The Real “Single Payer” Is You, the Taxpayer

Democrats, like lemmings following their leader head-first off a cliff, are apparently wont to plunge to their political death. Nothing else could explain their newfound embrace of so-called single payer health care, a policy idea that even Hillary Clinton said “will never, ever come to pass.”

And with good reason. Single payer health care is a terrifically awful idea that Democrats are spending a good amount of time these days convincing themselves is a brilliant one.

Ben Tulchin and Ben Krompak reports for the Sacramento Bee that the idea is quickly becoming a litmus test for the party.

Following California’s lead, Democrats nationally are embracing plans to expand Medicare to provide all Americans with health insurance. The trend is substantive and strategic, as the party seeks remedies to the country’s health care challenges, and looks to rebuild its base with working class voters facing rising health care costs. …

Today, with the California Senate passing a Medicare for All bill and states such as New York considering it, support for Medicare for All legislation championed for 15 years by Rep. John Conyers, D-Mich., has grown from 25 sponsors in 2003 to 111, a majority of House Democrats.

In the Senate, single-payer champion Bernie Sanders, who made Medicare for All a centerpiece of his surprisingly strong 2016 presidential campaign, has emerged as the leading Democratic voice on health care.

California demonstrates the problems that Democrats will face in moving from a politically popular idea to a crushing political reality. The Golden State has made the incredible promise of not just single-payer, but “free” government-run health care in which California residents will have no out of pocket expenses like co-pays or premiums and can receive any treatment that a provider deems medically appropriate. Somehow, Democrats believe that this will not have any impact on how patient’s utilize the system or how providers encourage the use of care.

That, quite simply, is fiscal insanity. Even Democrat Governor Jerry Brown, who saw the state returning to insolvency under the plan, used the Latin phrase “ignotum per ignatius” to describe it. “In other words,,” he said, “you take a problem and say, ‘I’m going to solve it by something that’s even a bigger problem,’ which makes no sense.”

That bigger problem is a complete inability to control costs, which could ultimately make the legislation’s already-exorbitant $400 billion price tag look downright affordable. Then again, Democrats’ other single-payer idea, colloquially sold as “Medicare for all,” suffers from the opposite expectations problem – it won’t offer nearly the level of benefits that people expect for the price it will cost.

For instance, Medicare requires premiums and co-pays from its enrollees, and those premiums are related to the relative costs of the program. That means that the out-of-pocket costs—just as we’re seeing with Obamacare—are likely to go up since costly, sick individuals are the ones most likely to buy-into the program.

Notably, Medicare also doesn’t cover certain things; namely, long-term care, which is one of the most significant medical expenses Americans face. And whereas Medicare has a fairly generous reimbursement rate, the only way for a single-payer solution to save money is to pay health care providers less money. Ezra Klein (who is certainly no conservative) explains in Vox,

“The real way single-payer systems save money isn’t through cutting administrative costs. It’s through cutting reimbursements to doctors, hospitals, drug companies, and device companies.

But to get those savings, the government needs to be willing to say no when doctors, hospitals, drug companies, and device companies refuse to meet their prices, and that means the government needs to be willing to say no to people who want those treatments.”

That goes against the entire foundation for Democrats’ pursuit of single payer, i.e. the idea that they can give away “free” government services without having to say “no” to anyone.

In other words, while chasing a political win-win that allows them to appeal to their populist base while also putting pressure on Republicans’ health care plan, they’ve actually created a lose-lose by setting expectations that they’re able to achieve both choice and affordability in the same plan. They can’t. But that hasn’t stopped them from chasing Bernie Sanders, the chief lemming, straight over the single-payer cliff.