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single-payer
A National Single-Payer Healthcare System Would Be Good for Employers, Too
Job-based insurance poses health-related and financial burdens on company employers and employees. These burdens would disappear with universal healthcare.
May 17, 2025
The National Day of Action is set for May 31, 2025, as a call to action in communities across the United States. The goal is to unite people locally and nationally to eliminate profit-based healthcare. This nonviolent campaign is a collective effort that aims to put National Single Payer on the national agenda. Everyone has a basic human right to healthcare.
This opinion piece shares research findings to advocate for a single-payer healthcare system. Among wealthy countries, the U.S. has by far the most expensive healthcare system, and yet the only one without universal coverage. It is fundamentally broken. The system is inequitable due to differences in insurance availability based on work status, income, and other factors. Individuals of different backgrounds don’t have the same level of access to quality healthcare services. Excess administrative costs for insurers and providers add to an estimate of $504 billion out of $1.1 trillion. The time that it takes providers to complete billing tasks can compromise patient-provider relationships and care delivery.
Employer-sponsored insurance plans are the mainstay of U.S. health insurance. More than 156 million Americans (workers and their families) are covered by job-based insurance. The plans can incur high costs for employees and their families. It also places a burden on employers, including premium payments, time spent managing insurance, and potential compromises to hiring and worker productivity. One study estimated annual transactions costs to companies of $21.6 billion. Time spent by employees dealing with insurance issues may constitute the “sludge” that reduces productivity.
“All my employees are friends of mine. It really pains me to see them not go to the doctor, especially for specialists.”
Researchers at the University of California, Berkeley and the University of California, San Francisco studied the consequences of the U.S. system of health insurance on employers. We conducted seven company case studies, with companies in various industries and of varying sizes. Companies were qualitatively and quantitatively explored for the burdens imposed on employers by providing health insurance to their workers and dependents. We interviewed company owners and managers. Below are summaries of the findings:
- All of the companies care about employee health and financial well-being. They strive to provide reliable health insurance, though employees often have other options (spousal coverage or Medicaid).
- Strategies vary widely in terms of types of coverage. Most companies reported substantial management time overseeing the insurance process. Several companies have utilized brokers or consultants for assistance.
- The two largest companies (both in the manufacturing industry) incurred unique costs related to being self-insured.
- Premium and other financial costs represented 4% to 27% of labor costs. The management cost component is up to 50% of the premium cost. Employee productivity lost to insurance activities was not significant. While there hasn’t been a significant impact on business operations, such as strategies to increase production to meet demand surges, it does affect hiring and can lead to significant costs.
Below are direct quotes from some of those interviews:
“Where [health insurance] really has an impact is who we can hire. The people who would want to work for us would want insurance and so that was always a big barrier to getting talent.”—Owner, Custom Gifts and Products company
“The cost of health insurance has limited, I mean that there’s a certain limit to my profit margin and particularly with other factors such as supply chain issues... I’m getting squeezed on a lot of different fronts, and if my health insurance didn’t go up 10% every year, I could pay people 10% more every year... They don’t want to give up their health insurance, but I think they know that it’s suppressing the wages that we can pay.”—Owner, Print and Design company
“All my employees are friends of mine. It really pains me to see them not go to the doctor, especially for specialists... And our specialist cost is very high... And for some of our employees, especially the warehouse employees, they’re not super high compensation.”—Owner, Aviation Distribution company
To conclude, job-based insurance poses health-related and financial burdens on company employers and employees. These burdens would disappear with the implementation of a national single-payer healthcare system.
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Heal This Sick Country: ‘Hands Up’ for the National Day of Action for Single Payer
Over 70 local and national organizations have endorsed the National Day of Action. On May 31, focus the outrage to move the engine of change and put single payer on the nation’s agenda and remove profit from healthcare.
