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single-payer
Improved Medicare for All Can Heal This Sick Country
A system that collects money from patients and employers then profits by withholding the promised care is not a business but a fraudulent, diabolical scam.
Jan 17, 2025
It’s the beginning of the end for corporate control of health care. The tsunami of outrage against the health insurance industry in the wake of the shooting of United Healthcare CEO Brian Thompson, can propel an urgent, unyielding demand for the removal of profit from healthcare and the enactment of a universal, national single payer system. That is, if the single payer, Medicare for All, national health service movement can summon the vision and audacity to rise to the occasion.
The myth, promoted by health care think tanks and policy experts, that people in the United States are satisfied with their health insurance was exploded in the social media rage unleashed in the aftermath of the killing of the United Healthcare CEO.
Fifteen years after the passage of the Affordable Care Act (ACA), our failing health care system is exposed with all its cruel denials, debt, disease, despair and death at the hands of the investor-owned companies for whom patients are merely pawns for the extraction of profit.
Health care in the United States comes in dead last when rated against comparable countries. The U. S. is at the bottom in overall performance, health outcomes, equity, access to care, and efficiency. As the Commonwealth Fund states: “In fulfilling this fundamental obligation [the ability to keep people healthy], the U. S. continues to fail.”
Health care in the United States comes in dead last when rated against comparable countries.
People in the United States aren’t living to their full potential. Already, the U.S. is 55th in life expectancy, behind Panama, Albania, and Czechia, and will fall in its global rankings by 2050 if the country continues the same trajectory. Years of life are lost to a health care system that serves profit over the value of life.
Our maternal mortality rate would be the shame of many of the poorest nations. In 2020, U.S. maternal mortality rate was higher than in Gaza. In 2022, there were 22 maternal deaths per 100,000 live births in the U.S. This is easily double, and often triple, the mortality rate in peer nations, which can be as low as 5 per 100,000 live births. Black mortality rate is criminally worse: 49.5 per 100,000 live births.
Over one million in the U.S. died in the pandemic, a rate much higher than other nations. Over 330,000 of the pandemic deaths in the U.S. were avoidable. Those lives could have been saved had we had a healthcare system that left no one with inadequate coverage.
Cancer patients must not only fight for their lives but also for the economic survival of their families. The newest treatments with so much hope are beyond the means of those who have insurance policies but no great wealth. About 30% of cancer survivors report lasting financial hardship.
Cancer patients are nearly 5 times more likely to experience bankruptcy, and the medical burden forces many to forego care.
Those who have employer-based insurance were assumed to have the gold standard in health care. Now even the highest paid workers are subjected to premiums, deductibles, and co-pays that impede their care despite the family plans that average $32,000 per year. More have insurance that covers less than a hospital gown. Gold has turned to scrap metal.
As people struggle to pay for the premiums, deductibles, and co-pays, revenues of the seven largest health insurance companies in 2022 reached $1.25 trillion and profits soared to $69.3 billion. That’s a 287% increase in profits in just one decade, when profits were $24 billion.
The toxicity of the health care profit makers that spread unnecessary suffering and death generates the hatred that is poisoning the land.
Medicare, our best health care program, publicly funded and open to all, is now strangled in the grip of the privatized Medicare Advantage plans and the Accountable Care Organizations facilitated by the Center for Medicare and Medicaid Innovation (CMMI). Medicare Advantage now controls a majority of recipients, not because it is better, but because the law that established it and the regulators that control it have allowed it to charge less in monthly premiums—plans that are also allowed to delay and deny care yet are overpaid by billions every year. CMMI issues waivers to the private plans exempting them from fraud and abuse laws and allowing kickbacks, self-referral, and illegal benefit inducement.
Millions on fixed incomes cannot afford the alternative of traditional Medicare plus a prescription drug plan and a supplementary Medigap plan. Those who have managed to escape the clutches of Medicare Advantage can still find themselves assigned, without their knowledge, to “value-based” payment schemes such as ACO REACH and other Accountable Care Organizations (ACOs) which privatize traditional Medicare. “Value-based” payment models are touted, without evidence, as reducing costs for Medicare, yet encompass a multitude of for-profit entities and subject patients to physicians incentivized to deny care. There is ample evidence that “value-based” payment schemes do not lower costs for Medicare. Nevertheless, the privatization of Medicare, through Medicare Advantage or ACOs, is now official policy.
