DEMOCRATIC MEDICARE FOR ALL VS. REPUBLICAN DON'T CARE AT ALL

It’s Time to Dump the Insurance Companies and Provide Healthcare as an American Right

Or: How We Became the Richest Nation on Earth That Still Can't Figure Out How to Take People to the Doctor

ACT I: The Setup (In Which We Discover We've Been Having the Same Argument Since Woodrow Wilson Was President)

Picture this: It's 1915. The Wright Brothers' first flight was only twelve years ago. World War I is raging in Europe. Women can't vote yet. And some wild-eyed progressives at the American Association for Labor Legislation are proposing—gasp—that maybe, just maybe, Americans shouldn't have to choose between seeing a doctor and eating dinner.

Flash forward to 2025. We have smartphones, electric cars, billionaires launching themselves into space for fun, and we're still having the exact same argument.

If insanity is doing the same thing over and over and expecting different results, then America's healthcare debate isn't just insane—it's a Groundhog Day nightmare directed by Kafka and produced by the insurance industry.

ACT II: The Tale of Two Systems (Or: Democrats Say "Medicare for All" and Republicans Say "Medi-SCARE for All!")

Let's be crystal clear about what we're actually debating here:

The Democratic Vision: Medicare for All

Healthcare as a human right
Single-payer system (the government pays, doctors stay independent)
No premiums, no deductibles, no medical bankruptcy
Comprehensive coverage including dental, vision, and mental health
You know, like every other wealthy country on the planet has figured out

The Republican Counter-Offer: Don't Care At All

"The free market will solve everything!" (Narrator: It didn't.)
"But socialism!" (Narrator: Medicare, the most popular government program, is already socialized medicine for seniors.)
"We can't afford it!" (Narrator: We're literally the richest country in human history.)
"What about choice?" (Narrator: The choice between bankruptcy and death isn't much of a choice.)

The irony so thick you could perform surgery on it (if you could afford the surgery): The Affordable Care Act—"Obamacare" to its friends and enemies alike—was literally modeled on a Republican healthcare plan.

That's right. The thing Republicans spent a decade trying to repeal was originally their own idea, implemented by Mitt Romney in Massachusetts in 2006. It's like watching someone set their own house on fire and then complaining about the smoke.

ACT III: The ACA—A Republican Plan That Republicans Hate (Because a Democrat Passed It)

Let's review this absurdist theater:

2006: Republican Governor Mitt Romney signs Massachusetts healthcare reform, including an individual mandate, insurance exchanges, and subsidies. Republicans applaud. The Heritage Foundation (a conservative think tank) celebrates it as a market-based solution.

2010: Democratic President Barack Obama passes essentially the same plan nationally. Republicans lose their minds. "Socialism!" "Government takeover!" "Death panels!"

2012: The Supreme Court, in a fit of judicial whimsy, makes Medicaid expansion optional, creating the "Medicaid Gap"—a coverage black hole where millions of Americans are too poor for ACA subsidies but don't qualify for Medicaid in the ten states that still refuse expansion. Because nothing says "pro-life" like leaving poor people without healthcare.

2017: Republicans control Congress and try to repeal the ACA approximately 70 times. They fail, but manage to eliminate the individual mandate penalty, the enforcement mechanism that kept the system stable.

2021-2025: Democrats enhance ACA subsidies, making coverage actually affordable. Enrollment hits record highs—24.3 million people. Success! Except those subsidies are about to expire because Congress can't agree on anything except their own pay raises.

The result? A healthcare system that's simultaneously:

Too expensive for patients
Too bureaucratic for doctors
Too profitable for insurance companies
Too complicated for anyone to understand
And somehow still leaves millions uninsured

It's like designing a car that doesn't have wheels, costs $100,000, and occasionally explodes—but hey, at least it's not "socialist."

