America’s healthcare problem is not too much public coverage. It is a rigged market that lets private gatekeepers turn illness into a bill. Allysia Finley’s Wall Street Journal op-ed, Socialist Chic and the ‘Medicare for All’ Sham, argues that Abdul El-Sayed’s single-payer proposal is dishonest, fiscally dangerous, and likely to produce long queues while enriching the already comfortable. She also suggests that his income, property, and family wealth expose a contradiction between his politics and his life. The second argument is gossip dressed as economics. The first deserves a real answer.
Finley is right on one narrow point: the label is imperfect. Traditional Medicare has premiums, deductibles, cost-sharing, separate prescription-drug plans, and no ordinary ceiling on out-of-pocket spending. That is an argument for finishing public coverage, not abandoning it.
The gaps in Medicare are not evidence that public insurance fails. They are evidence that partial coverage leaves people exposed. A system that covers older Americans but still makes them buy another plan for catastrophic protection is not a refutation of universal coverage. It is an unfinished version of it.
The article’s sharper trick is to treat every public dollar as government control while treating every private bill as freedom. A hospital charges a facility fee. A pharmacy-benefit manager inserts itself between the patient and the drug. An insurer denies a claim through an opaque network rule. A private-equity firm buys a clinic, loads it with debt, and cuts the service that made the clinic useful. The patient receives the bill and is invited to admire the market.
That is not freedom. That is a tollbooth with a waiting room.
Finley says healthcare problems are largely caused by government policy, pointing to Medicaid reimbursement and physician access. Some public rules can create real problems. Reimbursement affects which doctors accept which patients. Medicaid patients can face delays. These are genuine design failures.
But the article turns one true fact into a universal escape hatch. Private insurance has networks. Private insurers deny care. Private hospitals consolidate. Private firms also ration care, except they ration it by price, coverage language, and ability to pay. A patient who cannot afford the specialist does not experience that as liberty. She experiences it as being told to wait outside.
The British waiting-time statistic may show that Britain has a serious problem. A queue can ration care by time. America rations it by price, coverage rules, and billing confusion. Patients wait for appointments, postpone treatment, leave emergency rooms without care, or discover that an in-network hospital has an out-of-network anesthesiologist. The American queue is simply harder to see because part of it is financial.
The wealthy can sometimes jump that queue here as well. They buy concierge doctors, premium insurance, private facilities, and second opinions. Money already expedites care in America. The difference is that everyone else also gets the bill.
And Abdul El-Sayed’s income does not change the arithmetic. The op-ed reports that he and his wife earned $686,069, held substantial assets, owned rental properties, and received family help with a property purchase. Good for them. A politician’s bank account does not determine whether a child should lose access to insulin when a parent changes jobs.
Dress him in Carhartt or a suit. The family choosing between rent and a copay has the same problem.
If personal wealth settled policy questions, we would have to abolish public schools until every education secretary had taught in a one-room schoolhouse.
The real question is who pays. Under the current arrangement, employers pay premiums, workers lose wages to those premiums, patients pay deductibles, taxpayers subsidize uncompensated care, and families absorb surprise bills. The money does not vanish. It moves through insurers, hospitals, drug companies, contractors, and billing firms before landing on the patient.
A universal public plan changes that route. It pools risk broadly, removes the need to keep a job for healthcare, and gives patients a provider that cannot cancel coverage because the treatment became expensive. Private plans can remain for supplemental services or compete where competition is useful. But essential care should not depend on whether a person is healthy enough to comparison-shop.
That is harder here than in Britain or Denmark. America has fifty state insurance systems, fragmented public programs, powerful hospital chains, organized insurers, and a political culture that treats broad taxation as theft while accepting much larger private premiums as weather. Providers would fight. Insurers would fight harder. The transition would be expensive and administratively difficult.
Those are reasons to design the plan well. They are not reasons to pretend the present arrangement is neutral.
Start with automatic enrollment, a public option available in every state, negotiated drug prices, an out-of-pocket ceiling, and coverage that follows the worker rather than the employer. Build toward universal public insurance while preserving the clinics, doctors, and cooperative practices that already deliver care. Let private providers compete to serve patients. Do not let private gatekeepers decide which sick people are profitable.
The name can be Medicare or something less politically tidy. The working alternative is the same: a public floor under a private healthcare economy, with no family ruined because someone got cancer.
The market can sell sandwiches. It should not decide who gets chemotherapy.