Abdul El-Sayed in Michigan is building his US Senate campaign on Medicare for All, promising health care coverage for all Americans “cradle-to-grave.”

In Minnesota, Democratic Senate nominee Peggy Flanagan has likewise made Medicare for All a central plank of her progressive platform.

In New York, more than 100 state lawmakers have co-sponsored legislation to establish a statewide single-payer system.

Single-payer health care is back on the political agenda, pushed by Democratic Socialists and their leftist allies as the answer to Americans’ frustrations with private medical insurers.

But while excoriating insurance companies may be good politics, forcing everyone into a government insurance monopoly would be disastrous policy.

Today’s insurance market has flaws, granted — but at least Americans aren’t trapped.

Employers can move their workers to a different insurer; those who buy their own coverage can compare competing plans and switch during open enrollment.

Even Medicare beneficiaries — whose coverage is financed by the federal government — still enjoy real choices.

They can enroll in traditional Medicare or choose among competing Medicare Advantage plans run by private insurers, and many can also shop among competing Part D prescription-drug plans.

Choice and competition matter, and even one of America’s largest government health programs recognizes that.

Medicare for All would eliminate all those choices by effectively outlawing private insurance.

Competing insurers would no longer negotiate payments and prices with providers — leaving Washington to become the nation’s single payer for health care.

The Medicare for All bill Sen. Bernie Sanders (I-Vt.) introduced last year would require the federal government to establish a national health budget.

From that amount, Washington would set payment rates for physicians, hospitals and other care providers, with federal bureaucrats deciding what they may be paid for every service they deliver.

The sums Washington would have to raise and spend on such an endeavor would be staggering: roughly $32 trillion over a decade, according to independent estimates from the left-leaning Urban Institute and the libertarian Mercatus Center based on previous versions of Sanders’ plan.

Not even doubling all projected federal individual and corporate income taxes would be enough to cover the tab, Mercatus concluded.

Single-payer systems abroad show that even enormous government health budgets don’t eliminate scarcity.

The British government spent about $380 billion in public money on health care last year, while Canada is projected to spend roughly $204 billion.

Yet patients in both countries still endure the extraordinary waits and shortages their systems impose.

That’s the unavoidable tradeoff Medicare for All advocates rarely acknowledge.

Government can promise comprehensive health care to everyone, but it cannot conjure an unlimited supply of doctors, nurses, hospital beds or taxpayer dollars.

When demand exceeds what the government’s budget can finance, something has to give — and usually, it’s access to care.

Britain’s National Health Service shows what those tradeoffs look like at the bedside.

NHS England reported in June that an average of 2,241 patients a day were receiving “Corridor Care” — treatments in emergency-department hallways due to chronic overcrowding — and another 669 were treated daily in other inappropriate hospital spaces.

The strain isn’t confined to emergency departments: At the end of May, about 6.2 million people in England were waiting to start non-emergency specialist treatment.

More than 104,000 of those patients had been waiting over a year.

It’s the same story in Canada’s single-payer system.

Last year, the median wait for treatment from a specialist following referral by a general practitioner was more than 28 weeks.

Canadian patients also faced long waits for access to important diagnostics: a median of more than eight weeks for a CT scan and 18 weeks for an MRI.

Single-payer doesn’t spare physicians, either — a longitudinal study that tracked the same emergency physicians in Canada over nearly five years found persistently high burnout.

By 2025, almost half had reduced their clinical hours, and one in 10 had left emergency medicine entirely — hardly a recipe for improving patients’ access to care.

At least Britain has preserved an escape hatch from its government-run system.

Private medical insurance covered 6.5 million people there in 2024, giving many patients another option when the NHS could not deliver timely treatment.

Medicare for All would offer Americans no comparable way out.

Americans frustrated with insurers deserve the power to fire them.

Medicare for All would leave them stuck with the one insurer they could never fire — Washington, DC.

Sally C. Pipes is president, CEO and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. X: @sallypipes.