ACT IV: The United States vs. The Entire Rest of the Developed World (Spoiler: We're Losing)

Here's where it gets really embarrassing. Let's compare the United States to countries with universal healthcare:

Healthcare Spending Per Capita:

United States: $12,555 (2022)
Switzerland (2nd highest): $8,049
Germany: $7,383
Canada: $6,319
United Kingdom: $5,387

We spend TWICE as much as comparable countries. For that premium price, surely we get the best healthcare in the world, right?

Life Expectancy:

Japan: 84.8 years
Switzerland: 84.0 years
Australia: 83.3 years
Canada: 82.7 years
United Kingdom: 81.3 years
United States: 78.9 years

Wait, what? We're spending twice as much to die sooner?

Maternal Mortality Rate (deaths per 100,000 live births):

Norway: 2
Germany: 4
France: 8
Canada: 11
United Kingdom: 10
United States: 23.8

We're the only developed country where maternal mortality is increasing. Land of the free, home of the "maybe don't get pregnant if you can't afford to survive childbirth."

Medical Bankruptcy:

Every other developed country: Essentially zero
United States: 66.5% of all bankruptcies have medical causes

Two-thirds of American bankruptcies involve medical debt. In countries with universal healthcare, this statistic is literally incomprehensible. It's like telling someone from Norway that Americans regularly die from scurvy or get eaten by wolves. "But... you're a wealthy country. How is this possible?"

ACT V: "But We Can't Afford It!" (Screamed by the Richest Country in History)

This is my favorite argument against Medicare for All, because it requires Olympic-level mental gymnastics.

Things America Can Apparently Afford:

$858 billion annual military budget (more than the next 10 countries combined)
$1.9 trillion in tax cuts for corporations and the wealthy (2017 Tax Cuts and Jobs Act)
735 billionaires with a combined wealth of $4.5 trillion
Endless wars in the Middle East ($8 trillion over 20 years)
Corporate subsidies and bailouts whenever Wall Street sneezes
Elon Musk's companies receiving $4.9 billion in government support

Things America Apparently Cannot Afford:

Making sure people don't die from preventable diseases
Ensuring children can see a dentist
Preventing medical bankruptcy
You know, basic human dignity

The math is actually pretty simple. Multiple studies—including from the libertarian Mercatus Center (accidentally)—show that Medicare for All would actually SAVE money compared to our current system. We'd eliminate:

Insurance company profits ($60+ billion annually)
Administrative waste (31% of all healthcare spending)
Price gouging by pharmaceutical companies (insulin costs $10 to make, sells for $300)
Billing complexity (hospitals employ more billing specialists than nurses)

But sure, let's keep pretending the problem is that we can't afford to join every other developed nation in the 21st century.

ACT VI: "But the Profit Motive Works!" (If By "Works" You Mean "Kills People")

The Republican argument boils down to this: Competition and profit incentives create efficiency and innovation in healthcare.

Let's examine this claim:

Insurance Company "Innovation":

Denying claims (denied claim rate: 15-20%)
Narrow networks (surprise! your doctor isn't covered)
Prior authorization requirements (your doctor has to beg permission to treat you)
High deductibles (you have insurance but can't afford to use it)
Confusing billing (nobody knows what anything costs until after)

Wow, such innovation! They've innovated 1,001 ways to take your premiums and not provide healthcare!

Pharmaceutical "Innovation":

Insulin, discovered in 1921, now costs 10x more than it did in the 1990s (the formula hasn't changed)
"Evergreening" patents to prevent generic competition
Spending more on marketing than research
Charging Americans 3-10x more than other countries for the same drugs

The "profit motive" in healthcare doesn't drive innovation in care—it drives innovation in profit extraction. It's like hiring a fox to guard the henhouse and being shocked when you end up with no chickens and a very fat fox.

ACT VII: The Supreme Court Weighs In (And Makes Everything Worse)

Let's talk about how the Supreme Court has systematically undermined healthcare reform:

2012 - NFIB v. Sebelius: The Court upholds the ACA but makes Medicaid expansion optional. Chief Justice Roberts performs logical gymnastics that would make Simone Biles jealous, ruling that the individual mandate is constitutional as a tax but that the federal government can't require states to expand Medicaid.

