It sometimes baffles me why some Americans oppose Medicare for All. The most common objections I hear are “it’s government controlled healthcare”, or “we want doctors, not government, making decisions on our health care”, or “it costs too much, $30 trillion over 10 years, that’s crazy spending.” And yet the hard facts are this:

• In 2019, Americans spent an estimated $3.6 trillion on healthcare - all of which is paid by Americans through premiums, deductibles, direct payments to providers and/or taxes. Multiply that by 10 years = $36 trillion. We do this today.

• $1.4 trillion, or 39%, is paid through private insurance and direct payments outside of insurance (“out of pocket”). Americans paid on average $10-11k per year on health care, and costs could soar to $48 trillion over 10 years if we do nothing.

Healthcare costs continue to skyrocket, but with worse outcomes. People are getting hit with “surprise bills” (we did when our son had an emergency appendectomy); 2/3 of Americans are concerned they cannot afford unexpected healthcare costs. And by the way, 40% of Americans would not be able to afford an unexpected $400 expense.

Healthcare companies make a lot of money, enough to buy back tens of billions of dollars of their own stock. A sample set of just three companies, Merck ($10B), UHC ($18B), and Anthem ($5.5B) shows over $33B in share repurchases and repurchase authority. This is money that should be spent on healthcare but instead literally vanishes from the healthcare system. Profit margins can go as high as 69% (Merck), and that’s just the companies I looked at. Let’s not forget Perdue Pharma, who reportedly had revenues of $35 billion just on OxyContin.

Drug companies are not incentivized to invest in new drugs unless there’s profit in it. Check this stat out - in 2015, 9 out of 10 major drug companies spend more on marketing than on research. I don’t have a more current number, but I suspect that trend is not going down.

Medical debt accounts for 2/3 of all bankruptcies. People are being arrested over medical debt.

This is insanity - health care is not a “free-market” - you don’t choose when you actually need care. It is not like buying a car, where maybe you can’t afford a Porsche so you buy a Toyota instead. Or decide you don’t need a new car at all, the old one is just fine. Healthcare doesn’t work that way, and yet our healthcare is driven by profit, not best outcomes. (I still can’t believe the US doesn’t permit Medicare to negotiate drug prices.)

A pretty simple way to pay for Medicare for All is put forth by Kevin Drum - fund it through an employer payroll tax on employers - they are currently funding a huge part of today’s employer based health insurance scheme.

Here’s the thing - single payer would only switch the payer, not your doctor. If you’re worried about the “government” rationing health care, it is doctors who prescribe treatment, not insurance companies or Medicare. Rationing is happening today - insurance companies ration payments to providers, while providers continue to raise prices on services and treatments. Patients are on the hook for everything that isn’t paid for by insurance.

Everyone says this is a tall order politcally, but a majority of Americans support Medicare for All - 70% by this measure, while this poll has 63% having a positive reaction to Medicare For All, and a majority that supports it. Remember the GOP has also historically opposed Social Security and Medicare, saying these programs would destroy America. If you’ve been hit with big, unexpected medical bills, you probably know the current system is damaging America the way it is.

Anyway, that’s my view on Medicare for All. A public option might be workable, but the only way that works is if all providers are required to take it. Otherwise it’s not an option. Medicare for All really is the sane way to go.

Oh yeah, and Bernie’s not actually a socialist.