It's Obvious the US Healthcare System Isn't Working, So Why Not Try Medicare for All?

Between the (likely) expiration of the Affordable Care Act enhanced subsidies, cuts to Medicaid and Medicare, and the decade-long efforts to undermine and dismantle the ACA, the casualties and costs of our current healthcare system continue to grow as Americans continue to wait for a better option. Nearly 45,000 Americans aged 17-65 die each year due to lack of insurance, a number that could rise to over 51,000 preventable deaths in the coming years.

Yet, the Senate has failed to pass either healthcare plan proposed to keep health insurance premiums from skyrocketing in the New Year and the Medicare for All bill introduced by Sen. Bernie Sanders (I-Vt.) and US Reps. Pramila Jayapal (D-Wash.) and Debbie Dingell (D-Mich.) in April 2025 has not advanced in Congress. Ideas like Medicare for All or universal healthcare often make eyes roll. “That’s unrealistic,” we’re told.

But is it? Universal healthcare is, after all, the reality for most other high-income countries. And yes, it might be disruptive, but Americans have lived through unprecedented changes and significant events in the past five years: the Covid-19 pandemic, the January 6 insurrection, and the rapid development of generative AI. Throughout history, major healthcare reforms have been born from disruption; Medicare is rooted in the civil rights movement, and the ACA passed in the wake of the 2008 financial crisis.

Now, as the United States prepares to celebrate its 250th anniversary, our foundational rights and institutions are being tested in ways that once would have been unthinkable. In a moment when the boundaries of what is “reasonable” or “possible” have been completely blown open, universal healthcare no longer seems so unrealistic.

Do we accept being the only high-income country where getting sick can cost you your home, your job, or your life?

We certainly can’t continue as we’ve been going. As a nurse scientist and postdoctoral fellow, I have a front-row seat to the healthcare crises we are facing: unaffordable medical bills, growing healthcare costs, long waits for specialty and even primary care appointments, and the growing burden of chronic illness and mental health crises. Employers are now shifting employees into high-deductible plans with high out-of-pocket costs. People are effectively locked into jobs they cannot leave because losing coverage, even temporarily, can be a significant financial risk—especially for those covering spouses and children.

We have extensive evidence, both internationally and within the US, showing what strategies produce better results. Any meaningful reform should include:

1. Universal population coverage: Federal requirements must guarantee that every person living in the US has insurance that covers necessary healthcare services, including primary care, specialty care, mental health, reproductive health, preventive care, and hospitalizations.
2. Care that is free or affordable: A largely single-payer financing model like Canada, Australia, and most high-income countries (as proposed in the “Medicare For All” bill) or a hybrid public-private system, where private insurance is still available but federally regulated to ensure cost containment, limit out-of-pocket costs, and eliminate catastrophic medical expenses, protecting families from significant medical debt.
3. A focus on prevention and primary care: Meaningful investment in preventive services, primary care, and care coordination to reduce costs, prevent unnecessary emergency room visits and hospitalizations, and improve long-term health.

But people remain skeptical that we can achieve these goals in the US—largely because of public opinion and political will, both of which are significantly influenced by private health corporations, including insurance companies, large hospital systems, pharmaceutical companies, and other obscure middlemen that profit from the status quo.

For decades these corporations have spent hundreds of millions of dollars lobbying Congress and advertising to the public to protect their revenue and discourage solutions that most of us agree with and would benefit from. President Donald Trump himself criticized health insurers as “money-sucking,” calling them “BIG BAD insurance companies.” If policymakers on both sides of the aisle agree that corporate interests are getting in the way of healthcare reform, why do we continue to defer to them?

Opponents of single-payer, universal healthcare cite the costs, but the US already spends more on healthcare than other high-income countries with universal healthcare—and better health outcomes. It is expensive to maintain a broken system.

Major change is challenging but not impossible. Most Americans are dissatisfied with the costs, shortcomings, and complexities of our current healthcare system and support the idea of universal healthcare. We have the resources, expertise, and innovation to create a healthcare system that works for everyone. What we have not yet shown is the courage to do it.

As the country approaches its 250th anniversary, we should be asking what kind of nation we want to be. Do we accept being the only high-income country where getting sick can cost you your home, your job, or your life? Or do we finally build a system that treats healthcare as a public good rather than a commodity?

If the president really wants to “make America Healthy Again,” he can—through real healthcare reform. And for the rest of us, instead of just waiting to see what happens with the ACA subsidies, we can all work to build broad coalitions and support politicians who have a bold vision for healthcare and the courage to actually make a change.