As the American health care system continues to spend more and get ranked 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 to reign in government health care spending, prompting 52% of Democrats to say that they support a government takeover of health care (this is up from 33% in March 2014).
The shortcomings of the US status quo (and any potential Republican reforms) are greatly exaggerated, and adopting a single-payer system is likely to only worsen our quality of care. (For more on this topic, see "Government Makes Healthcare Worse and More Expensive.")
Who Actually Spends More
Under the guidance of politicians who have absolutely no background in health care, like Bernie Sanders or Elizabeth Warren, the left wing has epitomized the “success stories” of Nordic nations, such as Sweden and Denmark (which US News ranks second and first, respectively, for Most Well-Developed Public Health Care Systems). Little do they realize, however, that following these nations examples would undercut the rest of their proposed domestic policies.
The tax burden is shifted to individuals, who pay taxes as high as 60%
The reason Nordic countries can spend so little on health care and still score highly on health metrics is because they spend substantially more on social safety net services, like unemployment coverage, education, and foster care. When these are taken into consideration, Nordic countries actually spend more than the US per citizen. Keep in mind, all this spending falls on the government’s tab (i.e. the taxpayers), while in the US, the majority of health care spending is still paid by the individual.
Such high spending is only possible with proportionally higher taxation. However, to stay globally competitive, these nations must maintain low corporate tax rates. The tax burden is therefore shifted to individuals, who pay taxes as high as 60% (incidentally, the amount that the rich contribute is actually less than that of the US).
This social redistribution scheme, to which everyone eagerly pays in, is only possible because Scandinavian countries have small, homogenous populations, without any commitment to supporting historically impoverished and/or oppressed minorities. In fact, quite to the contrary, the Nordic countries have some of the most nativist and anti-immigrant policies in Europe, going so far as to build a wall to protect against illegal immigrants and Middle-Eastern refugees. Sound familiar?
American progressives can’t have it both ways: you either have a strong social safety net along with border protection and homogeneity, or neither.
Single Payer Doesn’t Work for a Growing, Diverse Population
A single-payer system has never been attempted in any country as populous and diverse as the US. Those European nations, like the UK or Germany, that did implement some ‘softer’ version of universal health care have seen mixed results: the UK is often ranked no better than the US, 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.
Europe’s spending is not sustainable for a growing, diverse population.
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 (thanks to the Schengen area visa-free travel), which adds an even more unmanageable burden onto their already strained safety nets. Combine that with the obligations that Germany 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 spending 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 have fomented nativist sentiments, leading to far-right political victories, more walls and fences, and even aggression towards refugees.
This, in turn, has only fanned the flames towards the already ostracized populations of Muslims, resulting in the horrific acts of terrorism that have become nearly synonymous with European daily news.
Strained social relations and opposing political agendas, goaded in some part by single-payer health care, are not just endangering national finances – they’re costing lives. The dangers of single-payer medicine in Europe should leave us wary of adopting similar measures in our own country. We have likewise witnessed a rise in racism and xenophobia, which is often justified and exacerbated by the belief that minority populations drain a nation of its resources. Such an ‘Elysium’ would eventually collapse under its own weight.
In expanding our social safety spending, the US would further these nativist sentiments to retreat back into its shell, abandoning the embrace of immigration and economic competitiveness that our nation was founded upon. In the short term, our poor may be lifted up, but in the long term, such an ‘Elysium’ would not be competitive globally and would eventually collapse under its own weight.
Sustainable Change Must Come from the Free Market
The strong social safety net necessary to improve our national health metrics would also perpetuate poverty by disincentivizing work, thus emboldening negative stereotypes about “lazy minorities.”
To be lasting and self-sustaining, economic mobility – and the subsequent improvement of lifestyles and health outcomes of the impoverished – must come from the free market.
Considering the plethora of options that businesses have around the globe for where to conduct business, the US must lower taxes if it is to remain competitive and augment said growth. The American public must, in fact, look to Europe, not as the “city upon a hill” which some progressive politicians paint it, but as a case study in what not to do. The American public must look to Europe as a case study in what not to do.
Single-payer is deceptive in theory and in name: although supporters like Bernie Sanders would have you believe that 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 on by single-payer health care.
Adam Barsouk
Adam Barsouk is a medical student at Sidney Kimmel Medical College, a researcher at the University of Pittsburgh Cancer Institute, a health policy contributor and the lead editor and author of the upcoming book “Igniting Liberty." Follow him on Twitter, Facebook and LinkedIn.
