Leon Trotsky — n.b., Millennials: He was Alexandria Ocasio-Cortez before she was — understood the power of single-payer systems: “The old principle: who does not work shall not eat, has been replaced with a new one: who does not obey shall not eat.”
The socialist powers of Trotsky’s time made good on that promise: They intentionally starved to death something on the order of 10 million Ukrainians and peasants in the other socialist republics who resisted the political project of “collectivization,” i.e., single-payer agriculture. Those fleeing the man-made famine were shot. Bringing the “New Socialist Man” into being entailed murdering many millions of the old kind.
F. A. Hayek, the economist and classical-liberal political theorist, understood the power of single-payer, too. Under comprehensive socialism, he argued, the state would be in practice the sole employer — i.e., single-payer labor — which would give its administrators powerful and probably irresistible powers of coercion over workers on the lines envisioned by Trotsky: Political dissidents could simply be excluded from the employment that would be the only means of material survival. There could be one big Holodomor killing millions, or millions of little holodomors stamping out a political dissident here, a critic there, a poet, a novelist, an artist . . .
Hayek, perhaps partially foreseeing our current witch-hunting environment in which the enforcers of political orthodoxy have recruited the employers as their instruments of discipline, worried about the rise of salaried employment as the standard model of compensation and the decline of the economically insubordinate class of the independently wealthy and unencumbered entrepreneurs. He was picking up the thread from John Stuart Mill, who worried about both official tyranny and “the tyranny of the prevailing opinion and feeling; against the tendency of society to impose, by other means than civil penalties, its own ideas and practices as rules of conduct on those who dissent from them; to fetter the development, and, if possible, prevent the formation, of any individuality not in harmony with its ways, and compel all characters to fashion themselves upon the model of its own.” I get into this at considerably greater length in my upcoming book, The Smallest Minority, but for the moment consider only the ways in which “single-payer” and other monopolistic systems of one kind or another create an entirely new class of “civic penalties,” e.g. the kangaroo courts on university campuses that suppress unpopular political views. It took a Supreme Court ruling — an opinion opposed by the so-called liberals on the court: Ginsburg, Kagan, Sotomayor, and Breyer — to liberate certain public-sector workers from the requirement that they affirm political speech with which they disagree as a condition of employment.