Apr 27, 2025
On Jan 17, 2025, on the heels of the shooting of UnitedHealthcare CEO Brian Thompson, we wrote about the failed system of our corporate controlled healthcare and the outrage against the health insurance industry the shooting spawned. We mentioned the possibility of setting a National Day of Action in 2025 to demand freeing healthcare from profit and covering everyone under a national single payer plan.
Today, we call on people across the country to gather on May 31, 2025, to put their “Hands Up” for:
- The recognition by our government that healthcare is a human right;
- The elimination of private health insurance and the banning of for-profit delivery of care;
- The enactment of a publicly financed, national single-payer program that would provide comprehensive coverage to everyone; and
- The transformation of care delivery from profit-seeking ventures into services organized to serve the people of our country, a system in which all caregivers are freed from corporate control.
President Donald Trump’s inauguration has introduced the prospect of severe hardships to working class and low-income people, people with disabilities, the elderly, and children with proposed cuts to Medicaid, Medicare, and Social Security necessary to fund tax cuts for the wealthy. This moment demands more than the protection of our public programs; it demands a national, single-payer healthcare program, free from profit, for everyone. One people, one plan.
The complicity of our government in the profit-making enterprise of health insurance has been exposed once again when, on Monday April 7, the Trump administration raised payment rates for Medicare Advantage insurers by 5.1%, significantly more than the Biden administration’s proposed increase of 2.2%, which was bad enough. This rate increase has the potential to increase payments to MA by $25 billion next year. However, the final sum will be closer to $60 billion, when the impact of gaming the system through risk scoring is included.
Paying health insurance premiums to a for-profit company that has been given permission to restrict and withhold necessary care is the great scam of modern U.S. healthcare.
As predicted, Medicare Advantage continues to gain enrollment because they offer lower premiums compared to Traditional Medicare. Now they can expect payment from the Medicare trust fund at a higher rate as they have almost every year under Democrat and Republican administrations since 2016. Early this month, while the rest of the market spun out of control due to the announcement of tariffs, insurance stocks soared after the Centers for Medicare and Medicaid (CMS) announced the Medicare Advantage rate hike.
Despite rate increases, Medicare Advantage will continue to operate within narrow networks that often don’t include specialty care, such as Cancer Centers of Excellence. Unlike Traditional Medicare, beneficiaries in Medicare Advantage must accept pre-authorization requirements to receive care that create the delays and denials of care. Many seniors are unaware that in all but four states, once they have enrolled in a Medicare Advantage plan, they cannot change to Traditional Medicare without being subjected to underwriting and the potential of very high premiums if they have preexisting conditions. Paying health insurance premiums to a for-profit company that has been given permission to restrict and withhold necessary care is the great scam of modern U.S. healthcare.
Medicare is only one part of the privatization of government sponsored health insurance: Medicaid is now largely privatized in 42 states, subjecting children from low-income families and low-income adults to the delays and denials that are the mainstay of cost controls in managed care private insurance plans. Seventy five percent of all Medicaid beneficiaries now are enrolled in a Medicaid Managed Care Organization (MCO), and Medicaid MCO denials are twice as high as denials in Medicare Advantage. Five Fortune 500 health insurance companies enroll 50% of all Medicaid beneficiaries, all publicly traded and high performing profit makers.
Over 90 million Americans eligible for government supported healthcare, both Medicaid and Medicare, are now captives of private insurance managed care schemes that control their access to healthcare. Many more millions on Traditional Medicare are being “aligned” by CMS into profit-seeking Accountable Care Organizations. The underlying profit extraction inherent in these schemes prevents critical services from reaching the right people at the right time.
The same can be said for employer-based insurance where workers are paying excessive premiums to health insurance companies to be given the privilege of paying deductibles and coinsurance that make accessing care so expensive that many forgo needed services. According to the Commonwealth Fund, premiums and deductibles consume 10% of the median household income in the U.S. This means that every household with employer health insurance making $80,610 per year or less is underinsured. Employers are faced with increasing insurance premiums for their employees that challenge their ability to stay in business, or in the case of public schools, the ability to keep schools open.
