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May 30, 2017 at 09:16 AM
(Bloomberg View) — Single-payer health care is the dream that just won’t die.
Eight years ago, when President Barack Obama came into office, there were folks on the left who hoped that somehow, his campaign concept of health care-reform-by-mandate-and-subsidy could be transformed into a single-payer system like Britain’s or Canada’s. When it became clear that this wasn’t going to happen, they latched onto the idea of a “public option” that could, by out-awesoming all the private insurers, function as a backdoor route into a unified government system.
(Related: Health Agents Fight Single-Payer Storm With Tornado)
The public option vanished from the final bill, but the dream did not die. In 2014, as Obamacare finally rolled out, Vermont proposed building its own single-payer system, and hearts went a-flutter at the thought that plucky Vermont might show the rest of us how it’s done.
I predicted at the time that the plan would be too expensive, and therefore never go into effect. Eventually Vermont’s government confessed that it was too expensive, and would not go into effect. Vermont was not done with us, however, and in 2016, Vermont Sen. Bernie Sanders kind-of-almost-came-close to winning the Democratic nomination on the slogan of “Medicare for All.” He lost to Hillary Clinton, and she lost to a candidate whose platform turns out to look more like “Medicaid for None.”
Hope springs eternal, however, and so do single-player plans. Their last run at the federal government having failed (along with a referendum in Colorado that voters rejected four to one), advocates are back at work in state legislatures. California and New York are both considering plans at the moment, and not just in the “Hmm, interesting. What’s for lunch?” sense. Say what you want about single-payer advocates, but say this too: You can’t stop them with much less than a Howitzer.
Of their plans, there are a few things to say. The first, and most obvious, is that none of them have solved the main obstacle to enacting single payer in the U.S.: the price tag.
Casual believers in single payer often eyeball European governments, eyeball what the U.S. spends, and conclude that there must be fabulous cost savings to be had from a single-payer system, making it easily affordable even for states on a tight budget.
Folks actually charged with designing a single-payer system know the truth: single payer will not make health care cheap.
Analyses by single-payer-friendly sources (such as Gerald Friedman of UMass Amherst, and the heavily Democratic California state senate) tend to indicate that moving to single payer would involve roughly doubling the budgets of even high-tax, high-spending states like New York and California.
