Why DO Americans freak out so over single-payer?

One recent morning, I watched another episode of “The West Wing” while on the elliptical trainer. It was the one titled “Drought Conditions,” the 16th episode of Season 6. It’s the one you might remember best from the scene when Josh and Toby actually get into a fight, right there in the West Wing, and Toby gets a nasty cut on his cheekbone. (See above.)

At this point in our story, Josh has left the White House to manage Matt Santos’ bid for the Democratic nomination for president. His candidate has done better than expected in New Hampshire, but Josh is worried about another candidate who has come out of nowhere to start grabbing support that should go to Santos. This new candidate, Rafferty, is using language that Toby once wrote for Bartlet in favor of a single-payer health care system. Toby admits he’s been collaborating with Rafferty. This is what precipitates the fight.

Anyway, there are two or three conversations about this, and we pick up on the fact that, way back before they won the White House, everybody else had to talk Toby (and presumably President Bartlet) down from their politically unpalatable position.

This was so familiar to me. This episode aired two years before I wrote my column asking why no presidential candidate, even in the Democratic field, dared to say “single-payer,” other than fringe extremists such as Dennis Kucinich. Barack Obama certainly didn’t dare say it. My attitude was much the same as Toby’s: What’s the point in even having Democrats, if they can’t stand up for something so obvious, so commonsense, so entirely accepted in the rest of the advanced world — and so in their wheelhouse ideologically?

Anyway, I finished watching the episode just as I finished with the elliptical trainer. (I do 40 minutes, which is almost perfect for watching American “hour-long” commercial TV shows.)

While doing my crunches and stretches after, I put on a few minutes of a “30 Rock” that I’d started watching previously. It’s the one when Jack and Avery have their baby, reluctantly, in Canada after failing to get back across the border before she gave birth.

Which leads to this exchange, which interrupts a phone call Jack is having with Liz Lemon:

Avery: This woman is trying to tell me that we don’t have to pay for any of this.

Woman: Right. The Canadian health care system…

Jack: Oh, no you don’t. We will not be party to this socialist perversion. You will take our money.

Woman: I’m sorry, sir, I can’t do that.

Liz (on the other end of the phone): Oh, this is gonna be good.

Jack: Avery, can you walk yet?

Avery (rising from her bed, holding the baby): I am right behind you, Jack.

Jack: Let’s go find a Canadian who will take our money.

That is played for laughs, and it is hilarious, particularly Jack’s hyperbolic crack about “socialist perversion.”

But what it’s making fun of isn’t funny. Why DO Americans freak out so over something that Canadians and Brits take for granted?

Y’all know me. I’m a center-right kind of guy (if you must place me on that stupid left-right spectrum), and on some things a neocon. I want the federal government out of things it has no business in, such as education (which means, by the way, that I would never vote for the fictional Matt Santos — he comes across like he’s running for school board rather than POTUS).

But putting everybody into the same risk pool and eliminating profit from the payment system just seems like common sense, not radical at all. Paying my premiums (or if you prefer, taxes) for coverage that I can never lose, no matter where I go to work in the future, also just makes sense to me. Having something simpler than either the patchwork of private coverage or the complex maze of Obamacare just makes sense to me.

I don’t get why it doesn’t make sense to other people — and in fact, freaks them out so. I mean, intellectually I understand that some people have a sort of religious horror of the government being involved with anything. I accept that they are that way. But I have trouble understanding why they’re that way. Why do Americans get so worked up about something that other people who are so like us culturally — such as the Brits, and the Canadians — take for granted, as a matter of course?

Some of y’all have tried to explain it to me in the past. Maybe you should try again. Maybe I’ll get it this time. Then again, maybe not.

The thing is, I can probably recite all of the objections. The words I know. What I don’t get is the passion, the horror at the idea. It’s the emotion that eludes my understanding…

26 thoughts on “Why DO Americans freak out so over single-payer?

  1. Barry

    “Many liberals in America dream about single-payer plans. Even if they acknowledge that asingle-payer plan cannot be enacted, they still think it the best reform. Another proposal may be politically necessary to achieve universal coverage, but it would be a compromise, a fall-back. Single payer is the ideal. This is wrong. Even in theory, single payer is not the best reform option. Here’s the problem: while it proposes the most radical reform of the health care financing system, it is conservative, even nostalgic, when it comes to the broken delivery system. It retains and solidifies the nineteenth century, fragmented, fee-for-service delivery system that provides profligate and bad quality care. ! ! ! Reform of the American health care system needs toaddress problems with both the financing and the delivery systems. As proponents of single-payer systems note, the financing system is inequitable, inefficient, and unsustainable”

    The Problem with Single-Payer Plans by Ezekiel J. Emanuel

    “Emanuel is the Diane and Robert Levy University Professor at the University of Pennsylvania, where he holds a joint appointment at the University of Pennsylvania School of Medicine and the Wharton School. Before joining the National Institutes of Health in 1998 he was an associate professor at the Harvard Medical School”

    1. Kathy

      Have you read “I Hope to Die at 75” by Ezekiel Emanuel? He is one weird person and someone I wouldn’t trust to take out my trash much less feed one of my cats. I believe he is a major author of ObamaCare.

