If ever a single day and single event represented the rapid leftward lurch of the Democratic Party, September 13, 2017, would certainly qualify. On that day, in a crowded hearing room in the Hart Senate Office Building, Bernie Sanders, Vermont’s socialist senator, reintroduced his single-payer health care legislation.
When he had introduced his single-payer bill at the start of previous Congresses, the launches scarcely attracted notice. No other senator co-sponsored his bill in 2013; in the Congress that ran from 2015 through 2016, Sanders did not even bother to reintroduce single-payer legislation.1 But after Sanders’s upstart presidential campaign took on the Democratic establishment—and elevated the issue of single payer for the far left—his colleagues suddenly showed far more interest.
As Time magazine noted on that September day, “a lot more Democrats now back[ed]” the Sanders plan.2 Including Sanders, a total of 16 Democrats—one-third of the Democrats then serving in the Senate—co-sponsored his bill in the 115th Congress.3 That list included five Democratic senators who later declared themselves candidates for president in 2020: New Jersey’s Cory Booker; New York’s Kirsten Gillibrand; California’s Kamala Harris; Massachusetts’ Elizabeth Warren; and Sanders.4
The election of a Democratic majority in the House of Representatives in November 2018 only increased the focus on single payer. A majority of Democrats in that chamber had already endorsed single payer as of 2017.5 But gaining the House majority led leftist Democrats, including Rep. Pramila Jayapal (D-CA), to go further, asking for, and receiving, a commitment from incoming Speaker Nancy Pelosi (D-CA) to hold the first-ever legislative hearings on single payer.6
Jayapal reintroduced a single-payer bill in the House in February 2019. The bill followed Sanders’s 2017 blueprint, but exceeded it in several respects.7 The House followed up the bill’s introduction with the first-ever hearing on single payer, in the House Rules Committee.8 The very next day, the Congressional Budget Office released an analysis of the policy choices necessary to create a single-payer system.9
But amid all the enthusiasm on the left for single payer, few have bothered to consider the implications of enacting such a major piece of legislation. It would massively disrupt the American health-care system, to say nothing of the United States as a whole.
Consider but a few of the ramifications: Tens of trillions of dollars in new spending—and commensurate tax increases to pay for that spending. The abolition of all private health insurance. Ironically enough for a self-described “Medicare for All” bill, the abolition of the current Medicare program. Taxpayer-funded abortions, and requirements for doctors and hospitals to perform abortions. Massive increases in government control of our health-care markets. Likely rationing of care as the only means to control skyrocketing costs.
Surveys suggest that support for single payer drops precipitously once individuals understand its downsides.10 Yet few if any books have taken on single-payer health care to demonstrate its obvious shortcomings. Perhaps conservatives have thought the idea too preposterous or outrageous to believe that the Left would seriously attempt to enact such a wide-ranging, and radical, measure. But as the far-left enthusiasm of the last two years has demonstrated, those days of complacency have long since passed.
This work attempts to make a comprehensive case against single payer. It focuses primarily on two bills: Sanders’s legislation in the Senate (S. 1129 of the 116th Congress), and the Jayapal bill (H.R. 1394 of the 116th Congress) in the House. While those bills closely resemble one another, they do contain differences, and the book delineates those where applicable.
It also discusses the various “incremental” bills, some called “Medicare for More,” because while they sound more innocuous in nature, they will eventually lead to single payer—not least because their sponsors proclaim that as their goal. Finally, it outlines effective solutions to the problems ailing our current health markets, recognizing that only better alternatives can stave off total government control of health care.
Lest anyone think that references to Sanders in the pages following mean that the Left’s movement for single payer will end if and when his 2020 presidential campaign does, think again. In many respects, single payer now represents the mainstream position of the Democratic Party. This work represents one attempt to outline the sizable flaws with that approach, and point a way toward better solutions.
1 S. 1782 (113th Congress), the American Health Security Act of 2013.
2 Nash Jenkins, “A Lot More Democrats Now Back Bernie Sanders’s ‘Medicare for All’ Plan,” Time, September 13, 2017, http://time.com/4937840/bernie-sanders-health-care-single-payer-medicare-all/.
3 Among the 2017 co-sponsors, Sen. Jeanne Shaheen (D-NH) decided not to co-sponsor Sanders’s new bill (S. 1129) in 2019, and Al Franken (D-MN) had resigned from the Senate; all other co-sponsors remained on the legislation.
4 All five again co-sponsored Sanders’s bill in 2019.
5 Daniel Marans, “House Democrats See ‘Medicare for All’ as the Answer to Trumpcare,” Huffington Post May 24, 2017, https://www.huffpost.com/entry/john-conyers-single-payer-health-care-political-winner_n_5925a104e4b00c8df2a0da51.
6 Peter Sullivan, “Pelosi Supports Holding Hearings on ‘Medicare for All,” The Hill, January 3, 2019, https://thehill.com/policy/healthcare/423690-pelosi-supports-holding-congressional-hearings-on-medicare-for-all.
7 Chris Jacobs, “Democrats’ New Single Payer Bill Will Destroy Everything Good about Your Health Care,” Federalist, March 1, 2019, https://thefederalist.com/2019/03/01/democrats-new-single-payer-bill-destroy-everything-good-health-care/.
8 House Rules Committee, Hearing on H.R. 1384, the Medicare for All Act of 2019, April 30, 2019, https://rules.house.gov/hearing/hr-1384-medicare-all-act-2019.
9 Congressional Budget Office, “Key Design Components and Considerations for Establishing a Single Payer Health Care System,” May 1, 2019, https://www.cbo.gov/system/files/2019-05/55150-singlepayer.pdf.
10 Ashley Kirzinger, Cailey Munana, and Mollyanne Brodie, “KFF Health Tracking Poll—January 2019: The Public on Next Steps for the ACA and Proposals to Expand Coverage,” Kaiser Family Foundation, January 23, 2019, https://www.kff.org/health-reform/poll-finding/kff-health-tracking-poll-january-2019/.