Senate hearing highlights how single-payer will ration health care

You would think that, given our polarized times, a topic like single-payer health care would give way to partisan bickering. Think again.

At a recent Senate Budget Committee hearing on the concept proposed by committee chairman, Senator Bernie Sanders, I-Vermont, witnesses from left, right and center all agreed: single-payer would lead to demand unsatisfied care.

They disagreed on the nature and scope of this conclusion, but the testimonies showed a surprising consensus on “free” health care creating a level of demand for care that doctors and hospitals could not. respond to all patient inquiries.

Massive demand for “free” care

Coming from the center, the nonpartisan Congressional Budget Office (CBO) summarized its earlier analysis of five hypothetical single-payer systems. The CBO concluded that in all five cases,

The increase in demand for personal health care would exceed the increase in supply, resulting in unmet demand greater than the amount provided by current law…Increase in unmet demand would correspond to increased congestion of the health care system, including delays and lost care.

This testimony encapsulates a persistent theme in CBO’s work. Its December 2020 analysis of the five hypothetical single-payer proposals used the word “congestion” to describe the impact of single-payer on the healthcare system no less than 28 times. Some might find “congestion” an overly polite euphemism for waiting lists and rationed care.

Either way, CBO’s frequent use of the term explains why the budget office admitted it hadn’t done a formal analysis of Sanders’ legislation. As a top member and then chairman of the budget committee, Sanders could have used his seniority to request — and receive — a full “score” of his bill years ago. The fact that he didn’t speaks volumes and suggests that Sanders doesn’t want the budget office to quantify exactly how long patients might have to wait for care under his approach.

Hundreds of billions of unmet care needs

From the right, Mercatus Center researcher Chuck Blahous spent part of his testimony dissecting how the CBO’s work provided estimates of potential unmet demand within the healthcare system. In the CBO scenario that most closely resembled the single-payer system modeled by Blahous in 2018, Blahous noted the CBO’s conclusion that “$254 billion of this new health care demand would simply not be met.”

Another hypothetical example examined by the CBO — the one that Sanders said in the hearing most closely resembled the parameters of his bill — presented an even more unmet demand for care. In this example, which would see the federal government provide low reimbursements to doctors and hospitals, while making cost-sharing (e.g., co-payments, deductibles, etc.) virtually non-existent for patients, Blahous pointed out how “ the CBO found that the majority of the additional demand ($319 billion out of $591 billion) would not be met.

Of course, the accuracy of the CBO’s estimates largely depends on the accuracy of its assumptions. Blahous raised the possibility that a single-payer system could achieve as many administrative savings as the budget office thinks. And his position has a logic to it; after all, how often has greater government involvement reduced bureaucracy?

Blahous found that, if half of nurses’ potential administrative reductions were not realized – that is, if the single payer reduced their paperwork burden by just 40%, instead of the 80% of CBO – then “over 97% of physicians and hospitals sought additional services under [single payer] would not be delivered. In other words, almost all of the additional demand for “free” health care would go unmet.

Ration a feature, not a bug?

One of the witnesses supporting single-payer implicitly agreed with much of Blahous’ analysis. Harvard Medical School professor Adam Gaffney criticized the CBO model because “it errs in contextualizing limited increases in utilization as unmet demand rather than salubrious reductions in large amounts of unnecessary care and even that are currently supplied”.

Translation: Yes, you may have to wait months for knee surgery or a heart transplant, but you’re cutting down on “unnecessary” care!

Sarcasm aside, Gaffney and the likes of him say they can eliminate unnecessary spending – and only unnecessary spending—within the health care system. Such a feat seems as likely as removing all green M&Ms (e.g., “unnecessary” healing) from a jar, while leaving all candies with other colors (e.g., healing needed) completely untouched.

As much as it makes sense to eliminate unnecessary care, the idea that any healthcare system, let alone a federally run system, can only eliminate unnecessary care without harmful consequences seems fanciful.


Here again, the whole movement for the single payer seems marked by flights. Another witness at the hearing, Abdul El-Sayed, included the following characterization of the single payer in his testimony: “A single solution for all our health problems”.

This kind of talk is as dishonest as it is embarrassing. No proposal, no matter how big or small, could claim to solve all the problems of the $4 trillion healthcare sector. I would never assume that a single Conservative policy proposal can solve all of the country’s problems, and not just because I believe the government cannot solve all of the country’s problems.

While some may try to deny it, the Senate budget hearing illustrated one of the major downsides of single-payer: lineups and rationing of care. I only hope I never live long enough to see these predictions of the impact of socialized medicine in the United States come true.

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