Medicare for All

1. The US Healthcare System is Uniquely Expensive and Inaccessible

America is exceptional on virtually every healthcare measure. But more often than not, we’re exceptional in exactly the wrong ways.

High costs, poor outcomes. The United States spends far more on healthcare than other developed nations, yet Americans experience worse health outcomes, including lower life expectancy and higher infant mortality rates. This is due to a combination of high prices for medical services and prescription drugs, as well as excessive administrative costs. For example, a day in the hospital costs $5,220 in America, compared to $765 in Australia.

Millions lack access. Despite the high costs, millions of Americans lack health insurance, and many more are underinsured, leading to delayed or forgone care. This lack of access disproportionately affects low-income individuals and people of color. More than 30 million Americans had no health insurance in 2019.

Systemic issues. The US healthcare system is fragmented and market-driven, leading to inefficiencies and inequities. The system prioritizes profit over patient care, resulting in a complex and bureaucratic structure that is difficult for both patients and providers to navigate. The current system contributes to poverty, unemployment, and housing instability.

2. Medicare for All Aims for Universal, Comprehensive, and Secure Coverage

Medicare for All is a simple idea: the government guarantees comprehensive health insurance to all Americans under a single, publicly funded plan.

Core principle. Medicare for All (M4A) proposes a single, publicly funded health insurance system that covers all US residents, regardless of income, employment status, or health condition. This system would replace the current mix of private and public insurance with a unified program. M4A would be an enhanced version of the traditional Medicare program.

Comprehensive benefits. M4A would provide comprehensive coverage, including medical, dental, vision, hearing, mental health, and long-term care services. It would also eliminate or significantly reduce out-of-pocket costs, such as deductibles and copayments. Leading proposals for Medicare for All would cover a full range of benefits with minimal or no out-of-pocket costs.

Secure coverage. Under M4A, health insurance would be a right, not a privilege, ensuring that all Americans have access to quality healthcare without fear of losing coverage due to job loss or other life changes. Every American would have secure, lifelong health coverage no matter how their circumstances might change.

3. Medicare for All Achieves Cost Control Through Pricing Power and Efficiency

By insuring all Americans, M4A becomes a monopsony in healthcare.

Negotiating power. A key feature of M4A is its ability to negotiate lower prices for prescription drugs and medical services, leveraging its position as the single largest purchaser of healthcare in the country. This negotiating power would help to control costs and make healthcare more affordable. M4A would neutralize the power of local monopolies, and more generally would prevent providers from taking advantage of a broken marketplace to raise prices.

Administrative savings. M4A would streamline the healthcare system by eliminating the administrative overhead associated with private insurance, such as marketing, executive salaries, and profits. This simplification would also reduce the burden on providers, who would no longer have to navigate a complex web of insurance plans and billing requirements. The administrative simplicity of a single payer would also decrease the time that clinicians and patients spend dealing with insurance issues.

Long-term cost reduction. By controlling prices and reducing administrative costs, M4A has the potential to significantly lower healthcare spending over the long term, making the system more sustainable and affordable for all Americans. M4A’s negotiating power could keep prices in check indefinitely, which could allow America to finally get a hold on runaway spending growth.

4. Progressive Financing and Public Accountability are Central to Medicare for All

M4A could replace the regressive financing of private insurance with progressive taxation, saving money for middle-class and low-income families.

Fairer financing. M4A would shift the burden of healthcare costs from individuals and employers to a progressive tax system, ensuring that those who can afford to pay more do so, while protecting low- and middle-income families. This would alleviate the financial strain on those who are currently struggling to afford healthcare. Private health insurance is financed regressively, with low-income families spending three times as much of their income on healthcare compared to high-income families.

Public oversight. Under M4A, the healthcare system would be accountable to the public, rather than to shareholders, ensuring that decisions are made in the best interests of patients and communities. This public accountability would help to prevent the abuses and inefficiencies that are common in the current for-profit system. Unlike a for-profit company, M4A can justify its decisions based on public health benefit and social mission rather than cost-cutting or profit-making.

