Canada’s single payer system as “free,” while lamenting the cost of pharmaceuticals in the U.S. as well as a lack of health coverage.

The last point, as noted above, is typically incorrect. His remaining claims are equally misleading. Single-payer systems are never free. Indeed, Senator Sanders’ health plan required a host of new taxes: a 52 percent top income tax rate, a new wealth tax, higher corporate taxes, and more. Yet, even with all that, it still came up trillions short. Related, Canadians have access to only a scant fraction of the pharmaceuticals that are essential to innovative new therapies. Indeed, for cancer patients, Canadians only have access to 11 percent of cancer drugs, compared to 90 percent in the U.S.

Some advocates for single-payer will never grapple with the realities of the U.S. health care system. For example, the Private Equity Stakeholder Project (PESP), along with its staff’s labor union, advocates for single-payer while deriding private investment in health care systems. These organizations serially deny the tradeoffs involved in moving towards a single-payer system. As a 2020 study noted, Medicare for All involves risks of hospital closures and significant shortages of physicians and nurses. This shortage will be felt most acutely in rural and otherwise vulnerable communities.

PESP has a clear agenda. It is willing to engage in misleading analysis to support it. Unfortunately, in the health care debate, they are hardly alone.

https://pinpointpolicyinstitute.org/the-point/the-willful-ignorance-of-single-payer-advocates/