Medicare for All Organizing Guide

Table of Contents

10. Medicare for All FAQ

This FAQ about Medicare for All has been adapted from materials used by PNHP, the Labor Campaign for Single Payer and Healthcare NOW. Members should consult this FAQ both to help train organizers and as the raw materials for speeches, town halls and political education around Medicare for All.

Question: What is Medicare for All?

Answer: Medicare for All is a universal national health insurance system in which a public agency organizes health financing, but delivery of care remains largely private. Under a universal public healthcare system, all U.S. residents would be covered for all services covered by a medical professional, including: primary care, hospital, preventive, long-term care, mental health, reproductive healthcare, dental, vision, prescription drug and medical supply costs. Patients would regain free choice of doctor and hospital, and doctors would regain autonomy over patient care. (Under Sanders’ Medicare for All Act of 2017, long term care will not be covered, and consumers may have to pay up to $250 on prescription drugs, but these are things that could be changed under the demands of a mass movement. Sanders’ bill also creates a four-year transition period to Medicare for All, budgets a significant amount for the creation of a medical industry jobs transition program, and offers educational debt relief for medical professionals.)

Question: How will we keep drug prices under control?

Answer: When all patients are under one system, the payer wields a lot of clout. The VA gets a 40% discount on drugs because of its buying power. This “monopsony” buying power is the main reason why other countries’ drug prices are lower than ours. This also explains the drug industry’s staunch opposition to universal national health insurance.

Question: Won’t Medicare for All lead to long wait times and rationing of care?

Answer: No. It will eliminate the rationing going on today. The U.S. already rations care based on ability to pay: if you can afford care, you get it; if you can’t, you don’t.

At least 30,000 Americans die every year because they don’t have health insurance. Many more people skip treatments that their insurance company refuses to cover. That’s rationing.

Excessive wait times are often cited by opponents of reform as an inevitable consequence of universal, publicly financed health systems. They are not. Wait times are a function of a health system’s capacity and its ability to monitor and manage patient flow. With a universal healthcare system — one that uses effective management techniques and which is not burdened with the huge administrative costs associated with the private insurance industry — everyone could obtain comprehensive, affordable care in a timely way. And indeed, according to a 2014 Commonwealth Fund study, most countries with single-payer health insurance do not have wait time problems for any category of care.

Question: I have good health benefits through my work. Why would I want healthcare reform?

Answer: Many with excellent workplace health insurance have found that a serious illness or injury may cause them to lose their job, and subsequently their health insurance. Under the current model, healthcare is tied to your job, and the costs are increasingly pushed onto workers. Under a public Medicare for All system, we would replace expensive and unpredictable employer-sponsored premiums with a stable and lower cost insurance that you can use regardless of your job status. Furthermore, employers pay the full cost of health insurance out of reduced wages, and healthcare costs are devastating municipal, state, and federal budgets, cutting into vital public services like education and infrastructure. Switching to a universal healthcare system means health security that cannot be taken away by misfortune; savings for workers, employers and government; and the ability to control cost growth into the future.

Question: Will this put the government between me and my healthcare provider?

Answer: No. Right now, many health decisions are made by corporate executives behind closed doors. They determine which physicians and hospitals you are allowed to see, imposing deductibles and co-payments that often make appropriate treatments impossible, and refusing to pay for care that your providers deem necessary. Insurance companies are interested in profit, not providing care, and as a result nearly 30 million have no insurance, tens of millions more are underinsured, and most are at risk of financial disaster should they become seriously ill. Under Medicare for All, every resident would have full choice of provider, we could eliminate cost barriers to recommended care, and all medical decisions would be made by doctors and patients together, with the health of the patient as the only factor determining treatment. No one will go without care.

Question: Would Medicare for All drive up my taxes?

Answer: Medicare for All would replace high, unpredictable premiums with lower, stable taxes. Unless you are among the top 5% of income earners, the bill is expected to reduce your total healthcare costs. In 2016, the average working family paid $6273 per year in premiums and deductibles to private insurance companies. Under Medicare for All, a family of four earning $50,000 per year would pay just $466 per year in taxes for single-payer healthcare, amounting to savings of over $5800 per year.

Currently, about 65% of our healthcare system is financed by public money: federal and state taxes, property taxes, and tax subsidies. These funds pay for Medicare, Medicaid, the VA, and coverage for public employees (including police and teachers, elected officials, military personnel, etc.). There are also hefty tax subsidies to employers to help pay for their employees’ health insurance.

Question: How can we afford to cover everyone/won’t it be too expensive?

Answer: Americans already have the highest healthcare spending in the world. Consider that over half of all the money spent on healthcare in the world is spent in the United States but only a fraction of our spending goes directly to medical care compared with other industrialized countries. Since we pay for healthcare through a patchwork of private insurance companies, about one-third (31 percent) of our health spending goes to administrative overhead (also known as “transaction costs”).

Potential savings from recovering the money currently squandered on billing, marketing, underwriting and other activities that sustain insurers' profits have been estimated at $400 billion/year. Combined with what we’re already spending, this is more than enough to provide comprehensive coverage for everyone. It turns out that it is much more expensive to keep patients away from healthcare in our current fragmented, market-based system than to provide care to all under an administratively simple universal healthcare system.

Question: Won’t Medicare for All just be another bureaucracy?

