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Nothing Less Than Improved Medicare for All

Now that we have the historic force of a united front in national Medicare for All legislation—HR 1384 and S. 1129—let’s review the bottom line

Middle-income families save an average 9% of income; for example, a family earning $62,000 today paying $10,000 per year out of pocket would pay $930. (Photo: Alex Wong/Getty Images)

Middle-income families save an average 9% of income; for example, a family earning $62,000 today paying $10,000 per year out of pocket would pay $930. (Photo: Alex Wong/Getty Images)

Isn’t this a “radical transformation” of the US healthcare system?

No. Medicare for All expands the role of public financing in healthcare- 60% of healthcare is already paid for by our taxes. It does so through an existing “single-payer” called the Medicare Trust Fund that already pays virtually every provider in the US but just for seniors. Under Medicare for All it will cover everybody and reimburse providers who remain mostly private. The new financing replaces all premiums, co-pays and deductibles –Medicare for All is the only reform program to do so.

Besides the government, the primary payers in the current system are the commercial insurance companies, funded by employer contributions, taxes, and individuals (those premiums, co-pays, and deductibles). These insurance companies are “middle men.” For prescription drugs, the insurance companies often pay Pharmacy Benefit Managers (PBMs) who set the limits on coverage and pay pharmacies.  The Medicare program in part currently uses insurance companies and PBMs. The new Medicare for All will directly pay for prescriptions, services and providers, cutting out all “middle men.”

How can we afford Medicare For All?  

  • Overall spending to cover everybody with comprehensive benefits goes DOWN by 9.6%;
  • Middle-income families save an average 9% of income; for example, a family earning $62,000 today paying $10,000 per year out of pocket would pay $930. (see economic analysis at;
  • Employers receive an immediate 8% reduction in healthcare costs;
  • We can take care of workers affected by the transition, allocating 1% of the annual budget for five years to income maintenance, job retraining for affected insurance and other administrative employees.


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How does “Medicare for All” achieve savings over the for-profit private insurance system?

  • Everybody in one insurance pool provides economies of scale to negotiate lower prices that along with the budget authority of a public program, contains costs;
  • The Medicare Trust Fund is the “single-payer” that pays negotiated payment rates and global budgets to service providers sufficient to sustain their caregiving operations; it finances capital expenditures separately;
  • Reduction of waste, bureaucracy, and inefficiency because the single-payer replaces hundreds of payers, often with their own distinct rules and procedures designed to enhance revenues and profits at the expense of prevention, continuity of care and clinicians’ judgment.

Won’t long term care bust the budget?

  • The economic analysis done by the UMass Amherst PERI ( included these services in their estimates of savings described above;
  • A transition to and more coverage of in-home support services for all, including people with disabilities, improves quality of life and provides more cost-effective care;
  • Even with a 12% increase in use, and projecting an additional 10% spending based on expanded coverage for these services, the financing from broad-based taxes (e.g. gross receipts or payroll) or a raise in the proposed tax rates on upper income is sufficient.

These numbers blow away the insurance industry-funded smoke screen. Medicare for All works. It’s the pragmatic alternative to the rising insecurity we feel from escalating costs and huge out of pocket spending – today, we don’t know if we’ll get the care we need.

Through Medicare for All we will.

Michael Lighty

Michael Lighty

Michael Lighty has organized, advocated and developed policy for Improved Medicare for All nationally and in California for 29 years. He is a founding Fellow of the Sanders Institute. Lighty is currently on sabbatical from the California Nurses Association/NNU where he was director of public policy. During his tenure there from 1994-2018, Lighty coordinated campaigns for an HMO patients’ bill of rights, clean money elections, Healthy California, and nationally, for a Robin Hood Tax. Lighty was the first openly LGBTQ person to lead a socialist organization as Democratic Socialists of America’s National Director in the early 90’s. In 2009 Oakland Mayor Ronald V. Dellums appointed Lighty to the Board of Port Commissioners. For NNU, Lighty coordinated the Peoples Summit in Chicago in 2016 & 2017, and the Bernie Bus campaign, an independent effort to elect Bernie Sanders for President. He currently serves on the Board of Directors of Peoples Action; Progressive Democrats of America; and the Martin Luther King, Jr. Freedom Center in Oakland, CA, where he lives with his husband. Follow him on Twitter: @mlighty60


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