By Maria Behan

Like many rich men, Uncle Sam relishes showy display—and cheaps out when he thinks no one is looking. A swaggering superpower flaunting its big bankroll on the world stage, America expects its citizens at home to meekly accept deficient programs that would outrage the residents of other, less affluent nations. Take our neglected infrastructure, which results in a myriad of hurts, both large (buckling bridges and unsafe drinking water) and small (a wheel warped by a pothole). As a visiting overseas friend observed with a mixture of shock and schadenfreude, “My god…California’s roads are worse than Malta’s!”

Why do Americans accept the myriad problems that flow from our decrepit infrastructure? Because we’re told we can’t afford better. And who tells us that? The rich.

Does it seem like there’s something wrong with that picture? Wait, there’s more…unfortunately, much, much more.

The literally life-or-death realm of healthcare is the most egregious example of our Gilded-Age government’s refusal to use the taxes Americans pay to fund programs that actually benefit us. Here’s a pithy summation of the current state of play: “Business owners are struggling to provide health insurance to their employees, workers’ take-home pay is shrinking as their premiums go up, patients are literally begging for their lives on fundraising platforms like GoFundMe, doctors and hospitals are drowning in paperwork dealing with insurance claims departments, and more than 80 million people lack adequate health insurance.” Who said that? Bernie Sanders? No, it was Wendell Potter, former vice president at health insurance giant Cigna. 

Americans are struggling to shoulder the burden of a largely for-profit healthcare system that costs roughly twice as much as in other countries. But surely by paying through the nose, we’re at least getting better care, right? Actually, the opposite is true: The United States has higher infant mortality and shorter life spans than other wealthy nations. Indeed, when the Commonwealth Fund ranked healthcare-system performance of 11 major nations in 2017, the United States came in dead last. Pun intended.

Until recently, the majority of Americans accepted this outrageous state of affairs because they bought the line of health-insurance companies and Big Pharma, who tell us that this is simply how it has to be—and pour considerable amount of money into disinformation campaigns, often of the scare-mongering variety. And because of Americans’ unfortunate tendency toward myopic exceptionalism, when healthcare interests tell us we have the best system we could possibly have unless we want to give up eating, too few of us poke our heads above the parapet to see that that’s just not true. Indeed, every other industrialized country manages to provide its citizens with some kind of universal healthcare. So why can’t the wealthiest one?

At last, more and more Americans are asking that question. In a January 2019 Harvard/Politico poll, 68 percent of respondents favored a taxpayer-funded national plan for health insurance. And more and more politicians are listening: The Medicare for All Act of 2019 was backed by more than 100 members when it was introduced in the House of Representatives last month, and Bernie Sanders is expected to reintroduce a similar bill in the Senate. Both bills would take the current Medicare program for seniors, improve it to cover all essential health services—including dental, vision, and long-term care—and extend it to everyone in America. On the presidential front, almost all of the many contenders for the 2020 Democratic nomination are espousing a dramatic overhaul of our broken healthcare system.

Accept No Substitutes

The push for universal healthcare has never been stronger—but like any reform that threatens entrenched interests, it’s drawing furious attempts to undermine or at least co-opt it. Predictably, Republicans are deriding Medicare for All as socialism that would sunder society’s fabric and force us to take out our own tonsils. It’s pretty much the same playbook they used when they attacked the original Medicare program—the one that U.S. seniors have been relying on for the past 53 years.

But many Democrats are also trying to tamp down the public’s enthusiasm for Medicare for All. Some oppose it because they’ve been bought and paid for by the medical-industrial complex, just like their Republican counterparts. (Healthcare interests spend more on campaign contributions and lobbying than any other sector of the U.S. economy, plowing back some of the huge profits they make from actual or anticipated illness to buy legislators’ loyalty and votes.) Other Democrats like—or say they like—Medicare for All in principle, but advocate getting there gradually, so that voters and healthcare providers will have time to adjust.

Toward that end, a few prominent Democrats have started touting programs that would let some individuals buy into public insurance through programs labeled “public option,” “Medicare for America,” or even “Medicare for All Who Want It.” The terminology is confusing, and it some cases, it’s meant to be. But here’s a tip: “Medicare for All” is like “100% whole grain”: It’s the label to look for when you’re looking for something that doesn’t just sound healthy, but actually is.

Any way we do it, America’s transition to universal healthcare will be a mighty heavy lift, so we definitely need to be strategic. I like Medicare for All because it rips the band-aid off quickly (to use a medical term) and gets us to a single-payer system that will yield efficiencies that translate into significant dollars saved. (Sadly, in some quarters of this country, especially in the corridors of power, dollars saved may be more important than lives saved—though many lives will be saved, too.) Half-measures may yield mixed outcomes…and any bad news will be used as an excuse to attack and derail reform. To me, it’s kind of like the way the Green New Deal tackles climate change: We’ve let the problem fester so long, if we don’t go big, we may be incapable of addressing it in a way that actually makes a difference. 

