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affordable care act
Obamacare Won’t Work: Time for Medicare for All
Our healthcare ‘system’—with or without the Affordable Care Act—is unsustainable: we have reached the end of the line.
Mar 14, 2026
Those without employer sponsored insurance (or Federal insurance like Medicare or the VA) in Red states, who signed up for the Affordable Care Act (aka Obamacare), are now learning what they voted for: higher premiums for health insurance, maybe unaffordable. Meanwhile, premiums continue to rise relentlessly for employers and employees.
Our healthcare "system" is unsustainable: we have reached the end of the line.
Americans pay more for healthcare (about18 percent of GDP) than any other developed country, with mediocre outcomes. Yet the other countries, with better outcomes, have universal coverage.
It is time for change. Extend traditional Medicare to all Americans (gradually, over the course of several years). Medicare is familiar; it works. Private for profit-health insurance, less than a century old, makes no sense today.
Sick and injured patients have turned to medicine—to healers—since time immemorial. Health insurance is new: Blue Cross started as a community non profit organization in 1929, to cover surgery in hospitals.
Private for profit-health insurance, less than a century old, makes no sense today.
Yes, we are a capitalist country, and markets are efficient at producing many things, like commodities: groceries, shoes, cars, even some insurance, when it is straightforward and highly regulated, like auto insurance. But for-profit health insurance does not work.
The idea of insurance is to spread risk over a maximum number of subscribers, each of whom is at the same low risk of unpredictable casualty, like fire. This was essentially the situation of Americans a century ago—illness and injury were acute and unpredictable, patients either recovered or died. Everyone was at similar risk, only surgery was expensive.
Today is different: illness is not only predictable, it can be chronic, even life long. Moreover, today’s scientific care is expensive. The social determinants of health—income security, education, adequate food and shelter, social support (your zip code, not your genetic code)—plus public health, keep healthy people healthy.
Medical care is for the sick.
For-profit health insurers maximize premiums, minimize cost (provider fees), keep the difference, and most important, avoid the sick. Insurers exclude those with “pre-existing” conditions whenever allowed (not under the ACA), deny "authorization" where they can. They tailor "plans" with carefully engineered restrictions you don’t discover until you file a claim. They are not even providing insurance: the payments from the Federal government are risk adjusted, so the insurers are paid more for riskier patients (and they are now illegally upcoding). The providers are not. Making this happen entails huge administrative expense, which adds no value for patients or providers, only massive returns to investors. United Health Group is the third largest company in the Fortune 500.
Healthy people don’t know what plan is "right for them"; they hate the annual "choice." They only know what they can afford. (Sick people know what they need.) They do want to choose their doctor.
Traditional Medicare eliminates these problems for its beneficiaries: by law, everything medically necessary is covered. The Federal government determines fees for doctors and hospitals based on cost, as it did historically when markets didn’t work. Beneficiaries pay premiums based on income.
Fee-for-service works when we pay the right fees for the right services. Today, based on 1950’s medicine, Medicare pays too little for office visits, so-called ‘cognitive’ services (versus procedures) both primary and specialized, so there are too few providers, especially as Medicare rolls expand with retiring
Boomers. No office doctor can make a living from Medicare anymore. That is, however, easy to fix: pay providers more to care for the sickest people, who need the services only highly skilled, experienced physicians can provide. Pay surgeons less.
Best of all, Medicare is simple—ask your grandmother.
But where will the money come from?
Start by eliminating Medicare Advantage (MA) and Part D, while updating Medicare to cover prescription drugs, along with vision, hearing aids, etc. MA was supposed to save taxpayers money by providing care more efficiently. Instead, Medicare pays MA companies 20 percent more than traditional Medicare for comparable patients.
Then, require all employers (including those who currently don’t provide insurance) to pay premiums to Medicare based on payroll. Require employees to pay Medicare premiums based on wages. Just like Social Security (of which Medicare is technically a provision). The Federal government continues to pay a share.
Everyone pays, everyone gets the care they need and nobody is left out. People can choose any qualified provider. Providers remain private, and are paid enough to attract and sustain the clinicians we want and need.
We have tried every kind of private for profit health insurance there is: employer sponsored, government subsidized, market based, capitation, value-based, catastrophic, health savings accounts—it no longer works for employers, taxpayers, or the sick. This year premiums will go up, coverage will go down.
Americans’ health will suffer.
Americans need care, not coverage. We clinicians have dedicated our lives to providing it. Medicare has served millions of us well for 60 years. We cannot allow opportunistic capitalists to stand in the way for the rest.
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Trump Administration's New Healthcare Plans Could Slap Families With $31,000 Deductibles
"Nobody wants that product," said one healthcare expert of the Trump administration's proposed plans.
Feb 26, 2026
The Trump administration is proposing new regulations for healthcare plans purchased through Affordable Care Act exchanges that, on the surface, could offer patients lower monthly premiums.
However, the New York Times reported on Thursday that these plans would make up for the lower premiums by charging deductibles as high as $15,000 for individuals and $31,000 for families, meaning that people on these plans would have to pay significant up-front costs should they get sick before getting any benefit from having insurance.
For perspective, the Times noted that these deductibles would be "eight times the average for someone with job-based insurance."
Health experts who spoke with the Times were blunt about these plans' prospects for success.
"Nobody wants that product," Harvard health economist Amitabh Chandra said. "It’s going to be a really cheap product that nobody wants."
