Medicare-for-All

Healthcare as a Human Right in the Wealthiest Nation

In the richest country in the world, no one should have to choose between paying for medicine and putting food on the table. Yet 27 million Americans remain completely uninsured, and millions more carry insurance policies with deductibles so high that healthcare remains effectively inaccessible when they need it most.¹ The United States spends seventeen point eight percent of its gross domestic product on healthcare—approximately twice the average of other high-income countries—yet achieves worse health outcomes measured by life expectancy, infant mortality, and preventable disease burden.¹ We spend more and get less, a damning indictment of a system designed to extract profit rather than deliver care.

Even those Americans fortunate enough to possess employer-sponsored insurance live with persistent anxiety. What happens if I lose my job? Workers facing layoffs confront not only lost income but also the terrifying prospect of losing health insurance at precisely the moment when economic stress takes the greatest toll on physical and mental health. This fear keeps people trapped in jobs they hate, prevents entrepreneurship and career mobility, and transforms the employment relationship into a form of coercion where workers cannot freely choose better opportunities.² Economists call this phenomenon “job lock,” and it undermines both worker welfare and economic efficiency.²

The Failure of Employer-Sponsored Insurance

Approximately one hundred fifty-four million Americans—roughly fifty-six percent of the nonelderly population—receive health insurance through an employer.³ This system ties healthcare access to employment status, creating profound vulnerability during economic disruptions. When workers lose their jobs, they can technically continue coverage through the Consolidated Omnibus Budget Reconciliation Act, commonly known as COBRA. But COBRA coverage requires unemployed workers to pay the full premium that employers previously subsidized, plus a two percent administrative charge. Monthly COBRA premiums typically range from four hundred to seven hundred dollars per individual, pricing most recently unemployed workers out of continued coverage precisely when they have lost their income.

Research documents the severe effects of tying health insurance to employment. Job lock reduces worker mobility by at least twenty-five percent, and the Affordable Care Act has not significantly improved this situation.² Being the sole source of health coverage for one’s family associates with twenty-eight percent lower job mobility compared to workers whose partners have employer-sponsored insurance.² For workers with pre-existing health conditions that could have led to insurance denials before the ACA, employer-sponsored insurance reduces job mobility by up to forty-five percent.² This immobility undermines labor market efficiency, makes it harder to match workers to suitable jobs, and cuts overall labor productivity.² People choose jobs or remain stuck in suboptimal employment due to their need for health insurance rather than because those jobs best utilize their skills or provide the most value to the economy.²

The crisis continues to worsen under current policy. If Congress fails to extend enhanced premium tax credits for Affordable Care Act marketplace plans beyond their 2025 expiration, marketplace enrollees will experience an average premium increase of seven hundred five dollars annually, and four million more people will become uninsured.¹ The Congressional Budget Office projects the uninsured rate will rise to nine percent by 2034, affecting approximately thirty-two million Americans.¹ Younger adults ages nineteen to sixty-five face the harshest impact, with eleven percent completely lacking medical coverage in 2024, compared to just six percent of children who benefit from higher Medicaid enrollment rates.¹

Congressional Legislation: The Medicare for All Act

On April 29, 2025, Senator Bernie Sanders, Representative Pramila Jayapal, and Representative Debbie Dingell introduced the Medicare for All Act in both chambers of Congress.⁴ The House bill, H.R. 3069, secured one hundred six original cosponsors, while the Senate version, S. 1506, received sixteen initial cosponsors.⁴ This landmark legislation would establish a single-payer national health program in the United States, finally guaranteeing universal coverage based on patient needs rather than insurance industry profits.⁴

The Medicare for All Act would provide comprehensive health coverage to every American regardless of employment status, income level, or pre-existing health conditions.⁴ The legislation expands traditional Medicare to include dental care, hearing services, and vision coverage, giving every American the freedom to choose their own doctors without network restrictions.⁴ Under this system, Americans would face no premiums, no deductibles, no copayments, and no out-of-network barriers to care.⁵ The fear of losing coverage when losing employment would disappear entirely, liberating workers to pursue better opportunities and enabling entrepreneurship without risking family health security.

This 2025 legislation builds on similar bills introduced in the 118th Congress during 2023-2024, when Representative Jayapal introduced H.R. 3421 in the House and Senator Sanders filed S. 1655 in the Senate.⁶ The reintroduction demonstrates sustained congressional commitment to single-payer healthcare despite opposition from the insurance and pharmaceutical industries.

Complementing federal Medicare for All efforts, Representative Ro Khanna and Senator Ed Markey have reintroduced the State-Based Universal Health Care Act.⁷ This legislation provides states with federal funding streams and regulatory flexibility to support affordable, universal health care plans at the state level.⁷ Representative Jayapal has endorsed this approach as “a critical step to provide millions more Americans with high quality and affordable care” while building momentum toward Medicare for All at the federal level.⁷ The state-based approach allows progressive states to experiment with single-payer systems, generating evidence and experience that can inform national policy.

