Politicians have been debating how to improve U.S. health care for years. The idea of adopting a national single-payer health care system, also known as “Medicare for All,” sparks strong opinions both in support and opposition. It’s emerged as a key issue in the race for the Democratic presidential nomination. Here’s one perspective on the issue.

Let’s face it, our health care system is doing us harm. Growing numbers of Americans are struggling with rising medical costs, while insurance and pharmaceutical industry profits are ballooning out of control. A rift is steadily widening between those who can afford medical care and those who can’t. Our nation needs a rational, comprehensive health care system. Medicare for All is the answer.

Of course, pharmaceutical and health insurance companies won’t tell you this. They’re raking in record profits. Cigna and Humana each reported greater than $1 billion in profits in just the second quarter of 2019. Those who are lucky, or wealthy enough to enjoy health care security, even if it’s temporary, may not sense the urgency of the situation. Some may not agree that change is needed. But what about everybody else?


In 2018, 27.5 million people in the United States lacked health coverage. That’s 8.5% of the population, a number which increased from 7.9% in just one year . But let’s focus on people who do have health insurance, specifically those who get it through their employers. Workers are feeling the squeeze of rapidly climbing costs.

Employer health plan deductibles more than tripled . The proportion of employees in high deductible health plans has reached 46%. Four in ten of the workers in these plans did not have enough savings to cover their deductibles. Nineteen percent of respondents in the nationwide survey claimed that deductibles had used up all, or most, of their savings. The poll also found that 24% of covered workers didn’t follow up with lab tests or treatments that their physicians recommended, due to the associated costs. Eighteen percent cut pills in half, skipped doses of medication completely or didn’t even fill prescriptions.

As a registered nurse, I routinely see people who delay or forgo treatment or stop taking their medications because they lose their insurance, or they simply don’t have the money for co-pays and deductibles. It’s dangerous and I’ve seen bad outcomes. As a nurse who also does community outreach, I see people who are slowly dying because they don’t have access to health services at all. And, while I witness the inadequacies of the current health system, I wonder if it’s even sustainable. One study predicts that, by 2027, 51% of the workforce will be made up of independent workers — people with no employment-based benefits. Another study finds that half of retiring boomers will be dependent upon Social Security. How are they going to afford co-pays and deductibles?

Medicare for All, a single-payer, publicly funded system, would solve all these problems by guaranteeing every person in America access to comprehensive health services. There would be no co-pays, deductibles or premiums. People could see a physician of their choice, and would be free of crushing medical expenses, regardless of their situation in life. And it makes economic sense.


Jacob McKean, Modern Times Beer’s CEO, says, “Private health insurance is a burden on my business, on all businesses. Medicare for All would free us from the nightmare of dealing with — and paying for — private health insurance. It would promote entrepreneurship and innovation by allowing us to invest our time and money in what we do best, rather than dealing with the wasteful insurance market.” Let’s face it, the drag of our health care system is also doing our businesses harm.

The United States spends 17.8% of its GDP on health care . By contrast, France’s universal health care system costs 11% of GDP. Much of this disparity stems from the fact that, in the U.S., we pay for huge corporate profits, and for the administrative costs and waste associated with a for-profit system. The administrative cost margin for the private health insurance industry is over 12% . Medicare, as it exists today, has a margin of 2%. The Canadian single-payer system spends 2.7% of its funds on administration.

The Political Economy Research Institute (PERI) at the University of Massachusetts-Amherst published a 2018 analysis that demonstrates the feasibility of single-payer health care in the U.S. The PERI study determined that Medicare for All would reduce total health care expenditures from the current $3.24 trillion to $2.93 trillion per year. In addition to slashing administrative costs, the plan would generate significant savings through firmly negotiating drug prices and through other measures. American households would pay up to 14% less than they are paying now. People would contribute via equitable taxes, rather than through premiums and deductibles, and overall, they would pay less!

Recently, plans that would blend private insurance with a public option have been touted. These would maintain co-pays and deductibles, promote administrative waste and allow private insurers to “cherry pick” healthier patients. These would not be the answer to our problem.


The only solution is to adopt true single-payer Medicare for All.

Hall, R.N., M.P.A., is San Diego Chapter director of Health Care for All - California.