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The Case Against Single-Payer Health Care


As the American health care system continues to spend more and rank lower than other developed countries, many progressives have suggested a shift to single-payer health care as a solution. Such attitudes have been exacerbated by recent Republican attempts, like the American Health Care Act, to reign in government health care spending, prompting 52% of Democrats to say they support single-payer health care (up from 33% in March 2014). The shortcomings of the U.S. status quo, as well as any potential Republican reforms, are greatly exaggerated, and adopting a single-payer system is likely to only worsen our quality of care.

The left-wing has idealized the health care “success stories” of Nordic nations, such as Sweden and Denmark (which are ranked second and first in public health care, respectively, by U.S. News). This narrative is pushed largely by politicians, such as Bernie Sanders or Elizabeth Warren, who have never interacted with patients or even worked in the private sector. Interestingly, fifteen of the eighteen physicians in Congress are, in fact, Republicans. This suggests that those with experience providing health care are skeptical of a single-payer system, and with good reason.

The Nordic countries are only able spend so little on health care and still score highly on health metrics because they spend substantially more on social safety net services, like unemployment coverage, education and foster care. When both health care and social services are taken into consideration, Nordic countries actually spend much more per citizen than does the United States. This spending falls on the government’s tab and is ultimately passed to the taxpayers. In the United States, the majority of health care spending is still directly paid by the individual.

Such high spending is predicated on proportionally higher taxation, but, in order to stay globally competitive, these nations must maintain low corporate tax rates, further shifting the tax burden to individuals. High-income earners in Nordic countries pay tax rates as high as 60%; however, their tax system is less progressive, and the annual income threshold for this highest tax bracket is much lower in Scandinavia than in the United States. This means that the amount that the richest citizens contribute, proportional to their wealth, is actually less than that in the United States. Our taxation scheme could arguably make us the more “generous” nation. And yet, to fund all the same social programs as the Nordics country would entail even more money siphoned away.

The extent of social redistribution in Scandinavia, is enabled, in part, because Scandinavian countries have small, homogenous populations, with relatively fewer historically impoverished or oppressed minorities. Recently, the Nordic countries have instituted some of the more nativist and anti-immigrant policies in Europe, with some going so far as to build a wall to protect against illegal immigrants and Middle-Eastern refugees. Sound familiar? As regressive as such border security may sound, it is often otherwise impossible to regulate the stream of migrants drawn in by the promise of safety and subsidized financial security. As a son of immigrants, I understand the opportunities that our nation can offer, and thus the stakes involved in ensuring its survival. The dilemma of unencumbered immigration is a Catch-22: It would be unethical to turn away all refugees in need, yet morally reprehensible to allow a large influx to drain the national resources that were funded by, and built for, its longtime citizens. In other words, American progressives can’t have it both ways: You either have an ironclad social safety net along with border protection, or neither.

A single-payer system has never been attempted in any country as populous and diverse as the United States. Those European nations, such as the U.K. and Germany, that did implement some version of universal health care have seen mixed results: The U.K. is often ranked no better than the United States, while Germany has a rampant two-tier system, with those able to afford private care receiving far better service than those on the public option. Not to mention, the health care spending is supplemented, once again, by extensive social spending. These countries are currently struggling with an unsustainable influx of immigrants and refugees (enabled by the Schengen area visa-free travel), which adds an even more unmanageable burden onto their already-strained safety nets. Combine Germany’s social spending with the obligation it has towards sustaining the rest of the European Union, who are themselves mired in their own debt crises, and the big picture becomes clear: Europe’s safety net is not sustainable for a growing, diverse population.

The increased taxation and debt that European nations are facing in order to take in these immigrants has also fomented nativist sentiments, leading to far-right political victories (like Brexit), more walls and fences and even aggression towards refugees. This, in turn, has only fanned the flames for already-ostracized populations, resulting in countless horrific acts of terrorism. A cycle of extremism and hatred is fomented by well-intentioned social support. Strained social relations and opposing political agendas, goaded in some part by single-payer health care, is not just endangering national finances – it’s costing lives.

The dangers of single-payer in Europe should leave us wary of adopting similar measures in our own country. We have likewise witnessed a recent rise in racism and xenophobia, fueled by the perception that our minority populations are draining our resources. Certainly, racism, prejudice and hate predate the social safety net in America. However, our reckless spending often gives fodder to false narratives, which overshadow the contributions that minorities and diversity have made to our country. In expanding our social safety spending, the United States would further such shameful nativist sentiments and thus retreat back into its shell, abandoning the embrace of immigration and economic competitiveness upon which our nation was founded. In the short term, our poor may be lifted up, but, in the long term, such an “Elysium” would fail to be competitive globally and eventually collapse under its own weight.

The strong social safety net necessary to improve our national health metrics could also perpetuate poverty by disincentivizing work if improperly implemented, which would risk emboldening negative stereotypes about “lazy” minorities. To be lasting and self-sustaining, economic mobility, and the improvement that follows in the lifestyles and health outcomes of the impoverished, must come from the free market. Moreover, the United States must keep corporate and income taxes low to remain globally competitive. Unfortunately, this means we cannot afford to fund many of the well-intentioned but oft unreasonable government programs. The Catch-22 of scarcity strikes again.

The American public must, in fact, look to Europe – not as the “city upon a hill” which some progressive politicians paint, but as a case study in what not to do. Single-payer is deceptive in theory and in name: Although Senator Sanders and like-minded politicians would have you believe the rich would be the “single payers,” in reality, all of us (and our posterity) would pay dearly. There is nothing singular about the suffering that would be brought about by single-payer health care.

Adam Barsouk Adam Barsouk (6 Posts)

Guest Writer

Sidney Kimmel Medical College


Adam Barsouk is currently a medical student at Sidney Kimmel Medical College at Jefferson University. He studied pre-medicine, health policy and anthropology at Pennsylvania State University. As a son of Soviet Jewish escapees, Adam values the opportunity and freedom that America has provided his family, and as a current cancer researcher at the University of Pittsburgh and an aspiring physician, hopes to share this commitment by liberating the infirm from the chains of chronic disease and suffering. Adam speaks 6 languages, has visited over 30 countries, and enjoys recounting his experiences while also learning anything he can from the people and places around him.