The hoax of “value-based” payments, promoted by CMMI, is exposed by the fact that, despite all the assertions of promoting equity, the inequities of health care are expanding.
Medicaid, the program for children and adults with low income, is almost completely privatized, subjecting the recipients to delays, denials and restrictions imposed by the private managed care organizations that control it.
The Center for Medicare and Medicaid Services (CMS) is hurtling down the wrong track. They invite venture capital and health care investors into the Health Care Payment Learning and Action Network (LAN) that they created. CMS holds conferences, seeking advice and collaboration from the very profiteers that are the cause of high cost, low-quality care. The “value-based” payment scheme promoted by CMS has advanced the power of the profit makers, raising costs, cutting care, and pretending to promote equity for minorities and low-income patients.
It’s time to end the chaos. No more foxes in the hen house, no more poison in the system, no more profit in health care.
The toxicity of the health care profit makers that spread unnecessary suffering and death generates the hatred that is poisoning the land.
It’s time to end the chaos. No more foxes in the hen house, no more poison in the system, no more profit in health care. The nation has rejected the insurance company health care model that delays and denies care, demands skin in the game, asserts that there is massive unnecessary care, throws up barriers against care, and walks away with billions. A system that collects money from patients and employers then profits by withholding the promised care is not a business but a fraudulent, diabolical scam.
This system built on profit cannot be tweaked or regulated into better performance. Runaway trains are not deterred by guardrails.
There is one way to heal the nation. Put single payer on the nation’s table and focus the steaming rage to move the engine of change. Raise the demand for removal of profit and enactment of an Improved Medicare for All free from profit to a level commensurate with the damage that our current failing system is causing the patients’ and the country’s goodwill.
Some look at the current Congress, make the assessment that it’s not possible to pass single payer, then change their demand to a lesser proposal. But incremental changes are at the root of the privatization and profit schemes we are locked into now. Fifteen years after the ACA we have a failing health care system. We have witnessed that more incrementalism does more harm than good. Power concedes nothing without a demand, and the demand must be equal to the solution needed.
There is one way to heal the nation. Put single payer on the nation’s table and focus the steaming rage to move the engine of change.
As Marcia Angell, former editor of the New England Journal of Medicine, taught us, in our current private profit-based system, proposals that lower costs also decrease care, and proposals that increase care, raise costs. To improve care and control costs, we must turn to national single payer, free from profit or a national health service.
The status quo is deadly, and people are demanding a stronger more effective fight. We must organize and educate, locally and nationally with a new determination. In every town hall, classroom, union, organization, and neighborhood, people must hear the message and join the fight. Redirect the rage into a positive force for change.
The new anger in the nation makes possible what we could not do before. Many are now discussing the possibility of setting a National Day of Action in 2025 to demand freeing health care from corporate profit and covering everyone under a national single payer plan. That’s a great idea. Actions across the country lifting up that demand could inspire the movement we need.
National Single Payer—an Improved Medicare for All free from profit with everybody in and nobody out. Nothing less can heal the nation.
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Americans Are Angry About Their Health Insurance—With Good Reason
As a physician, I have seen patients suffer and die in order to pad the bottom lines of corporate health insurers—and in recent years I have seen this problem getting much worse.
Jan 01, 2025
How should we react when a man is shot to death on the street on his way to work? Our humanity tells us that we should be shocked and horrified—and feel that something is deeply wrong with such a brazen act of murder. Ideally, we would do what we could to help sooth the survivors, condemn the violence, and bring the perpetrator to justice.
So why did hundreds of thousands of people have the exact opposite reaction when UnitedHealthcare CEO Brian Thompson was executed in New York City last month? Because Americans are furious with health insurance corporations—and they have every right to be.
In the immediate aftermath of the shooting, many Americans took to social media not to mourn, but to celebrate. Caustic posts about prior authorization and denied medical claims were common. Sympathetic statements were met with rancor—and in the case of UnitedHealth Group’s own statement, over 70,000 “laugh reactions” before the company made that tally private. Even verbose political figures like Elon Musk and President-elect Donald Trump declined to comment for days. This shooting touched a raw nerve.
