Much is being made of a progressive proposal for “Medicare for all” as we approach the 2026 midterm elections.
There are variations of exactly what the proposal entails but agreement exists among supporters that healthcare would continue to be delivered as a combination of private and public providers — but a single public payer system would be created to pay for the healthcare goods and services provided.
Critics argue the proposal is far too radical and expensive. Proponents argue it is a reasonable proposal in response to the healthcare issue which the American public identifies as the third-leading public issue in American politics.The American healthcare issue is identified by the public and policy makers as a multipart issue involving high cost, limited access and poor results.
Annual healthcare spending in the U.S. is nearly $5.3 trillion and accounts for approximately 18.5% of our nation’s GDP. The per capita spending is approximately $15,600.
Both the total spending and the per capita spending levels are nearly twice that of all other democratic industrialized nations, all of which provide some version of public, universal and comprehensive healthcare for the citizenry.
The high cost of healthcare in the U.S. is traceable to multiple factors including the fact that the industry employees state of the art expensive technology and high-salaried professionals. Other factors accounting for high costs include the lack of price visibility and regulations for drugs, devices and procedures, the fee for service practice and the high administrative costs associated with administering a tangled web of scores of private and public health insurance plans.
Our highest level of global healthcare spending fails to provide the highest level of access and the best healthcare results. Access is limited by several obstacles including lack of personal funds and insurance, rural medical provider shortages, insurance restrictions on care, and lingering social and racial disparities.
The most recent government reports identify nearly 9% of the American public or approximately 28 million persons lack healthcare insurance of any type and that number is expected to increase by nearly 3.5 million during this calendar year because of Affordable Care Act insurance premium subsides being eliminated and federal funding for Medicaid being reduced by $800 million due to the One Big Beautiful Bill.
The lack of coverage is not spread evenly across the public. Nearly 30% of households with incomes below $25,000 per year lack health insurance which explains in part why our low-income public suffer disproportionately worse health conditions. Children have a high level of health insurance coverage with approximately 5.6% being uninsured while nearly 12% of the adult public between 18 and 64 years old have no health insurance.
Our nation’s public, 65 years old and older, enjoy the highest level of coverage due to Medicare.
High costs and an inability to afford the high costs limits access to quality care which leads to poor healthcare results in the U.S. Our life expectancy, infant mortality rates, chronic illness rates and the number of avoidable deaths all compare unfavorably with statistics and rates found in other democratic industrialized nations. The American lifestyle and a lack of emphasis on preventive health along with limited access discussed above all contribute to our poor healthcare results.
Nothing discussed above is new to our list of public issues. We have been faced with these same healthcare realities for decades, yet our policy makers bring us only incremental change. We find some satisfaction in Medicaid and Medicare approved in the mid-1960s, and the Children’s Health Insurance Program that followed and the 2010 Affordable Care Act but the healthcare issues outlined in this essay persist. Under the current Trump Administration and the Republican controlled Congress, funding and regulation regression has been the direction of policy change in healthcare giving us even higher costs, more limited access and poorer results. Perhaps it is the right time for a leap beyond incremental change in the form of Medicare for all.
A single integrated, regulated and funded healthcare payer system promises universal access, more efficient spending of our healthcare dollars and results competitive with the rest of our democratic industrialized cohort nations. Over 30 modern democracies have proven public funded and regulated universal and comprehensive healthcare is a more efficient and effective use of healthcare spending.
Those who insist the proposal is a radical version of socialized medicine are invited to advance a better alternative model of healthcare that will address our current challenges of high cost, restricted access and poor results.
The status quo promises more of the same.