Answer: The United States has the most bureaucratic healthcare system in the world. Over 31 cents of every healthcare dollar goes to paperwork, overhead, CEO salaries, profits, etc. Because the U.S. does not have a unified system that serves everyone, and instead has thousands of different insurance plans, each with its own marketing, paperwork, enrollment, premiums, and rules and regulations, our insurance system is both extremely complex and fragmented.

The Medicare program operates with just 3% overhead, compared to 15% to 25% overhead at a typical HMO. Provincial universal plans in Canada have an overhead of about 1%. It is not necessary to have a huge bureaucracy to decide who gets care and who doesn’t when everyone is covered and has the same comprehensive benefits.

Question: What about medical research?

Answer: Most breakthrough medical research (for example, basic drug development) is already publicly financed through the National Institutes of Health (NIH). In fact, according to the NIH website, of the last 30 Americans to win the Nobel Prize in medicine, 28 were funded directly by the NIH.

Medical research does not disappear under a universal healthcare system. Many of the most important advances in medicine have come from single-payer nations. Often, private firms enter the picture only after the public has paid for the development and clinical trials of new treatments (the HIV drug AZT is one example). On average, drug companies spend more than half of their revenue on marketing, administration and profits, compared with 13% on research and development. Negotiating lower prices will allow Americans to afford drugs without hurting research.

Question: I or my partner/family-member/friend works in the insurance industry. Will they lose their job under Medicare for All?

Answer: A universal national health system will still need some people to administer claims. Administration will shrink, however, eliminating the need for many insurance workers, as well as administrative staff in hospitals, clinics and nursing homes. More healthcare providers, especially in the fields of long-term care, home healthcare, and public health, will be needed, and many insurance clerks can be retrained to enter these fields. Many people now working in the insurance industry are, in fact, already health professionals (e.g. nurses) who will be able to find work in the healthcare field again. But many insurance and healthcare administrative workers will need a job retraining and placement program. We anticipate that such a program would cost about $20 billion, a small fraction of the administrative savings from the transition to national health insurance.

Question: How will Medicare for All affect women, LGBTQIA+ people, and people of color?

Answer: Women are more likely to use the healthcare system for themselves and their children than are men. This includes reproductive healthcare, care for aging women (who have longer life expectancy than men), and care for others in their families. The Sanders bill would repeal the Hyde Amendment, which bars taxpayer dollars from being used for abortions. The bill also prohibits discrimination based on sex stereotyping, sexual orientation, and gender identity.

Racial discrimination is rampant in healthcare. Among adults under 65, Hispanics, American Indians and Alaska Natives are more than twice as likely as whites to be uninsured. African Americans are also uninsured at a higher rate than whites. More adults under 65 are uninsured among Asians, Hispanics, and African American immigrants compared to whites. Uninsured Asians have the largest share of immigrants (67%), including 28% who are naturalized citizens. Immigrants account for nearly six in ten (59%) uninsured Hispanics; including 50% who are non-citizens. Universal and comprehensive coverage would begin to address these issues.

Question: Why is DSA prioritizing Medicare for All?

Answer: We know that Medicare for All is a transformational demand, but aren’t there many different issues socialists need to be working on? After all, who is to say that one issue facing workers is more or less morally urgent than any other? People are dying of police brutality; they are suffering under sub-living wages and terrible working conditions; they are being displaced and made homeless by skyrocketing rents. Given the overall disastrous state of our society, the decision of where to focus our limited resources must be a strategic one.

Medicare for All was adopted as our national strategic priority for a number of reasons. It is a universal demand that appeals to the majority of working Americans. It will disproportionately benefit low income people, people of color, single mothers, immigrants, and those with disabilities. Focusing on universal demands with broad bases of social support allows us to unify diverse sections of the working class and to forge solidarity across the divisions that are used cynically by the ruling class to weaken popular political will.

The fight for Medicare for All also affords our members an opportunity to build their practical organizing capacities and skills by having straightforward, programmatic political conversations with regular people. Healthcare is a great issue to lure leftists out of their normal activist circles because it’s a really easy topic to talk with strangers about, regardless of their political beliefs. Most people are unhappy with their health insurance, or at least likely to know someone with healthcare struggles. Most people agree that an increase in take-home pay is a good thing. Most people are outraged to find that health insurance executives are lining their pockets by denying a basic right to health to all people. Even people who would normally be opposed to universal healthcare can be appealed to because the system is currently failing so spectacularly. And thanks to Bernie Sanders and major nurses’ unions like NNU, Medicare for All is at the forefront of mainstream political discourse. It has become so popular that even corporate Democrats have to talk about it!

For all of these reasons, a conversation about Medicare for All is a strategic conversation for democratic socialists because it provides a concrete example of how capitalism is incapable of providing for the basic needs of working people. A conversation about Medicare for All is an opportunity to show how the relentless pursuit of profit conflicts with the interests of the majority. If socialists can make these links, then Medicare for All has the opportunity to be the exemplary non-reformist reform of our moment.

Beyond this concrete goal, it advances our struggle by heightening class conflict, beating back capital, and empowering the working class to make further democratic socialist demands. This momentum can contribute to a popular democratic socialist consensus around the decommodification of other basic necessities like housing and education, and establish the working-class organization and militancy we need to win a society and economy that are truly democratic.