Here we go again. Some lawmakers in Washington state will just not give up on their quest for a state-run single-payer health care system. Their latest attempt is SB 5233, “Developing the Washington health trust.” After several years of meetings and after realizing they had no practical funding mechanism, supporters of the health trust have added SB 5233 to force more taxes on Washington state taxpayers.
SB 5233 would be a continuation, with some financing clarification, of the Washington health trust. The trust is essentially the first step toward a single-payer, government-based system for Washington state. From the opening paragraph of the bill:
“AN ACT Relating to the expansion and consolidation of public health plans in Washington under a unified financing system in order to universalize eligibility to all Washington residents, ensure comprehensive medical coverage including primary care, dental, vision, and prescription drug benefits, and achieve cost savings through administrative efficiency, bulk pricing, and cost controls…”
The trust’s board will decide essential benefits, provider payments, and which drugs and services will be paid for. And everyone in the state is included in the plan, including individuals who are in the country illegally. If you like your current health insurance, you can keep it, although the stated goal is to eventually gather everyone under the single-payer plan. This includes the employed, those in Medicare, Medicaid, and potentially the retired military.
The funding is more than ambitious. It includes a new employer tax, a long-term capital gains tax, a self-employment tax, and a new tax on individuals earning more than 300 percent of the federal poverty level.
Other states have considered a state-based single-payer system, yet even some of the most progressive states have given up on the idea because of the cost. Vermont came close to instituting a single-payer system on a state-level basis. In 2011, the Vermont Legislature passed and Governor Peter Shumlin signed “An Act Relating to a Universal and Unified Health System.” The state-wide, single-payer system was to start in 2017.
By 2014, however, fiscal estimates showed that the state budget would need an extra $2 billion in 2017 to fund the program. This would be a 35 percent increase over the state’s original $5.7 billion 2017 budget. The state would need to raise taxes to levels unacceptable to the public and at the same time, decrease provider payments to unrealistic amounts. Vermont officials admitted failure and abandoned the plan in December 2014.
In spite of enthusiastic campaigning and support of a single-payer system, Colorado voters turned down a single-payer ballot initiative in 2016. The voters realized the overwhelming cost and enormous tax increase to fund the initiative. They were also concerned about losing their current health insurance.
California legislators have considered a single-payer system in the past few legislative sessions. They have not passed any legislation, again because of the unknown but likely exorbitant cost to state taxpayers.
Canada is the poster child for a single-payer system and is often referenced by supporters of a government-run system in the U.S. The Fraser Institute is a well-respected national think tank based in Vancouver, British Columbia. For the past 25 years, the organization has tracked waiting times for patients to receive health care in Canada. It surveys specialist physicians across 12 specialties throughout Canada. The institute recently released the waiting list data for 2024.
It found the median time for specialty treatment once a patient was referred by a primary care doctor was 30 weeks. On average, Canadians waited 15 weeks to see a specialist, then waited an additional 15 weeks to receive treatment. Every Canadian is covered by the plan and, in theory, has access to medical care. The provinces administer the plan with funding from federal taxpayers. The government determines what procedures are medically necessary based on “data and statistics.” The data confirm that simply having health insurance does not guarantee timely access to health care.
In addition, the Canadian single-payer system has created severe shortages. Medical care is rationed using long waiting lists and by limiting the number of certain medical procedures allowed. Simple medical problems, if not treated early, can turn into chronic or life-threatening conditions, so long wait times prolong pain and suffering for patients. Costs have skyrocketed and now represent the largest expense for every province’s budget.
Almost 90 percent of Canadians live within driving distance of the United States. For those who can afford it, quality health care is immediately available in the U.S. In reality, Canada has a two-tiered health care system, with the U.S. providing timely care for those able to travel and pay more. Most Canadians say they like their system, but their expectations are different than those in the U.S. Waiting 30 weeks for needed medical treatment would not be acceptable to the overwhelming majority of Americans.
The exact cost of Washington's proposed SB 5233 is unknown. What is known is the fact that the supporters of a single-payer system in Washington state are counting on everyone in the state to participate. This would require multiple waivers from the federal government to force people who are now in Medicare, Medicaid, and employer-paid plans into the state program. This would be virtually impossible with the incoming federal administration.
It is past time for elected officials in Washington state to abandon their irresponsible quest for a single-payer health care system. Rather than more bureaucratic control, officials should focus on health care reform that puts patients in charge and gives them more control over their health care decisions and their health care finances.