The Economic Case: Medicare for All Saves Money

Despite relentless propaganda from corporate healthcare lobbyists, the evidence overwhelmingly demonstrates that Medicare for All would save the United States trillions of dollars. A systematic review of twenty-two studies analyzing single-payer proposals over thirty years found “a high degree of consensus for the fiscal feasibility of a single-payer approach in the U.S., with savings likely even during the first year.”⁸ Every single study examined predicted that Medicare for All would yield net savings over several years.⁸

The Congressional Budget Office released its own analysis in December 2020, concluding that replacing the current system with single-payer healthcare would insure every American while reducing overall health spending in the country.⁹ The CBO found that a single-payer system would save between forty-two billion and seven hundred forty-three billion dollars in 2030 alone, depending on specific design features.⁹ The option most closely approximating current Medicare for All proposals—featuring low payment rates to providers and low cost sharing for patients—produces six hundred fifty billion dollars in savings in 2030.⁹ Proponents of the 2025 Medicare for All Act cite these CBO projections, noting that the Congressional Budget Office estimated Medicare for All would save the healthcare system six hundred fifty billion dollars annually.⁴

Yale University epidemiologists conducted their own analysis, finding that Medicare for All would save approximately sixty-eight thousand lives per year while reducing United States healthcare spending by roughly thirteen percent, equivalent to four hundred fifty billion dollars annually.¹⁰ The Political Economy Research Institute at the University of Massachusetts Amherst estimated five trillion dollars in cumulative savings between 2017 and 2026.¹⁰ Remarkably, even the right-wing Mercatus Center—despite opposing Medicare for All politically—found approximately two trillion dollars in net savings over ten years in its analysis.¹⁰

These savings would flow from multiple sources, each addressing fundamental inefficiencies in the current system. Administrative costs would plummet as the bloated bureaucracy of private insurance companies disappears. Traditional Medicare’s administrative overhead accounts for approximately two percent of total revenue, compared to twelve percent overhead for private insurers.⁹ Under single-payer healthcare, the CBO projects overall administrative spending would fall to below two percent, translating into approximately four hundred billion dollars in annual savings.⁹ Private insurers spend billions on advertising, executive compensation, shareholder dividends, and elaborate claims denial systems designed to avoid paying for care. All of these expenses would vanish under Medicare for All, redirecting those dollars toward actual medical services.

Drug prices would fall dramatically as the government gains power to negotiate directly with pharmaceutical companies. Currently, Medicare cannot negotiate prices for many drugs, and private insurers lack the market power to demand reasonable prices from manufacturers who enjoy monopoly patents. Every other developed country negotiates drug prices at the national level and pays a fraction of what Americans pay for identical medications. A single-payer system would bring American drug prices in line with international norms, saving hundreds of billions of dollars.

Preventive care would improve as financial barriers disappear. When people can see doctors without worrying about copayments, deductibles, or network restrictions, they catch health problems early before they develop into expensive emergencies. Treating diabetes before it progresses to kidney failure costs far less than dialysis. Addressing high blood pressure prevents strokes and heart attacks. Removing financial barriers to primary care shifts healthcare dollars toward prevention rather than crisis intervention.

Finally, Medicare for All would eliminate profit extraction from the healthcare system. Under the current model, insurance companies and healthcare corporations extract profits that could instead fund patient care. Healthcare dollars would go to actual medical services rather than shareholder dividends, venture capital returns, and private equity fees.

The Moral Imperative

As artificial intelligence and automation displace millions of workers over the coming decade, the connection between employment and health insurance becomes increasingly untenable. We cannot expect American families to navigate the most disruptive economic transformation in generations while simultaneously worrying about losing healthcare coverage every time AI automates another job category. The intersection of technological unemployment and employer-based insurance creates a humanitarian crisis in slow motion.

Healthcare represents a human right, not a commodity to be bought and sold in markets. Medicare for All embodies this principle in policy form. When Senator Sanders, Representative Jayapal, and Representative Dingell introduced the Medicare for All Act, they declared that healthcare should be based on patient needs rather than insurance industry profits.⁴ This moral clarity distinguishes Medicare for All from half-measures that preserve the private insurance system while attempting to expand coverage around its margins.

We have both the economic resources and the technical capacity to guarantee healthcare to every American. Twenty-two independent studies confirm the fiscal feasibility. The Congressional Budget Office projects hundreds of billions in annual savings. Other wealthy democracies have demonstrated for decades that universal healthcare works. The only barrier to Medicare for All is political will—the question of whether we choose solidarity or abandonment, shared security or individual vulnerability, human dignity or corporate profit.

The choice could not be clearer. We can continue allowing insurance companies to extract hundreds of billions in profits while millions go uninsured and medical bankruptcies destroy families. Or we can join every other advanced democracy in treating healthcare as a right, establishing Medicare for All to guarantee coverage for all Americans while saving massive sums currently wasted on administrative overhead and corporate profits. We must pass H.R. 3069 and S. 1506. We must choose compassion over cruelty, efficiency over extraction, life over profit. Healthcare is a human right. Medicare for All makes that right real.

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