'Free' Health Care is Anything But

P.J. O’Rourke once famously wrote, “If you think health care is expensive now, wait until you see what it costs when it’s free.” Pennsylvania House Democrats want to test that theory.

This bill is wrong for Pennsylvania for many reasons. Scott’s bill would blow a hole in the already precarious state budget, hammer taxpayers and employers alike, and reduce access to quality health care.

The proposal’s price tag is utterly outrageous! Scott’s plan costs nearly $70 billion in its first year, more than doubling the size of the entire state budget. It would quadruple what every Pennsylvanian pays in state income taxes.

The bill’s proponents will argue that the new single-payer system will replace Pennsylvania’s Medicare and Medicaid obligations. But state lawmakers can neither rewrite federal entitlement programs nor guarantee that waivers will exempt Pennsylvania from those massive financial burdens.

The state budget already faces about $2.6 billion in delayed Medicaid payments, meaning we will still have to pay whatever we owe this year on top of what we owe next year. Forget “Medicare for All” — we can’t even afford “Medicaid for Some.”

By raising taxes, of course. HB 2763 will enact a new 10-percent income tax to cover costs!

But the bill’s tax hike isn’t limited to wages. It will also tax investment income, capital gains, interest, business income, and any other revenue source not excluded in the bill’s purposefully vague language.

Combined, this proposed tax hike would be the biggest in Pennsylvania history, dramatically increasing our already sizable tax burden.

And what happens when these new taxes aren’t enough? When projected expenses inevitably exceed revenue (as is the case for almost all government programs), the bill proposes raiding the state’s General Fund. Fewer plans are less reassuring or logical than the age-old practice of robbing Peter to pay Paul.

This reckless tax-and-spend plan would only exacerbate the commonwealth’s current fiscal crisis.

What would we get for a massive tax hike and spending increase? Worse health care.

This government-run health care plan would ban all private insurance. And that’s the wrong approach. Government-provided coverage delivers lower-quality health care. That’s true of single-payer systems in other countries, and it’s true of Medicaid and Medicare: longer wait times, less access to doctors, denial of services, and worse overall health outcomes.

We don’t need to increase costs for Pennsylvanians by canceling their insurance and putting everyone on a government program. Instead, we need to cut high health-care costs — and that begins by empowering patients and practitioners.

Pennsylvania faces a doctor shortage, meaning longer waits and higher prices. The Health Resources and Services Administration projects that the commonwealth will be short of 2,500 physicians by 2038.

The best shortage workaround is to expand the labor pool. For example, granting full-practice authority to nurse practitioners, often the only medical professionals available in rural communities, would increase the availability of affordable providers for many services.

Pennsylvania law also blocks alternative coverage plans. Self-funded association health plans (AHPs), which let small businesses and self-employed individuals pool resources and purchase insurance as a unified group, are not allowed in the commonwealth. Even worse, in 2018, then-Attorney General Josh Shapiro, alongside 9 other states and the District of Columbia, sued the federal government to block the expansion of AHPs.

Lawmakers must inject healthy competition into the marketplace by expanding such alternatives. AHPs provide savings up to 29 percent on health-care claims, according to the Foundation for Government Accountability.

Only by addressing cost drivers can Pennsylvania begin to make health care affordable and accessible. Creating a new government program that will crush Pennsylvanians with more taxes is not the answer. Increasing the availability of services and providers—primarily by pushing government out of the way—is a far superior alternative to government-mandated coverage and fiscal calamity.

Megan Martin is the chief operating officer and general counsel for the Commonwealth Foundation, Pennsylvania’s free-market think tank.