Those who support incremental approaches to healthcare reform may be well meaning, but they also may undermine the prospects of reaching a true single-payer Medicare for All system. “As we saw during the four year roll-out of the Affordable Care Act vs. the efficient, ten-month transition to Medicare, lots of lies can be told, the industry can game the system, and opposition can organize,” warns Medicare for All advocate Michael Lighty.

“It’s time for Democrats to stop proposing health care reform that relies on insurance companies to play fair. After two decades in the for-profit health insurance industry, I can assure you they never will,” says my favorite ex-insurance exec, Wendell Porter, who adds “I can tell you firsthand that by focusing on a half-baked measure like a Medicare buy-in, Democrats would hand a huge gift to the private insurance industry while doing less than the bare minimum to help struggling businesses, workers, families, and patients.”

Don’t Let Donald Trump Ruin Yet Another Thing

Some Democrats shy away from Medicare for All because they have a single goal in mind: defeating Donald Trump in the 2020 election. I share that goal and laud their focus. But just as I don’t think that nominating a has-been centrist like Joe Biden is smart politics in the current political environment, I don’t think pursuing warmed-over Obamacare is the way to galvanize the electorate. Especially if that healthcare proposal is marred by the same flaw as Obamacare: leaving for-profit insurers in the equation. Not only does that decision make Obamacare more expensive than it needs to be, it abets Republicans’ relentless attempts to dismantle the policy, which they have recently renewed. (Perversely, Trump’s latest salvos against Obamacare have caused Democrats to put aside their emerging differences on healthcare, since all agree that we must shore up the imperfect system we have now before moving on to something better.)

Those who are terrified that Medicare for All might prove to be an unpopular campaign pledge that could cause Democrats to snatch defeat from the jaws of victory in 2020 point to a few polls that show that Medicare for All support drops when people are told that it would replace employer-provided health coverage, which about half of Americans are lucky enough to have today. (Or sort of lucky…even those with such coverage often face big co-pays, huge drug bills—and possible bankruptcy should serious illness strike. Indeed, medical costs are the number-one cause of personal bankruptcy in the United States, including for those insured through Obamacare or employers.)

But should we really abandon the fullest and most fiscally sound solution to America’s healthcare woes because some people don’t “get” it when they’re first introduced to the concept of single-payer Medicare for All? If we can make ourselves heard over the fear mongering of for-profit insurers, it should be pretty easy to make the case. Which is better: a) limited, more-expensive coverage that’s contingent upon keeping a particular job or b) comprehensive, less-expensive health coverage that people receive simply because they’re alive?  People’s initial confusion doesn’t mean we should opt for an inferior policy; though it does mean that Medicare for All advocates have some ‘splaining to do.

The reason Medicare for All is better than sound-alike proposals isn’t just ideological purity—though there is that—it’s dollars and cents. Unlike the “lite” proposals, Medicare for All would not only cover everyone in the country, it would deliver the efficiencies and cost savings that come with a single-payer system—that single-payer being Uncle Sam.

Those cost savings are estimated to be dramatic—and much needed when you’re talking about something as expensive as healthcare. The U.S. government projects that the patchwork for-profit insurance system we currently have will cost about $50 trillion to maintain over the next decade. Every Medicare for All plan would cost far less—Bernie Sanders’ 2017 Senate bill was priced at around $33 trillion over the same period. That’s still a pretty stiff price tag, but considering the alternative, you can’t say Medicare for All is “unaffordable.”

Like all government endeavors, Medicare for All would be funded by taxes, though the details of that funding have yet to be determined. The necessary revenue could come from a variety of sources, including increasing the top tax rates for wealthy individuals and corporations and repurposing some funds currently allocated to the military (the U.S. currently spends more than the next 10 nations combined). We might even get creative and have some fun with it, for instance, demanding repayment of the staggering sums taxpayers shell out for travel and security whenever Trump heads down to Mar-a-Lago for golf and shrimp cocktail, his sons jet off to Dubai to negotiate business deals for the Trump Organization, or Ivanka and her husband fancy a ski trip.

Even in funding schemes that raise taxes more broadly, most Americans would see considerable net savings because they’d no longer have to pay insurance premiums, co-pays, or deductibles. In other words, taxes may go up on one side of the ledger, but costs will definitely go down on the other—and individual households will come out ahead. The same goes for businesses: even if there’s an increase in the payroll tax, the majority of businesses would save money because they’d no longer have to fund their employees’ private insurance.

I’m not saying there aren’t political and financial complexities to be addressed on the road to Medicare for All. But because of the efficiencies inherent in a single-payer system, Medicare for All looks like the best way for America to finally join the ranks of nations who provide their citizens with universal healthcare. And if Medicare for All proves to be politically unattainable after advocates have made a concerted effort to counter misinformation and help people understand how the program might work for them and their families, maybe we’ll have to admit defeat (for now) and pivot to an approach that keeps private insurance companies in the mix (for now). But if we give up before we start and don’t advocate for Medicare for All, America will lose its chance to provide the most people with the best care at the lowest cost.