Result: Ten states still haven't expanded Medicaid, leaving millions in the coverage gap. These states—shockingly—tend to have Republican governors who claim to be "pro-life" while literally denying healthcare to their poorest citizens.

The Ongoing Threat: With a 6-3 conservative majority, the Court remains one lawsuit away from potentially dismantling what's left of the ACA. Because nothing says "judicial restraint" like unelected judges overturning laws passed by Congress and signed by the President.

ACT VIII: Every Other Country Figured This Out (What's Our Excuse?)

Let's take a world tour of healthcare systems that actually work:

Canada: Single-payer system. Everyone covered. No medical bankruptcy. Costs half what the US spends per capita. Yes, there can be waits for elective procedures. No, Canadians aren't fleeing to the US for healthcare (despite what your uncle posts on Facebook).

United Kingdom: National Health Service. Free at point of service. Funded by taxes. Founded in 1948 by a Labour government. Still the most popular institution in Britain. Even Conservative governments don't dare dismantle it.

Germany: Multi-payer system with non-profit insurance funds. Universal coverage. Costs 60% of US spending. Excellent outcomes. Proof that you don't need single-payer to achieve universal coverage—you just need to actually care about covering everyone.

France: Hybrid system. Ranked #1 by WHO in 2000. Universal coverage. Costs half of US spending. The French will protest if you look at their healthcare system wrong, yet somehow they've maintained it for decades.

Taiwan: Adopted universal healthcare in 1995. Studied systems worldwide and chose single-payer. Covers 99.9% of residents. Administrative costs: 2% (vs. 31% in the US). Customer satisfaction: 85%+.

The common thread? These countries decided healthcare is a human right, not a profit center. They spend less, cover everyone, and get better results.

But sure, America, let's keep pretending we're "exceptional" while our citizens die from rationing insulin.

ACT IX: The Expiring Subsidies Crisis (Or: How Congress Is About to Make Everything Worse, Again)

Here's where we are right now, in December 2025:

The enhanced ACA subsidies—which made coverage actually affordable and drove enrollment to record highs—are expiring on December 31st. Congress just rejected both Democratic and Republican proposals to extend them.

What happens if they expire:

Premiums more than double for millions of Americans
3-5 million people lose coverage
We backslide toward pre-ACA uninsured rates
Insurance companies keep making record profits

It's like watching someone drown, throwing them a life preserver, pulling them to safety, and then... throwing them back in the water.

This is American healthcare policy in a nutshell: Take one step forward, two steps back, then argue about whether we should have taken any steps at all.

ACT X: The Real Question—Why Are We Still Debating This?

Here's what makes this entire debate so infuriating: We've been having the same argument for 110 years.

Theodore "Teddy" Roosevelt did first try to introduce national health insurance in 1912 as part of his Progressive "Bull Moose" Party platform, advocating for social insurance to protect workers from sickness and old age, making him a key figure in early U.S. health reform efforts. Fails.

1915: AALL proposes health insurance. Fails.
1945: Truman proposes national health insurance. Fails.
1960s: Kennedy/Johnson create Medicare and Medicaid. Partial success!
1974: Nixon proposes employer mandates. Fails.
1993: Clinton proposes Health Security Act. Fails spectacularly.
2010: Obama passes ACA. Partial success! (Immediately undermined.)
2025: We're still arguing about whether healthcare is a human right.

Every other developed country figured this out decades ago. But America? We're still debating whether poor people deserve to see a doctor.

Why?

Follow the money:

Insurance industry lobbying: $642 million spent in 2023-2024 election cycle
Pharmaceutical lobbying: $373 million in 2023
Hospital lobbying: $132 million in 2023

These industries have a vested interest in maintaining the profitable status quo. They fund campaigns, hire armies of lobbyists, and run scare campaigns about "government takeovers" and "socialism."