The health insurance industry doesn’t have a communications problem, it has a profiteering problem—and no amount of marketing will convince people who have already been burned.
As a physician who’s treated countless victims of gun violence, and who’s life’s work is to care for all of my patients, I found this response to be deeply unnerving. But I also can’t waive it away with simple explanations like online radicalization or trolling. Something much deeper is at play.
For decades, health insurance corporations like United have been growing more powerful and more profitable. How do they generate these profits? By taking in as much money as possible in premiums and paying out as little as possible in medical claims. Over time, they have tried everything from requiring “prior authorization” of care, to excluding high-quality providers from their networks, to imposing a Byzantine series of charges including ever-growing copays, coinsurance, and deductibles. When all else fails, many insurers simply deny claims.
Behind each of these practices are millions of Americans who are made to suffer. I hear these stories routinely in my practice, and they never become easier to stomach. I have seen patients with aggressive cancer who avoided seeing a doctor for months because they feared bankruptcy; patients with chronic conditions like diabetes who are denied treatments that would improve their quality of life; and gunshot victims whose fight to recover and gain a semblance of normalcy is complicated by their health plans saying no, no, and no again.
I have seen patients suffer and die in order to pad the bottom lines of corporate health insurers—and in recent years I have seen this problem getting much worse.
These are the stories that Americans are sharing in this fraught moment. We have to ask ourselves: Are we listening? And what are we going to do about it?
Insurers like UnitedHealthcare will have their own responses. Their PR teams will no doubt work overtime to marginalize aggrieved voices and to highlight what they consider to be the “value” of their health plans. Expect to see glossy commercials and towering billboards touting the “peace of mind” that Americans should enjoy knowing that their medical needs are “covered.” But the health insurance industry doesn’t have a communications problem, it has a profiteering problem—and no amount of marketing will convince people who have already been burned.
Behind the scenes, corporate insurers will no doubt lobby for the preferential treatment they have come to expect. Our newly elected Congress may acquiesce, or they may decide that the industry needs to be regulated—a strategy that has failed to live up to its promise.
Republicans and Democrats have made separate attempts to combine federal requirements with federal largesse in order to make corporate health insurers play nice. But both the Affordable Care Act and the Medicare Advantage program have only succeeded in ballooning the profits of firms like United—without improving Americans’ health or sparing their wallets.
It’s also clear that violence is not the answer, both on a purely human level and because corporate insurers will simply not be moved. UnitedHealthcare will have a new CEO in short order, and it will be that person’s responsibility to boost profits and make shareholders wealthier. Responding to patients’ cries will not serve these ends, so it is not in the cards.
What would help is a proven reform proposal that is long overdue: a single-payer national health program. Such a system would provide universal coverage and comprehensive benefits—with zero out-of-pocket costs. It could be easily implemented given the gargantuan sums we spend on healthcare in this country, and it would be a boon for those who are suffering, and for those who are fearful.
Americans are crying out in pain—and are recognizing that they are not alone in their pain. We should listen to these cries and we should finally, after decades of delay, do something about it.
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Why Didn't the Covid-19 Pandemic Result in Medicare for All?
Nobody should die in the richest country on Earth because they can’t afford health care. But this what happens day after day after day, whether we're experiencing a pandemic or not.
Nov 25, 2024
In 2002, the American economist Victor R. Fuchs wrote that “national health insurance will probably come to the United States in the wake of a major change in the political climate, the kind of change that often accompanies a war, a depression, or large-scale civil unrest.”
You couldn’t have designed a crisis much better suited to deliver us this outcome than Covid-19. In 2020, the U.S. faced the largest public health emergency in its history, at a time when 28 million Americans did not have health insurance and millions more were underinsured.
The faulty, patchwork nature of our health care system greatly compounded the effects of the pandemic. In fact, a study by the Proceedings of the National Academy of Sciences (PNAS) found that the U.S. could have seen around 338,000 fewer deaths from Covid-19 if we’d had universal coverage and we could have saved billions in health care costs associated with hospitalizations from the disease.
