7 Inconvenient Truths About Single Payer

Give Senator Bernie Sanders credit: he’s been consistent on single payer for years. He reintroduced his signature legislation this spring and has made a government-run health care system the cornerstone of his 2020 campaign. Still, many are unclear about the stark realities of his plan. Here are seven inconvenient truths about single payer.

1. Single payer is a political loser. Senator Sanders’ own state of Vermont passed single payer but had to abandon it because of costs and its regressive impact on families. Colorado voters rejected it by a margin of 58 points in 2016 (79% to 21%). In 2018, only two Democrats in competitive House races mentioned support for single payer or Medicare for All. Both of those candidates lost winnable seats.

2. Single payer opens the door for GOP control over health care services. What happens to government-run health care when that government is controlled by the GOP? Democratic voters become terrified when they learn that someone like Vice President Mike Pence could control what services are provided, including women’s reproductive care and services for immigrants or LGBT people. Democratic primary voters oppose Medicare for All by 40 points (63% to 23%) when faced with that fact.

3. Once people know the details, public support plummets. Based on polling from the Kaiser Family Foundation, support for Medicare for All plummets when people learn that it eliminates private insurance (support drops from 56% to 37%), requires most Americans to pay more in taxes (support drops to 37%), or leads to delays in tests and treatments (support drops to 26%).

4. 156 million people will lose their employer-sponsored coverage. Seventy-three percent of Democrats believe that Medicare for All is “a health care plan that lets anyone buy Medicare instead of their current private insurance, if they want to.” But Section 107 of Sanders’ single-payer legislation outlaws private health insurance. That means 156 million mostly-satisfied people who get coverage through their job would see their plans replaced with a government-only plan.

5. Medicare Advantage would be gone. More than one-third of Medicare beneficiaries are in Medicare Advantage­­—private plans offering comprehensive benefits—which would be eliminated under single payer.

6. It costs more than $3 trillion a year and puts workers on the hook. Senator Sanders has outlined a series of tax increases that only partially pay for single payer, including a new payroll tax of 8.4% on top of the current payroll tax (2.2% paid by families and 6.2% paid by employers, which most economists believe would come out of the employee’s paycheck).

7. Health care would face massive cuts in services. Medicare reimburses at lower rates than private health plans, a fact which would have repercussions throughout the system. Financially unstable hospitals, which today depend on higher payments from private plans, would close—including many that serve rural communities. Others would be forced to stop providing certain services, such as emergency care, in order to keep their doors’ open. Health care practitioners, from nurses to x-ray technicians, would be paid less or laid off. Any attempts to increase payments beyond current Medicare levels would cause even more new taxes on taxpayers.