And it works. Because Americans have been so propagandized that we actually believe:

Healthcare is a commodity, not a right
Profit-driven medicine is more efficient (it's not)
Government-run healthcare means "death panels" (private insurance already has death panels—they're called claims adjusters)
We can't afford universal healthcare (we're literally paying more for worse outcomes)

ACT XI: The Moral Argument (Or: When Did We Decide Profits Matter More Than People?)

Let's strip away the policy wonkery and get to the heart of it:

Is healthcare a human right or a consumer product?

If you believe healthcare is a human right—like police protection, fire departments, public education, and national defense—then the current system is a moral obscenity.

We don't ask people to shop around for the best fire department while their house burns. We don't means-test police protection. We don't tell kids, "Sorry, your parents can't afford school, so you'll just have to stay illiterate."

But we absolutely tell sick people: "Sorry, you can't afford treatment, so just... die, I guess? Have you tried a GoFundMe?"

The United States is the only developed country where:

People ration insulin and die
Families hold fundraisers to pay for cancer treatment
People stay in jobs they hate for health insurance
Medical debt is the leading cause of bankruptcy
People die from preventable diseases because they couldn't afford a doctor

This isn't a policy failure. It's a moral failure.

ACT XII: "But Socialism!" (The Laziest Argument in American Politics)

Whenever someone proposes Medicare for All, conservatives scream "SOCIALISM!" as if they've just spotted Bigfoot riding a unicorn.

Let's clear this up:

Things Americans Already Accept as "Socialized":

Public schools
Police departments
Fire departments
Libraries
Roads and highways
The military
Medicare (for seniors)
Medicaid (for the poor)
Veterans' healthcare
Social Security
Public parks
The postal service

Nobody's screaming about "socialized fire protection" or demanding we privatize the military (okay, Blackwater tried that, and it went great /s).

But suggest that maybe—just maybe—we should extend Medicare to everyone, and suddenly we're Venezuela.

Here's the thing: Medicare for All isn't socialism. It's social insurance, like Social Security. The government pays for healthcare, but doctors remain independent. Hospitals stay private. You still choose your doctor (unlike now, where insurance companies choose for you).

It's literally the system we already have for seniors—the most popular government program in America—extended to everyone.

If Medicare is socialism, then we've been socialist since 1965, and somehow we didn't turn into the Soviet Union.

ACT XIII: The Transition Plan (Or: How We Actually Get There From Here)

"Okay, fine," you say. "Medicare for All sounds great. But how do we actually do it without destroying the economy and putting millions of insurance workers out of jobs?"

Great question! Here are the practical pathways:

Option 1: Lower the Medicare Age Gradually

Year 1: Medicare at 60
Year 2: Medicare at 55
Year 3: Medicare at 50
Continue until everyone is covered
Allows gradual transition, industry adjustment

Option 2: Public Option First

Create a government-run insurance plan that competes with private insurance
Let people choose
If it's better and cheaper (it will be), people will naturally migrate
Private insurance either competes or dies (natural selection!)

Option 3: Medicare for All, Full Stop

Pass comprehensive single-payer legislation
4-year transition period
Job retraining programs for displaced insurance workers
Savings from administrative efficiency fund the transition

What about the insurance workers?

The insurance industry employs about 2.9 million people. That sounds like a lot until you realize:

Many would transition to government administration
Others would move to supplemental insurance (like in other countries)
Job retraining programs (funded by healthcare savings)
It's fewer jobs than the coal industry, and we're supposed to care deeply about coal miners

Also, "we can't fix a broken system because it would eliminate jobs" is a wild argument. Should we have kept elevator operators? Switchboard operators? Blockbuster Video employees?

Progress sometimes means job displacement. The solution is job retraining and social safety nets, not maintaining a parasitic industry that kills people for profit.

ACT XIV: The Cost Argument (Let's Do Some Math)

"But how do we pay for it?!"

