Single-Payer Will Worsen Healthcare Workers’ Plight


Healthcare workers are exchanging scrubs and gloves for signs and megaphones. In what’s been called “Striketober,” frontline staff are walking out of hospitals, emergency rooms, and doctor’s offices to insist on better pay, benefits, and hours.

Earlier this month, Kaiser Permanente workers in California voted to authorize a strike over a proposed new wage system. A Minneapolis health center recently suspended all emergency and urgent care services when its nurses went on strike. Nurses at Saint Vincent Hospital in Massachusetts have been on strike for most of 2021.

Their demands for better compensation and working conditions in the wake of the pandemic aren’t surprising. What’s puzzling is that many of these workers also back a policy that will only make things worse for them: single-payer health care, also known as “Medicare for All,” where private coverage would be banned and the government would become the sole payer.

Single payer has grown increasingly popular among the medical community in recent years. The American College of Physicians, the country’s second-largest doctor’s group, endorsed Medicare for All in 2020. National Nurses United, a union that represents 175,000 nurses, also favors nationalizing American health care. And in 2019, the American Medical Association—the biggest doctor’s group in the country—almost fully overturned its opposition to single payer.

Even if conditions are difficult now, providers would be far worse off if the government had control of our healthcare system.

Consider wages. Workers would get paid far less if the government were writing all the checks. A 2018 study by economist Charles Blahous of the Mercatus Center estimated that providers would be reimbursed at rates roughly 40% lower than those paid by private insurers under Senator Bernie Sanders’s proposal for Medicare for All.

A separate analysis from FTI Consulting concluded that these lower reimbursements would cause 90% of the country’s hospitals to run consistent budget deficits. If hospitals can’t cover their costs, they’ll lay off staff and cut salaries.

Economics dictates that demand rises when a good is made free at the point of service. And that’s just what would happen under Medicare for All.

A 2020 analysis of several single-payer proposals from the nonpartisan Congressional Budget Office concluded that the “increase in demand [for care] would exceed the increase in supply, resulting in greater unmet demand than the amount under current law.”

In other words, under Medicare for All, physicians and nurses would be asked to work more and would be paid less—or even nothing at all. In the United Kingdom’s universal coverage system, a recent survey found that over half of employees worked additional unpaid hours.

Doctors and nurses won’t just accept lower wages and longer hours. They’ll find other things to do. According to that same FTI analysis, Medicare for All could force 45,000 physicians and 1.2 million nurses out of the profession by 2050.

That’s the last thing the country needs, given that we’re set to face a deficit of up to 124,000 doctors by 2034.

Doctors and nurses in Canada and Great Britain have already seen these projections play out in practice in their countries.

Take pay. The average physician salary in the United States is about $300,000—more than triple that in the United Kingdom. Surveys show that pay and benefits are key motivators for Canadian nurses who pursue employment in the United States.

Providers have been agitating for better pay in the United Kingdom and Canada for years. Nurses, midwives, radiographers, and paramedics struck for higher pay in 2014. A little over a year later, junior doctors put a stop to all but emergency care in a dispute over hours and pay. Britain’s nurses threatened to strike this summer over what they considered a measly pay raise.

Workers from several hospitals in Alberta recently walked off the job over proposed employment cuts. Hundreds of them were disciplined for their labor action mere months later.

The long waits for care endemic to single payer make working conditions worse. Staring down a waiting list of nearly 6 million patients—as U.K. providers are currently doing—is daunting. It’s no wonder that less than half of NHS providers believe they have sufficient time to juggle all their responsibilities. The share of workers who look forward to their work has been on the decline in recent years.

It’s understandable that America’s healthcare workers desire better working conditions after nearly two years of battling a pandemic. But Medicare for All isn’t, and will never be, the answer.

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