Improved health equity. By providing universal coverage and eliminating financial barriers to care, M4A would help to reduce health disparities and ensure that all Americans have the opportunity to live healthy lives. M4A seeks to give all Americans reliable access to healthcare no matter their life circumstances—and to make the healthcare system itself more resilient.

5. Key Design Choices Determine the Scope and Impact of Medicare for All

These policy questions will also shape the political debate around Medicare for All.

Benefit coverage. Policymakers must decide which services to include in the M4A plan, such as long-term care, reproductive healthcare, and gender-affirming care. These decisions will impact the cost and comprehensiveness of the program. The inclusion of long-term services and supports could add hundreds of billions of dollars to the annual costs of M4A.

Out-of-pocket costs. Policymakers must determine the level of cost-sharing, if any, that will be required under M4A. Eliminating out-of-pocket costs would increase access to care but could also increase overall spending. The raw number of people with health insurance does not tell the full story about how Americans are protected from healthcare costs: Americans are not just uninsured but underinsured.

Provider payment. Policymakers must decide how to pay doctors and hospitals, whether to build on Medicare's existing payment methods or move to a system of global budgets. These decisions will impact the financial incentives of providers and the overall efficiency of the system. The most effective way to increase revenue was to command higher prices from privately insured patients.

6. The Battle for Medicare for All Hinges on Key Stakeholders

The prospects of M4A—and the political strategy that might be deployed to get it passed—will depend critically on the stakeholders that are lined up for and against the proposal.

Nurses and front-line workers. Nurses and other front-line clinical workers have become powerful voices in support of M4A. Their unions are potent sources of people power. They are among the most adept and committed organizers in the healthcare debate, helping organize people and resources to broaden support and engage in direct activism.

Healthcare corporations. The most important and most powerful opposition to M4A is healthcare corporations. They leverage that money to move the public conversation by maxing out on campaign contributions, supporting industry-friendly candidates with outside spending during elections, hiring armies of lobbyists on Capitol Hill, and launching massive advertising campaigns to sway public opinion.

Conservative infrastructure. The full conservative infrastructure has lined up against M4A, including the Republican National Committee; advocacy organizations like Turning Point USA, FreedomWorks, and the American Action Network; and conservative think tanks like the Heritage Foundation, the American Legislative Exchange Center, and the Mercatus Center.

7. Organizing and Public Opinion are Critical to Overcoming Opposition

The challenge of hundreds of millions of dollars spent by insurance companies and drug companies to beat this back can only be overcome by a massive groundswell of people across the country.

Grassroots power. A popular national movement is essential to overcome the opposition from powerful interest groups and build the political will for M4A. This movement must engage in grassroots organizing, educate the public, and mobilize voters to support pro-M4A candidates.

Shaping the debate. M4A supporters must effectively counter the arguments used by opponents, such as claims that M4A will take away choice, raise taxes, and lead to government control of healthcare. They must also reframe the debate to focus on the benefits of M4A, such as universal coverage, comprehensive benefits, and lower costs.

Building a broad coalition. To succeed, the M4A movement must build a broad coalition of supporters, including doctors, labor unions, seniors, and businesses. This coalition must be diverse and representative of the American public.

8. The Path to Medicare for All Requires Navigating Political Realities

M4A is possible. But it is not inevitable.

Political will. Passing M4A will require strong political will within the Democratic Party, as well as a supportive president and Congress. This will require electing pro-M4A candidates and holding them accountable to their promises.

Legislative strategy. M4A supporters must develop a clear legislative strategy, including navigating the Senate filibuster and addressing concerns about the cost and implementation of the program.

Long-term vision. The fight for M4A is a long-term project that will require sustained effort and commitment. It is essential to build a movement that can withstand setbacks and continue to push for progress toward universal healthcare.

Last updated: February 24, 2025