  2. Barry

    and I know the show you cited was joking (I guess, even if they tried to make a silly point that some people blindly accept)

    and as anyone above 4th grade knows – a visitor giving birth in Canada will owe thousands- if not more – on their bill – IF – and it’s a big IF- they can get a doctor to see them in Canada. You don’t just walk in to see a doctor in Canada.

    Typically, if you are close to giving birth- Canada may not let you enter their country (unlike America)

    and unlike America- Canada takes a VERY NEGATIVE view of birth tourism. They put up roadblocks as best they can to prevent it.

  3. Bart

    1. America has the best health care in the world, bar none. You can argue all you want but it is a fact.
    2. Even with the best health care in the world, it is the ACCESS and COST for health care that is the problem.
    3. Will single-pay sovle the problem of access and cost? Most likely not unless it is set up and administered properly with sufficient and ENFORCEABLE oversight by a responsible agency with no damn political agenda driving their administrative duties.
    4. Until a workable system that appeals to the better side of human nature is presented, the divide will remain.
    5. America resisted Social Security and Medicare when both became law. Now, both are accepted by the majority but the abuse is becoming too much for the treasury to cover and eventually, when enough is enough, voters will elect politicians who promise to “reform” the system. Then when reform is enacted, and the recipients of the benefits are hit in the wallet, the screaming will be heard from coast to coast and the next election cycle will result in throwing the SOBs out and bringing back politicians who will restore benefits to what they were.
    6. Fewer and fewer Americans are planning for the future when they reach retirement age. A few thousand in the bank won’t do it. More and more are depending on Social Security and Medicare to cover their needs for retirement. What they do not realize is that the SS increases are less than they once were and the costs for Medicare supplement and drug coverage is increasing by 25% to 50% annually. Each year, the bite out of SS is increasing and is directly connected to the increase in Medicare costs.
    7. Romney was excoriated over his 47% remark but it was a true statement of fact. In the interim, the 47% is ever increasing and if I had to hazard a guess, it is probably well over 50% by now. Republicans MAY take the senate this year and if they try to cut benefits, in 2016, they will become the minority party once again – in both houses. Message: “don’t screw with my monthly government check”, and party affiliation will not matter.

    I do not kid myself, I don’t have the answers and am not in the position to do anything other than voice my thoughts on the issues at hand. Voting has become what has always been, “a choice between the lesser of 2 evils”, and the way politics has become, “my way or the highway”, my gag reflexes come into play when I press the “VOTE” button.

  4. Harry Harris

    I believe the reason many Americans “freak out” when single-payer is mentioned is our tendency to respond to hyperbolic labeling, straw men, and heavily-repeated disinformation. We hear “socialism, rationing, death panels, government takeover” and react without study. There are huge, powerful economic interests who would be gored by taking the administrative and profit layer away from the health care payment mix. The ability of a super-large payer (eg Medicare) to jawbone delivery pricing also threatens the outlandish cost structure prevalent in the current fee-for-service system.

    1. Juan Caruso

      re: “There are huge, powerful economic interests who would be gored by taking the administrative and profit layer away from the health care payment mix. ” – H. Harris

      While the government is totally exempt from a profit layer, it is similarly bereft of businesses” preventive disciplines that minimize waste, fraud and abuses.

      According to a recent GAO report (September 22, 2014), being able to match wage company-filed W-2 information with amounts people report could help the IRS boost detection of fraudulent claims.

      Specifically, the IRS has already processed about 60 percent of refunds before it received any W-2 forms. In one fraud the IRS had received over 2,000 returns from a single address – paying out over $3.3 million in refunds,” said House Ways & Means Committee Chairman Dave Camp (R-Mich.). “That is not just a simple error, that is clear mismanagement.”

      These same ill disciplined, overpaid bureaucrats are set to administer the AFC. The government will fail citizen after citizen accrue automatic pay raises for our representatives, and claim regularly a need for more tax dollars as it continues to do waht it always does — mismanage byzantine bureaucracies with unaccountable supervisors like Lois Lerner.

  5. Lynn T

    47% pay no federal income tax. Only 14.4% pay neither income or payroll taxes for SS and Medicare. 9.7% pay neither because they are elderly, 3.4% because they are not elderly but have income below $20K, and 1.3% are “other.” In short, there are a lot of ways to slice and dice the numbers, but it is not true that 47% of the population, or any number near that, is getting a free ride on government benefits.

    1. Bart


      My comments were just that, comments. The 47% at the time was in reference to people who pay no federal income tax, not in reference to SS, Medicare, and other taxes we pay in every day life. If anything, according to the Tax Policy Center in 2013, the number dropped to 43%. I stand corrected. As for the jist of my comment on the 47%, the point was, unless you and Kathryn missed it, is that any politician who makes a campaign promise to cut benefits to anyone on the receiving end will not be elected or if elected, will not remain in office very long if he or she fulfills their campaign promise.

      Kathryn, your “French” is pardoned. Lynn’s facts are accurate according to several sources. And guess what? GASP! CHOKE! SPUTTER! One of the replys supporting Lynn’s facts was published by the evil media empire, FOX!

