Improved Medicare for All

By Jill Zorn

medicareI attended the National Single-Payer-Strategy Conference in New York City this past weekend.

With the Affordable Care Act (ACA), Medicaid and even Medicare under threat by incoming President Trump and the Congress, single-payer advocates are more energized than ever to pursue their goal.  The meeting, co-sponsored by three organizations:  Healthcare-Now!, the Labor Campaign for Single-Payer Health Care and One Payer States, had over 600 people registered – the largest attendance ever for this annual conference.


Here is how Healthcare-Now! defines single-payer:

The United States is the only country in the developed world that does not guarantee access to basic health care for residents. Countries that guarantee health care as a human right do so through a “single-payer” system, which replaces the thousands of for-profit health insurance companies with a public, universal plan.

In practice, many advocates have begun to refer to single-payer as Medicare for All, a term that was used successfully by the Bernie Sanders presidential campaign to draw attention to his health care policy.  Many people know what Medicare is, and Medicare is largely viewed favorably by the public.  In contrast, “single-payer” is a more insider term that isn’t widely known outside progressive circles.

Medicare for All also comes from the name of a single-payer bill, The Expanded and Improved Medicare For All Act (HR 676) that has been introduced for many years in the U.S. Congress, and will no doubt be introduced very soon as the 115th Congress gets underway.

Regardless of what it is called, the concept is popular.  In a poll conducted in June, more people favored replacing the ACA with a “federally funded healthcare system”, than preferred keeping the ACA.


It is hard to argue with single-payer as policy.  According to Physicians for a National Health Program, a prominent single-payer organization, an expanded and improved Medicare for All system would:

vastly simplify how the nation pays for care, improve patient health, restore free choice of physician, eliminate copays and deductibles, and yield substantial savings for individuals, families and the national economy.


It is in the politics of single-payer where the challenges lie.

During the health reform fight that culminated in passage of the ACA, lobbying groups like Big Pharma, the American Medical Association, the American Hospital Association and America’s Health Insurance Plans fiercely opposed single-payer.  Even including a public option as part of the ACA was not politically feasible.  The lobbying clout of these groups has not disappeared.

Another major political hurdle is the fact that health coverage would change for everyone currently receiving insurance through their employers.  Even though they may not be 100% satisfied with the current health insurance system and support the concept of federally-funded insurance, many people may not truly be ready for such a massive change.

There is no way around the fact that a shift to a single-payer system would also mean tax increases for at least some Americans – never an easy political sell.

What Next?

The conference drove home that Medicare for All is a worthy vision for our health care system.  It was inspiring to be reminded of what we truly need:  guaranteed, quality health care for all; with far less complexity, waste and profiteering than our current system embodies.

But even though the policy arguments for single-payer seem more attractive than ever, the daunting political realities have not changed.   The movement for improved Medicare for All will have to become a lot more powerful if it is to overcome these huge challenges.

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