We have to be careful what we wish for. Imagine if an administration like our current one were even more empowered to call the shots on healthcare delivery and payment by controlling a single-payer system. Government-run systems always run the risk of politicization and ideological sabotage. The health policy tools already in place are dangerous enough. Would you really want the federal government redefining health and medicine the way this administration is redefining science? At least there are NGOs and private-sector buffers to the damage to science, rather than a single-payer research infrastructure. We place enough bets as it is on the wisdom and decency of people empowered by the whims of a volatile electorate without adding healthcare to the gamble. In health as in all fundamental areas of well-being, we have no guarantees against foolishness or malevolence beyond distributing their risks across multiple systems.