Government involvement in health care remains one of the most contentious topics among Americans. A 2024 Gallup poll found 46% supported a government-run single-payer (universal) system, with numbers over time hovering close enough to 50% to prevent real movement in either direction. As the federal debate continues, individual states propose their own versions; Washington’s current SB 5233 is its latest attempt.
Supporters have pushed the program for years, but they have never been able to secure funds to pay for it. This latest proposal levies significant new taxes on capital gains, employers, and residents making over 300% of the poverty level. All residents, including illegal immigrants, would need to enroll in this public health insurance for the plan to work. And yet, after all this number-crunching, the actual cost to implement the proposal is still unknown. Even on paper, the plan is chaotic.
A single-payer healthcare system utilizes one umbrella entity—typically the government—to manage financing for all patients. Funding decisions, actuary services, and prioritization of care all fall under this powerful organization. Because the structure necessary to deliver this service is far more complicated than it appears to any one actor in the system, misinformation regarding its inner workings abounds. This confusion keeps hope in the concept alive, despite overwhelming evidence of its futility.
The Promises
Proponents of universal care point to the economies of scale inherent in large undertakings. Products and services often become affordable and ubiquitous when production centralizes. Thousands of individuals, each working alone, managing their own limited capital, and performing every task, will not maintain an efficient business. Consolidation creates greater efficiency and negotiating leverage to lower prices when done correctly.
But ironically, people who want universal coverage often express distaste at the idea of running health care like a business. Profit as incentive is seen as immoral, which presents a conundrum. People want the efficiency of a serious business, with the heart of a lemonade stand. They want workers to be paid more, while patients pay less. And despite the government’s infamous history of destroying virtually every industry it controls, they want it to run this impossible project.
As IBM Systems’ Jesse Samberg said, “In the private sector, the profit motive drives change, efficiency, and innovation. The government is a very different animal. It has to respond to all kinds of different, competing interests, including political considerations.” No organization is less equipped to manage health care.
What About Canada?
If universal coverage is doomed, how do we explain its success in Canada? In Taiwan? In Japan?
The truth is that we don’t. Even perpetual champions of their systems admit to serious shortfalls. For example, Canada has a staggering median 30-week wait for a specialist referral. Although comparisons with the overall U.S. are difficult due to a lack of data, Vermont reports a 14-week wait for this service. The U.S has one of the lowest overall wait times, and Canada has one of the highest. The discrepancy extends to other services, such as emergency room use, as well. The problem is both acute and systemic.
In addition, of all the places to try to force an unequal equation to balance, the United States may have the least hope. Even healthy countries such as Taiwan and Japan are struggling to prevent their universal systems from collapsing, and they do not have the detrimental personal lifestyle habits endemic in the United States.
Americans have notoriously poor eating and exercise regimens, with obesity alone costing the country $260.6 billion annually. With universal coverage, people maintaining healthy lifestyles are forced to subsidize those who make no such efforts. It can hardly be considered fair to destroy the healthcare system for everyone so that some people can irresponsibly abuse the “free” service.
Despite the rosy picture painted by the media, countries with single-payer care are not thriving, and simple laws of economics clearly indicate that will not change. The U.S. states that have made attempts here have fared no better, often abandoning the effort when the costs inexplicably surprised the experts who should have predicted them. Vermont, California, Colorado, and New York are some recent examples that should have deterred Washington. But the fairytale of universal health care is seemingly too appealing for even adults to leave behind.