The fatal attraction of single-payer

Advocates for a single-payer health care system address legitimate concerns for the shortcomings of our prevailing system.  They philosophically believe that a free market has limitations, especially in an area of such individual and social importance as our health care system.  They also believe that single-payer systems abroad with vastly different dynamics have admirable results that we can emulate by adopting their more evolved solution.

Reform is seductive.  It is like the curvy woman with the soft voice you met at the bar.  The next thing you know, you have a boiled bunny in your kitchen.  The faults of the status quo are always clear, even when the causes of these faults are not.  The successes of reform are promising but unconfirmed.  It is the choice between the chemo that has been used for decades with a 30% chance of success and the new discovery with great hype but little empirical data.

The status quo is entombed in dozens of volumes, many in their third printing.  The results of reform haven't made it into a first draft.

Single payer is a magical solution that circumvents the greed of those who profit from health care.  It can reduce costs and improve access without any sacrifice of quality, innovation, or service (wait times).

It can eliminate the inefficiency of competition and ill informed consumers.  It is a stunning irony that to justify single-payer and other market restrictions, such as certificate of need for new hospitals, the progressives use the same justification as the robber barons of the Gilded Age, when they created vast trusts and monopolies to better serve their customers. 

Progressivism, developed to protect us from the commercial special interests, has become the special interest that threatens us.  The single payer decides which health care administrator, new life-saving product, or treatment facility lives or dies.  J.P Morgan and John Rockefeller would be envious.

This new efficiency in administration, unfound anywhere else in our government, will be free of the fraud that plagues Medicare and every other government health care program.  The difficult decisions individuals face when managing their health care will disappear when we assign these decisions to a bureaucrat removed from the cost and the outcome of the decision.

Greed and human bias that plague the health care market will be replaced by the rational angels who will administer the single-payer system.

Health care is not a single stock-keeping unit (sku) on the shelf; it is a market with thousands of products and services.  Most of it is non-emergency and quite responsive to market competition.  To insinuate that market forces are irrelevant because of the inability of a gunshot victim to negotiate is not at all different from suggesting that we require single-payer for food distribution because a starving person is poorly positioned to compare prices.

Our health care system is plagued by an accumulation of perverse incentives, mandates, cross-subsidies, market restrictions, and lack of accountability.  Yet the single-payers think the problem is the free market and the inability of health care to respond to market forces.  The problem is that it does respond, and we wish to pretend it doesn't.

We want high-quality, universally available health care but don't want to pay for it.  States that sought single-payer quickly abandoned the idea when the cost became clear.  Our cross-subsidy is a trap.  Medicare costs are partially born by increased charges to privately insured patients.   This subsidy is eliminated with single-payer, and the true cost becomes glaringly visible.

Let the market function where it can, which it can in most health care decisions.  Regulations should increase competition and reduce market barriers.  Health care for the poor should be funded honestly and transparently.

Single-payer can improve access, but at a cost we wish to obscure.  Countries with single-payer have experienced significant cost increases even while quality, innovation, and wait times have worsened.

Free-market thinkers are considered ideologues blind to the suffering of those without health insurance, which is quite different from being without health care.  But single-payers are also quite blind to the true costs of centralized control, and thus easily seduced by promises without a price.

Henry Oliner blogs at