Nobody should die in the richest country on Earth because they can’t afford health care. The Covid-19 pandemic should have made clear once and for all how irrational and cruel our system is. We are the only developed nation that doesn’t guarantee health care to all citizens. As a result, tens of millions of Americans every year suffer without access to basic medical care, while insurance companies are allowed to make record profits. There are people in America who have to ration prescription drugs, while a few miles over the border in Canada, they could get these same pills at a fraction of the cost. There are people who have to forgo life-saving surgeries, because they can’t afford the procedures. Roughly a third of all GoFundMe campaigns in the U.S. go to people raising money for medical treatments.
In April, 2020, a nurse in the intensive care unit of a New York City hospital named Derrick Smith, wrote on Facebook that one of his patients asked “who’s going to pay for this?” before being intubated and placed on a ventilator, seemingly more concerned about the cost of the procedure than what the outcome would be. These would end up being his last words.
Meanwhile, the CEOs of 300 health care companies collectively made more than $4.5 billion in 2021, according to Stat News. The obvious conclusion is scathing.
Lockdown orders during the pandemic led to a massive spike in unemployment, yet despite significant job losses, the number of insured Americans actually increased, primarily due to emergency Medicaid eligibility policies. This amounted to the government (at least, partially) performing the function of a national health care system – i.e. filling gaps in coverage left by the private insurance industry. Unfortunately, as pandemic-era emergency measures ended, millions of Americans lost this coverage and private insurance returned to business as usual.
A number of factors contributed to America’s poor pandemic performance relative to other countries; a slow government response in terms of travel and testing, PPE shortages and delays in testing rollout. But it’s almost certain that addressing Covid-19 would have been easier if everyone had health insurance. According to the consumer health advocacy organization Families USA, roughly 40% of Covid-19 infections were associated with lack of health insurance.
In general, gaps in insurance coverage tend to accelerate the spread of diseases. People are less likely to get tested if they don't have insurance for fear of large medical bills. The more people who have insurance and a relationship with a primary care physician, the more cases can be diagnosed and treated quicker, thus reducing the likelihood of serious infection. Slowing the spread also reduces the strain on hospitals, making it easier to treat all patients.
There were some countries with single-payer that fared poorly during the pandemic. Italy, for instance, was hit very hard, in part because they had a lot of people in the vulnerable age range. However, many of the best-performing countries, particularly outside of Europe (New Zealand, South Korea), were those with single-payer systems. Taiwan, which transitioned to a single-payer system in the 1990s, achieved Covid-19 zero without a lockdown.
There were other factors which should have made Covid-19 uniquely suited to deliver us major health care reform. Unlike a number of other public health crises (the opioid epidemic, homelessness), Covid-19 received near-constant media coverage. It was front-and-center in everybody’s mind for three years. It also came on the heels of two back-to-back election cycles in which Medicare For All was a key issue in both debates and public policy discussions.
Public support for Medicare For All was at an all-time high in 2020. And in 2021, when Rep. Pramila Jayapal introduced the legislation, it was co-sponsored by a majority of Democrats in the House. Nothing like that had ever happened before. Even according to right-wing outlets like the Pacific Research Institute (PRI), Covid-19 led to a significant spike in support for single-payer.
Why, then, did nothing happen? One major problem was that the pandemic kept people inactive. The public was too atomized and immobile for any effective, coordinated response to cohere. The pandemic created a lot of pent-up anger, much of which got unleashed in the summer of 2020 via the Black Lives Matter protests, coming at a time when many people had been stuck in lockdown for months, many without jobs. When the spark was lit, it quickly became a lightning rod for solidarity and popular discontent.
The biggest problem is that single-payer health care is opposed by some of the most powerful special-interest groups in the country; the private insurance industry, pharmaceutical companies, and the for-profit hospitals. Health care is a massive sector of our market economy, a multi-trillion-dollar a year industry, so despite widespread popular support for the program, there is currently no mechanism strong enough to bring this public pressure to bear on politicians.
If we are to rise to the level of the rest of the developed world and guarantee health care to all citizens, we need to constitute an organized popular opposition which can participate in shaping public policy. Ideally, this will mean grass-roots initiatives backed by a strong labor sector—unions in the nursing, trades, and service sectors working in conjunction with local advocacy groups. We must capitalize on the momentum built up in 2020 and continue to push single-payer forward. If we organize and act to exercise our power, this is hardly a utopian goal.
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