Enough is enough! Over 70 local and national organizations have endorsed the National Day of Action. On May 31, join an action or plan an action in your community. Focus the outrage to move the engine of change and put single payer on the nation’s agenda and remove profit from healthcare. On May 31, put your “Hands Up” for National Single Payer—an Improved Medicare for All free from profit with everybody in and nobody out. Nothing less can heal the nation.
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Improved Medicare for All Can Heal This Sick Country
A system that collects money from patients and employers then profits by withholding the promised care is not a business but a fraudulent, diabolical scam.
Jan 17, 2025
It’s the beginning of the end for corporate control of health care. The tsunami of outrage against the health insurance industry in the wake of the shooting of United Healthcare CEO Brian Thompson, can propel an urgent, unyielding demand for the removal of profit from healthcare and the enactment of a universal, national single payer system. That is, if the single payer, Medicare for All, national health service movement can summon the vision and audacity to rise to the occasion.
The myth, promoted by health care think tanks and policy experts, that people in the United States are satisfied with their health insurance was exploded in the social media rage unleashed in the aftermath of the killing of the United Healthcare CEO.
Fifteen years after the passage of the Affordable Care Act (ACA), our failing health care system is exposed with all its cruel denials, debt, disease, despair and death at the hands of the investor-owned companies for whom patients are merely pawns for the extraction of profit.
Health care in the United States comes in dead last when rated against comparable countries. The U. S. is at the bottom in overall performance, health outcomes, equity, access to care, and efficiency. As the Commonwealth Fund states: “In fulfilling this fundamental obligation [the ability to keep people healthy], the U. S. continues to fail.”
Health care in the United States comes in dead last when rated against comparable countries.
People in the United States aren’t living to their full potential. Already, the U.S. is 55th in life expectancy, behind Panama, Albania, and Czechia, and will fall in its global rankings by 2050 if the country continues the same trajectory. Years of life are lost to a health care system that serves profit over the value of life.
Our maternal mortality rate would be the shame of many of the poorest nations. In 2020, U.S. maternal mortality rate was higher than in Gaza. In 2022, there were 22 maternal deaths per 100,000 live births in the U.S. This is easily double, and often triple, the mortality rate in peer nations, which can be as low as 5 per 100,000 live births. Black mortality rate is criminally worse: 49.5 per 100,000 live births.
Over one million in the U.S. died in the pandemic, a rate much higher than other nations. Over 330,000 of the pandemic deaths in the U.S. were avoidable. Those lives could have been saved had we had a healthcare system that left no one with inadequate coverage.
Cancer patients must not only fight for their lives but also for the economic survival of their families. The newest treatments with so much hope are beyond the means of those who have insurance policies but no great wealth. About 30% of cancer survivors report lasting financial hardship.
Cancer patients are nearly 5 times more likely to experience bankruptcy, and the medical burden forces many to forego care.
Those who have employer-based insurance were assumed to have the gold standard in health care. Now even the highest paid workers are subjected to premiums, deductibles, and co-pays that impede their care despite the family plans that average $32,000 per year. More have insurance that covers less than a hospital gown. Gold has turned to scrap metal.
As people struggle to pay for the premiums, deductibles, and co-pays, revenues of the seven largest health insurance companies in 2022 reached $1.25 trillion and profits soared to $69.3 billion. That’s a 287% increase in profits in just one decade, when profits were $24 billion.
The toxicity of the health care profit makers that spread unnecessary suffering and death generates the hatred that is poisoning the land.
Medicare, our best health care program, publicly funded and open to all, is now strangled in the grip of the privatized Medicare Advantage plans and the Accountable Care Organizations facilitated by the Center for Medicare and Medicaid Innovation (CMMI). Medicare Advantage now controls a majority of recipients, not because it is better, but because the law that established it and the regulators that control it have allowed it to charge less in monthly premiums—plans that are also allowed to delay and deny care yet are overpaid by billions every year. CMMI issues waivers to the private plans exempting them from fraud and abuse laws and allowing kickbacks, self-referral, and illegal benefit inducement.
