ICYMI from Reason: “After 40 Years, No One Has Produced a Workable Single-Payer Health Care Plan”

CARSON CITY, Nev. – In case you missed it, in a recent op-ed published in Reason, Veronique de Rugy, a senior research fellow at the Mercatus Center at George Mason University, examines why decades of efforts to establish government-run health care systems have repeatedly failed to produce a workable model capable of delivering on promises of lower costs and expanded coverage.

The article highlights a critical point Nevada policymakers should seriously consider. Citing Jessica Riedl, an economist with the Brookings Institution, de Rugy notes that supporters of government-run health care have not identified either “a provider payment system that actually saves money” or “a financing mechanism” capable of funding expanded coverage without shifting costs elsewhere in the system. As de Rugy writes, “Despite hundreds of legislative proposals and multiple presidential campaigns built around the issue, no one has met the challenge.”

De Rugy further points to several state-level examples that illustrate these challenges. In 2014, Vermont lawmakers abandoned their single-payer effort after determining the payroll and income taxes required to sustain the program would be “politically unsurvivable.” In 2016, Colorado voters rejected their single-payer initiative after the legislature stated it would raise taxes by $25 billion to fund the system. And, in 2022, a California legislative analyst reported that the proposed single-payer system would cost between $494 billion and $552 billion annually.

These lessons should serve as warning signs as Nevada evaluates the future of its public option and Section 1332 waiver. Nevadans have already demonstrated limited uptake of Battle Born State Plans. Enrollment has fallen short of expectations since Battle Born State Plans launched in January 2026. Nevada achieved only about 10 percent enrollment in 2026, falling far short of the waiver application’s 35 percent enrollment threshold. As a result, Nevada will be required to provide additional premium support, placing additional financial strain on the state while asking taxpayers to subsidize a program that consumers rejected.

Access to care is another pressure point. Nevada ranks 48^th nationally in primary care physicians per capita. The newly implemented public option could make an already dire shortage worse. Any reimbursement cuts to providers under a public option could push much-needed physicians to leave the state.

Hospitals could also face financial pressure. An actuarial analysis by Wakely Consulting Group estimated that achieving a 16 percent premium reduction could require hospital reimbursement cuts of 25 to 30 percent, potentially creating financial hardship for hospitals whose margins are sensitive to commercial reimbursement rates. Those concerns have only grown since the analysis was conducted: following the One Big Beautiful Bill Act, Nevada hospitals are now expected to lose $300 million in supplemental Medicaid payments in 2028 and $507 million in 2029, while rising Medicaid coverage losses are expected to increase uncompensated care costs.

The failures highlighted across the country, combined with Nevada’s own experience with its public option, should give policymakers pause before preserving or even expanding state government-run health care initiatives.

Instead of repeating mistakes that have already played out in other states, policymakers should carefully consider whether proposals that expand government’s role in health coverage would ultimately create new financial risks for taxpayers, patients and providers without addressing the underlying drivers of health care costs.

Read the full Reason op-ed HERE.

Read the full Wakely Consulting Group analysis HERE.