Progressives continue to advocate for some type of single-payer health care system in the United States. The euphemistic catchphrase is "Medicare For All," which sounds like a simple expansion of the existing government-controlled health insurance plan for seniors.
A recent opinion article in The Wall Street Journal, however, explained exactly why a single-payer government-controlled health care system would not be financially viable. The WSJ article warns, “…applying Medicare payment rates to all services provided to all patients would destroy the American healthcare system."
Our current health care system is financed by a mix of private and government insurance. Medicaid, the entitlement for low-income Americans, pays much less than private insurance depending on the patient’s diagnosis. Medicare pays a bit better, but in 2024 hospitals lost 12 cents on every Medicare dollar they received. A recent Rand study found that private insurance paid hospitals 2.5 times the Medicare rate. Provider reimbursements are likewise much less for Medicare and Medicaid patients depending on the specialty.
In other words, it is the mix of insurance payments, including private reimbursements, that currently allows hospitals to keep their doors open and allows providers to see patients with government insurance.
Proponents of a single-payer system claim, however, that an increase in taxes could offset the loss of private insurance payments. The reality is that the magnitude of the tax increase would stifle the economic growth of the United States. “Medicare For All” has an estimated cost of $32 trillion dollars for the first ten years. Tax increases would be in the neighborhood of 20 percent, with a serious detrimental impact on the country’s gross domestic product (GDP).
Reasonable policymakers will admit that the tax increase will affect not only the rich, but also the middle class in the U.S. Americans would see not only an increase in income tax but also undoubtedly a significant increase in payroll taxes.
The real tragedy with “Medicare For All” or any single-payer system would be the total bureaucratic control of our health care system. Once it becomes obvious that the country couldn’t afford the single-payer system, rationing would occur.
Canada is the poster child for a single-payer health care system, having had complete socialized medicine for the past 40 years. Every Canadian has health insurance but not necessarily timely access to care. The Fraser Institute in Vancouver, B.C., has monitored wait times in Canada for many years. In 2025, the average wait time for a patient in Canada from seeing a primary care provider to specialty treatment was 29 weeks. This wait time for treatment would be totally unacceptable to American patients.
Another problem under a single-payer system is that health care spending must compete with all other government activities, such as defense, education, and transportation. This makes health care even more political than it is today and subject to change with every new budget. It also forces each health care sector, for example, hospitals and doctors, to compete with each other for government money.
The free market has provided the amazing standard of living that Americans now enjoy. Instead of more government involvement in our health care delivery system, elected officials should work toward more patient control over their medical care.
Health care reform should include patients, not the government or employers, controlling their own health care dollars; providers and hospitals competing on price as well as quality; health insurance reform so it functions like other forms of insurance; streamlining drug approvals; and expanding innovative technologies such as telemedicine.
By allowing consumerism and competition to drive patients’ decisions, rather than unseen bureaucrats, health care would function like every other economic activity in Americans’ lives. “Medicare For All” sounds great, but the reality is quite different.
Dr. Roger Stark is a visiting fellow with Mountain States Policy Center, an independent research organization based in Idaho, Montana, Washington and Wyoming. Online at mountainstatespolicy.org. A retired surgeon, Dr. Stark has authored three books including “Healthcare Policy Simplified: Understanding a Complex Issue,” and “The Patient-Centered Solution: Our Health Care Crisis, How It Happened, and How We Can Fix It.”