Millions on fixed incomes cannot afford the alternative of traditional Medicare plus a prescription drug plan and a supplementary Medigap plan. Those who have managed to escape the clutches of Medicare Advantage can still find themselves assigned, without their knowledge, to “value-based” payment schemes such as ACO REACH and other Accountable Care Organizations (ACOs) which privatize traditional Medicare. “Value-based” payment models are touted, without evidence, as reducing costs for Medicare, yet encompass a multitude of for-profit entities and subject patients to physicians incentivized to deny care. There is ample evidence that “value-based” payment schemes do not lower costs for Medicare. Nevertheless, the privatization of Medicare, through Medicare Advantage or ACOs, is now official policy.
The hoax of “value-based” payments, promoted by CMMI, is exposed by the fact that, despite all the assertions of promoting equity, the inequities of health care are expanding.
Medicaid, the program for children and adults with low income, is almost completely privatized, subjecting the recipients to delays, denials and restrictions imposed by the private managed care organizations that control it.
The Center for Medicare and Medicaid Services (CMS) is hurtling down the wrong track. They invite venture capital and health care investors into the Health Care Payment Learning and Action Network (LAN) that they created. CMS holds conferences, seeking advice and collaboration from the very profiteers that are the cause of high cost, low-quality care. The “value-based” payment scheme promoted by CMS has advanced the power of the profit makers, raising costs, cutting care, and pretending to promote equity for minorities and low-income patients.
It’s time to end the chaos. No more foxes in the hen house, no more poison in the system, no more profit in health care.
The toxicity of the health care profit makers that spread unnecessary suffering and death generates the hatred that is poisoning the land.
It’s time to end the chaos. No more foxes in the hen house, no more poison in the system, no more profit in health care. The nation has rejected the insurance company health care model that delays and denies care, demands skin in the game, asserts that there is massive unnecessary care, throws up barriers against care, and walks away with billions. A system that collects money from patients and employers then profits by withholding the promised care is not a business but a fraudulent, diabolical scam.
This system built on profit cannot be tweaked or regulated into better performance. Runaway trains are not deterred by guardrails.
There is one way to heal the nation. Put single payer on the nation’s table and focus the steaming rage to move the engine of change. Raise the demand for removal of profit and enactment of an Improved Medicare for All free from profit to a level commensurate with the damage that our current failing system is causing the patients’ and the country’s goodwill.
Some look at the current Congress, make the assessment that it’s not possible to pass single payer, then change their demand to a lesser proposal. But incremental changes are at the root of the privatization and profit schemes we are locked into now. Fifteen years after the ACA we have a failing health care system. We have witnessed that more incrementalism does more harm than good. Power concedes nothing without a demand, and the demand must be equal to the solution needed.
There is one way to heal the nation. Put single payer on the nation’s table and focus the steaming rage to move the engine of change.
As Marcia Angell, former editor of the New England Journal of Medicine, taught us, in our current private profit-based system, proposals that lower costs also decrease care, and proposals that increase care, raise costs. To improve care and control costs, we must turn to national single payer, free from profit or a national health service.
The status quo is deadly, and people are demanding a stronger more effective fight. We must organize and educate, locally and nationally with a new determination. In every town hall, classroom, union, organization, and neighborhood, people must hear the message and join the fight. Redirect the rage into a positive force for change.
The new anger in the nation makes possible what we could not do before. Many are now discussing the possibility of setting a National Day of Action in 2025 to demand freeing health care from corporate profit and covering everyone under a national single payer plan. That’s a great idea. Actions across the country lifting up that demand could inspire the movement we need.
National Single Payer—an Improved Medicare for All free from profit with everybody in and nobody out. Nothing less can heal the nation.
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