Single-payer health care systems are frequently proposed as the solution to the problem of health care access for the uninsured.
While single-payer plans can guarantee that all citizens have a health insurance policy, they cannot guarantee access to medical care—much less prompt delivery of quality care to provide desirable medical outcomes.
Many nations have gone the single-payer route. From their experiences, we know single-payer plans inevitably control costs through a global health care budget . . . which means rationing of care and limited access to cutting-edge medical technology. Government-run health care systems are bureaucracies wrought with high and hidden administrative costs. As they bloat, more tax dollars are needed to support them, and taxpayers get less accountability in return.
During the last two legislative sessions at the state level, grassroots activists sought legislation or launched single-payer ballot initiatives in Alaska, California, Colorado, Florida, Illinois, Maine, Maryland, Massachusetts, Minnesota, Missouri, New York, and Oregon. For the most part, those initiatives failed. In Washington State, where single-payer most recently failed, Initiative 245 would have created a system in which a new state government entity would pay for basic health care for every state resident. The $10.4 billion plan would have been financed by a new business tax and premium payments or payroll taxes on individuals; governed by an un-elected board; and not subject to normal appropriations or oversight processes.
The Universal Myth
Despite the failure of many state initiatives, and the dramatic failure on the national level of the Clinton administration’s single-payer proposal, the Health Security Act of 1993, the states continue to test their waters for interest in single-payer health care. They inevitably phrase their survey questions and stump speeches to claim single-payer plans have the advantage of being universal: They serve everyone. Yet single-payer health care is anything but universal, in its approach or in its delivery of health care.
Single-payer plans inevitably exempt some employers from the tax required to fund the plans. Among those typically exempted are government entities: public schools, colleges, and universities; local fire and police departments, the city council, county board, and other governing bodies; local taxing districts; and, of course, the governor’s office and mayors’ offices across the state.
The workforces laboring for exempt employers are nevertheless eligible for benefits under single-payer proposals. In a government-run system of health care, then, the burden of paying for the system is borne entirely by those who are not government employees.
We Have Been Warned
Some countries with single-payer plans have experienced health care inflation lower than the double-digit growth experienced in the United States. But in order to hold costs down, virtually all decisions with regard to health care services and pricing are made by a centralized government bureaucracy. Here in the United States—with managed care, Medicare, and Medicaid—we’ve had only the smallest taste of the intrusiveness that accompanies a single-payer health care system.
Imagine being allowed to buy a car from only one manufacturer, or allowed to purchase your groceries from only one supermarket. What would happen to the innovation and customer-responsiveness that now characterizes those industries? Single-payer means dramatically limited choices for consumers, and that discourages creativity, risk-taking, efficiency, and quality among providers.
Government-run health care has its roots in nineteenth century European socialism. That alone should be a warning to policymakers considering single-payer proposals.
“We have become a prosperous nation by separating the economy and the state, not by making the state the source of employment, as have the communists, with the disastrous results known to all,” writes Dr. Thomas S. Szasz, professor of psychiatry emeritus at New York Upstate Medical University, in the Spring 2001 issue of The Independent Review. “We can become a healthy nation only by separating medicine and the state, not by making the state the source of health care, as have the communists, with similar disastrous results.”