Tyler Cowen, Columnist

Incentives Are All Wrong for Single-Payer Health Care

Americans won't give up their private insurance unless the government option is better. And that won't be cheap.

September 12, 2017 at 6:49 PM UTC

Tyler Cowen is a Bloomberg Opinion columnist, a professor of economics at George Mason University and host of the Marginal Revolution blog.

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The conventional wisdom these days is that the major Democratic presidential candidates for 2020 will end up endorsing some version of single-payer health care. Senator Bernie Sanders is expected to introduce his Medicare for All bill this week, with a considerable number of co-sponsors. This political posturing, however, is far from a practical proposal.

There’s an obvious problem with moving Americans to a single-payer system: Most people with private health insurance are pretty happy with their current arrangements. They are not looking to trade in that coverage for a new government program of uncertain quality, along with unknown higher taxes. When President Barack Obama was selling the Affordable Care Act, he promised Americans that they could keep their health insurance if they wanted to. When this didn’t turn out to be true for everyone, there was a significant backlash.