Single-payer healthcare is discussed across several episodes of The Bob Zadek Show as a policy in which, in the definition offered by Sally Pipes, there is one payer for all healthcare and that payer is the government. Guests and the host treat the term as overlapping with “Medicare for All,” and the excerpts show the topic arising both as a direct subject of debate and as a comparison point in arguments about welfare states, medical innovation and consumer finance.
Definitions and proposals
Pipes, introduced by Bob Zadek as President and CEO of the Pacific Research Institute, describes single-payer Medicare for All as envisioned by Senator Bernie Sanders, Representative Pramila Jayapal and Elizabeth Warren, and sometimes by Kamala Harris. Under the Sanders and Jayapal plans, she says, the government would be both payer and provider, with only the Veterans Administration and the Indian Health Services left as separate groups and everything else rolled into one system. She notes that Sanders released a single-payer bill in 2017 without saying how much it would cost or how it would be paid for, then introduced a revised plan in April, and later said his plan would probably cost between $30 and $40 trillion over 10 years, paid for by new and higher taxes. She also describes Harris saying in Des Moines that she supported single-payer and wanted to get rid of the insurance companies, then backtracking, and placing her hand up at the first debate alongside Sanders, Warren and Bill de Blasio. Pipes characterizes Joe Biden’s support for a public option as a stepping-stone approach, arguing that such plans would crowd out private coverage and end in a single-payer system Sally Pipes on the High Cost of Free Stuff (2019).
Zadek opens that episode by calling single-payer, Medicare for All and free healthcare a major battleground of the 2020 election, and says that when a politician offers something for free, “free” is political speak for “very expensive,” with the difference being that somebody else pays. He describes the debate as involving gutting the health insurance industry and getting rid of healthcare that 150 million Americans enjoy Sally Pipes on the High Cost of Free Stuff (2019).
Canada and international comparisons
Will Wilkinson, responding to Zadek’s question about the political danger that wealth-transfer guarantees only increase once begun, argues that the question is best answered by looking at the data. He says Canada famously has socialized healthcare and a single-payer system in which the state finances most healthcare spending, that this is very expensive, and that Canada takes a hit in the economic freedom index because taxes must be higher and government must spend a higher percentage of GDP. Nevertheless, he says, Canada comes out higher than the United States in terms of economic freedom, and places with single-payer or other government-financed healthcare do well on other dimensions of economic freedom and on Cato’s personal freedom index. He concludes that many places with the biggest welfare states are also some of the freest places in the world Will Wilkinson: G.O.P. Should Embrace the Welfare State (2017).
Pipes, who says she is Canadian and grew up under single-payer, states that Canada bans all private coverage for anything considered medically necessary, and refers to long waits, rationed care and tax costs as matters to discuss later Sally Pipes on the High Cost of Free Stuff (2019).
Market alternatives and the food analogy
Zadek proposes that the healthcare system ought to look like the food system: food is as much a necessity for life as healthcare, the food marketplace is for the most part unregulated, there is tremendous choice, and at the bottom there are food stamps or SNAP. He asks why it is difficult to imagine a healthcare system mirroring the food delivery system, which he says works perfectly. Wilkinson agrees, saying he believes in prices and free exchange, and that the healthcare system is a nightmare in large part because it is so heavily regulated. He argues that medical licensing restricts who may legally provide services, that someone good at sewing could give stitches, and that it should not be illegal for such a person to have a shop, and that these restrictions drive up costs. He adds that if it were legal to sell an insurance policy reflecting actuarial risk, that would be great, and notes that nobody has food insurance Will Wilkinson: G.O.P. Should Embrace the Welfare State (2017).
Zadek observes that nobody on the far left has said food is a right, and that people ought to have food but nobody has found it necessary to elevate eating to an abstract right because food is plentiful and cheap; he says there is nothing special about healthcare. Wilkinson replies that there are people who say food is a right, and that the rights language is an area where libertarian-leaning and left-wing people speak different languages, with the left talking in terms of positive rights and libertarians distinguishing negative from positive rights. He says everybody agrees people ought to have enough food and access to healthcare, that whether to couch this in rights language is a choice about words, and that if people have a right to healthcare, what they are entitled to is whatever system of institutions most reliably delivers the goods — which is not necessarily government provision Will Wilkinson: G.O.P. Should Embrace the Welfare State (2017).
Innovation and medical debt
In a discussion of Operation Warp Speed, Zadek credits the Trump administration with turning to the private sector, placing an order for $100 billion worth of activity and letting private business work unfettered by government, and says people will talk for decades about a vaccine that should have taken four years taking nine months. Jeff Deist responds that medical innovation has been remarkable within living memory, citing dentistry, MRIs, CAT scans and surgical procedures, and argues that in a lot of systems with single-payer healthcare and national health services, the innovation is just not there Austrian Economics Triumphs (2021).
Todd Zywicki, discussing credit ratings and medical debt, describes a desire to fiddle with the reporting of medical debt as part of a long-term effort to move to a single-payer healthcare system by making it difficult to bill and collect medical debt over time. He says that if there is to be a debate over single-payer healthcare it should be held openly, rather than through the back door by making medical practitioners unable to collect debt for services provided. Zadek compares the manipulation of credit criteria to university admissions policies, saying that in both cases the result is chosen first and the criteria are then adjusted The Weaponization of Consumer Finance (2022).
Across episodes
The topic recurs in four episodes, but the excerpts show no development of a single argument across them: Wilkinson in 2017 treats Canada’s single-payer system as evidence that big welfare states can rank high on freedom indices, Pipes in 2019 describes single-payer as government monopoly payer and provider with rationing and high tax costs, Deist in 2021 asserts that innovation is absent in single-payer and national health systems, and Zywicki in 2022 describes medical-debt reporting changes as a back-door route to single-payer.
What the sources do not cover
The excerpts do not describe any enacted single-payer statute, its legislative history, or any court decision concerning it. They do not state the outcome of the state-level proposals Pipes’ episode summary refers to, nor the mechanics by which Sanders’ or Jayapal’s plans would be financed beyond higher taxes. Figures such as the $30–$40 trillion estimate and the 150 million Americans said to enjoy current coverage are given as speakers’ statements, not independently verified in the excerpts.