  6. Brad Warthen Post author

    By the way, elaborating on what I said above:


    … I’m feeling the same way about the gas tax in SC. It’s so obvious that we need to raise it, and it’s so disgusting that Democrats won’t stand up for it — blaming Republicans, saying you just couldn’t get it past the GOP — and instead pushing casinos to pay for our roads…

    Democrats who won’t stand up for a tax increase that is OBVIOUSLY called for are like Republicans (from Rand Paul to Thomas Ravenel) who won’t stand up for a strong national defense…

    1. Mark Stewart

      Some Republicans should stand up for the gas tax increase. Some should be willing to lead.

      But first, maybe we need to get the legislature to start devolving road control (non “real” highways) back to the counties? We need to raise the funds, but SC also needs to figure out a way to get control of the road miles inventory. Statewide control of nearly every roadway isn’t a solution with long term viability. Like with most things, it was pushed to increase the political patronage machine. That needs to be addressed as well. It isn’t like SC has a track record of efficient stewardship at the top of SCDOT.

    2. Silence

      Once again, I’ll reiterate my earlier statement that all taxes are really general fund taxes. If we raise the “gas tax” or the “H-Tax” or add a “penny for progress” or a lottery, of course it adds to the overall revenue haul, but it also supplants other monies that would have needed to be spent anyhow. Let’s stop the marketing or selling of taxes that accompanies attaching them to a specific popular cause, like fixing highways or imrpoving education and instead, let’s call things what they are.

      Short version: Taxes is taxes, let’s stop wasting money on crap and pay for the important stuff first, rather than paying for all the crap first and then “needing” to add taxes to pay for important programs.

      1. Brad Warthen Post author

        Generally speaking, I agree with you. I think everything should be funded from the general fund, according to priorities set by elected representatives.

        But the gas tax is our established method of paying for roads. So the most honest, transparent and efficient way to raise more money to pay for roads is to raise the gas tax.

        I wouldn’t normally say that, though.

        Of course, to be completely transparent — you know that I have an ulterior motive for wanting it to be the gas tax. It also helps implement my Energy Party agenda

  7. Doug Ross

    A trillion dollar military or a trillion dollar healthcare system. Pick one. All the supposed model countries chose healthcare. When you can provide an example of a country that does both, then we can talk. Until then, we’ll continue with the second class government run systems that are loaded with fraud and mismanagement.

        1. Brad Warthen Post author

          Yes, I know that’s your ideological belief.

          I have no ideological belief on this matter. Therefore I see that sometimes government does something better, sometimes the private sector does.

          1. Harry Harris

            Yeah, Brad, I guess there’s sinners working everywhere. And co-workers who turn their heads while they sin. I’m sure the documented thievery Halliburton (a private contractor) paid fines for doing in Iraq and Afghanistan doesn’t reflect badly on either the military or on the private sector.

        2. bud

          Really Doug as a government employee that’s a load of crap. Big companies may not have the “waste, fraud and mismanagement” issues as defined by libertarians but what they do is, in many cases, far worse. They exploit people. They exploit their workers. The CEOs who make 3, 4, 5 or more hundred times what average workers make are little better than thieves. And it’s all in the name of producing crap products that they peddle onto the unsuspecting and easily duped masses who buy into the pig in a poke mentality that masquerades as some sort of utopian product or service that can be and do all for everyone. Take the I-phone 6. Folks line up to replace their I-phone 5s for $3-4 hundred dollars that is essentially the same thing in a different package.

          And who benefits from all this frivolity? Only a handful of the lucky and well connected who scheme and collude on a massive scale through political shenanigans and a corrupt judicial system that allows the plutocrats to rule the government. It really is sad when so few can become so rich with so little actual contribution.

          In the meantime tireless government workers toil away trying to maintain roads, keep our homes and workplaces safe and our children educated. And what do they get for all their efforts? A bunch of no it all libertarians who know nothing but claim to know everything. And the rich get richer while the rest of us stagnant. Our nation is becoming a plutocracy run amok. In the end even the rich will suffer.

          1. Doug Ross


            As they say, nobody ever went broke underestimating the intelligence of the American public.

            There is a simple rebuttal to all your claims about the imagined plutocracy that you think exists: the U.S. has the highest standard of living in the world. The “poor” people in this country have cellphones, cable TV, cars with expensive rims, $200 sneakers. They spend their money on cigarettes, lottery tickets, and alcohol instead of on educating themselves. People are a result of their choices.

            When I go into a fast food restaurant and see a 40 year old man covered with tattoos working behind the counter and he can’t get my order right, am I supposed to blame the rich people in the world for his plight? He should be glad some “rich” person invested his time and money to own a restaurant.

            When you have an economy that depends less and less on unskilled labor, those without any skills will be left behind. Manufacturing jobs aren’t coming back. Farm work and construction jobs are done by illegal immigrants willing to accept less money because it’s still better than what they had at home.

            1. Bart

              I’m raising my hand. I work for myself and my boss is a total you-know-what. I can’t do anything to please him, haven’t had a raise in years, no days off, and the working conditions are horrible. I am exploited every day of the week, even the weekends.


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