Dr. Joseph Betancourt, president of the Commonwealth Fund, told the Times that the plans being mulled by the administration would push greater assumption of risk onto patients and away from insurers.
"There's no doubt that we have an affordability crisis," he said. "As we move forward to shifting more of the burden to patients, there’s a chance to really exacerbate the crisis."
Katherine Hempstead, senior policy adviser for the Robert Wood Johnson Foundation, told the Times that the cheaper Trump plans are "normalizing hardship, and... normalizing catastrophe" by creating a form of health insurance that offers even less coverage than the cheapest plans available on the exchanges.
The high-deductible plans are being pushed by Medicare and Medicaid Administrator Mehmet Oz, who made headlines earlier this year by saying the goal of the Trump administration's healthcare policy was to have Americans be healthy enough so they could stay at work for at least an extra year before retiring.
"If we can get the average person... to work one more year in their whole lifetime, just stay in your workplace for one more year," Oz said during an interview on Fox Business, "that is worth about $3 trillion to the US GDP."
Democratic California Gov. Gavin Newsom, who is widely expected to seek the presidency in 2028, pounced on the report about the high-deductible plans.
"[Trump's] economic agenda is simple," Newsom wrote in a social media post, "force hard working families to pay more and give billionaires a tax break."
Johanna Maska, a former aide to President Barack Obama, expressed disbelief that this was Republicans' long-promised replacement plan for the ACA.
"A $31,000 deductible is unacceptable," she wrote. "This is the Republican long awaited plan? This is not healthcare that helps Americans."
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Trump's Health Plan Is Doomed to Fail—We Need Medicare for All
Unsurprisingly, Trump’s concepts of a plan don't even begin to reverse the damage he caused when he made massive cuts to Medicaid and the Affordable Care Act in order to fund tax cuts for billionaires.
Jan 17, 2026
President Donald Trump’s new “Great Health Care Plan” is anything but.
Unsurprisingly, Trump’s concepts of a plan fail to even begin to reverse the damage he caused when he made massive cuts to Medicaid and the Affordable Care Act in order to fund tax cuts for billionaires. Now, Trump and his Republican allies are trying to cover up the gaping wound they have created with a Band-Aid. At the same time, Americans are desperate for relief from Trumpflation, including rapidly rising healthcare costs.
Too many Americans struggle to get the healthcare they need even with insurance. A recent poll found that more than 1-in-3 adults in the US had skipped or postponed needed healthcare in the last 12 months because they couldn’t afford the cost. The situation is even more dire for the uninsured, with 75% of uninsured adults under age 65 reporting going without needed care because of the cost.
Shutdown negotiations and subsequent scattershot health ideas from the White House and Republicans in Congress show they have no real idea what to do when it comes to actually bringing down the cost of healthcare in America. President Trump’s half-baked plan appears doomed to fail and doesn’t even have the support of Republicans in Congress. Plus the only alternate Republican plans for healthcare that currently exist strictly serve corporations and fail to provide relief to patients.
Every other comparably wealthy country has some version of universal healthcare, and none of them would trade their systems for the wasteful and haphazard US system.
Meanwhile, the Trump administration has undertaken efforts to further privatize Medicare, including adding Medicare Advantage-style prior authorization to traditional Medicare, risking access to care for seniors by delaying and denying needed care. It also plans to place Medicare enrollees in private health contracts, similar to Medicare Advantage, where the corporations in charge are incentivized to place corporate profits ahead of patient needs.
Americans are angry about our broken healthcare system, and they want a comprehensive solution. One recent survey found that 65% of voters support a Medicare for All-style system. A similar number of voters said that the federal government right now does too little to ensure Americans can afford the healthcare they need. An in-depth study that looked across four years of data found that more than a quarter of adults went without needed care or experienced cost burdens for care they did receive over the four-year period of the study. The high cost of care and limited coverage leaves tens of millions of Americans without adequate coverage, and millions of them end up saddled with medical debt, something unheard of in other comparably wealthy countries. We need to take bold but commonsense action to finally guarantee that everyone in the US can get the healthcare they need.
Providers and hospitals are also desperate for reform. The cost of doing business in our broken healthcare system is causing hospitals to close or shutter crucial services. Providers are facing huge challenges as greedy profiteers, including private equity companies, gobble up their hospitals and medical practices and impose cost-cutting measures in the service of maximizing profits.
Fortunately, Medicare for All would address all of these issues and finally put the health of Americans ahead of corporate profits. Medicare for All would guarantee that everyone in the US can get the care they need when they need it, without financial barriers or hoops to jump through, and would be cheaper than our current system while providing coverage that is better than any commercial health insurance plan. It would do this by taking Medicare—one of the most popular parts of our healthcare system—improving it by expanding available services, ending out-of-pocket costs, and expanding it to everyone in the country.
Corporations and certain members of Congress purposefully make such a commonsense system sound like an impossible leap from America’s current broken system in order to stifle American dissatisfaction with our healthcare and keep shareholders happy. But every other comparably wealthy country has some version of universal healthcare, and none of them would trade their systems for the wasteful and haphazard US system.
We continue to see more members of Congress signing on to support Medicare for All in both the House and the Senate, and more municipalities supporting resolutions in favor of Congress passing Medicare for All. The time has come to unite around Medicare for All and build the movement that can finally make it a reality.
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