Current System Costs (2023):

Total US healthcare spending: $4.5 trillion
Per capita: $12,555
27.5 million uninsured
Millions more underinsured

Medicare for All Projected Costs:

Multiple studies estimate $3.5-4.0 trillion annually
That's a SAVINGS of $500 billion to $1 trillion per year
Covers everyone
No deductibles, no co-pays, no medical bankruptcy

How to fund it:

Payroll Tax (4% employer, 2% employee): Replaces current insurance premiums. Most families save money because premiums disappear.
Wealth Tax: A 2% annual tax on wealth over $50 million raises $250+ billion annually.
Close Tax Loopholes: End capital gains preferential treatment, close corporate tax havens. Raises $100+ billion annually.
Negotiate Drug Prices: Like every other country does. Saves $500+ billion annually.
Reduce Administrative Waste: Single-payer cuts administrative costs from 31% to ~5%. Saves $600+ billion annually.

The math is simple: We're already paying for healthcare. We're just paying more, getting less, and funneling billions to insurance company shareholders.

Medicare for All doesn't cost more—it costs less. The question isn't "How do we afford it?" It's "How do we afford NOT to do it?"

ACT XV: Addressing the Bad-Faith Arguments

Let's rapid-fire through the common objections:

"People will abuse it and go to the doctor for every little thing!"

Good! Preventive care is cheaper than emergency care.
Catching problems early saves money and lives.
Also, you think people enjoy going to the doctor? Nobody's getting a colonoscopy for fun.

"Wait times will be terrible!"

Current US wait time for specialist appointment: 26 days average
Canada specialist wait time: 27 days average
We already have wait times, plus we have "can't afford it" times

"The government will decide your treatment!"

Insurance companies already do this. It's called "prior authorization."
At least government isn't profit-motivated to deny your care.

"Doctors will leave the profession!"

Doctors in universal healthcare countries: Still doctors, still well-paid, less administrative burden
Many US doctors support Medicare for All because they're tired of fighting insurance companies

"Innovation will stop!"

Most medical research is publicly funded (NIH budget: $47 billion)
Drug companies spend more on marketing than R&D
Other countries with universal healthcare still innovate

"It's a government takeover!"

Medicare for All: Government pays, doctors stay independent
Current system: Insurance companies decide everything
Which sounds more like a "takeover"?

ACT XVI: The Political Reality (Why This Is So Hard)

Here's the uncomfortable truth: Medicare for All is popular with voters but unpopular with donors.

Public polling:

69% of Americans support Medicare for All (KFF, 2023)
77% support allowing Medicare to negotiate drug prices
Majorities support expanding Medicare to younger people

Congressional action:

crickets

Why? Because Congress doesn't represent voters—it represents donors. And donors like the current system just fine, thank you very much.

The healthcare industry spends over $1 billion annually on lobbying. That buys a lot of Congressional inaction.

This is why we need:

Campaign finance reform
Lobbying restrictions
Politicians with spines
Voters who actually vote in primaries

The policy is easy. The politics is hard. But that's not an excuse—it's a call to action.

ACT XVII: The Billionaire Problem

Let's talk about the elephant in the room wearing a top hat and monocle: billionaires.

The United States has 735 billionaires with combined wealth of $4.5 trillion. Their effective tax rate? Often lower than their secretaries', thanks to capital gains loopholes and creative accounting.

Meanwhile, we're told we "can't afford" to provide healthcare to everyone.

Let's do some math:

A 2% annual wealth tax on fortunes over $50 million would raise $250 billion annually
That alone would cover a huge chunk of Medicare for All
These billionaires would still be billionaires
They'd just have slightly smaller yachts

But here's what really grinds my gears: Many of these billionaires made their fortunes in industries that depend on:

Public infrastructure (roads, internet, GPS)
Publicly educated workers
Government-funded research
Legal and regulatory systems
Taxpayer bailouts (looking at you, Wall Street)

They didn't build that wealth alone. They built it on public investment. And now they're lobbying to avoid paying back into the system that made them rich.

It's not "class warfare" to ask billionaires to contribute to a functioning society. It's basic math and basic decency.

FINAL ACT: The Time for Action Is Now (It's Been "Now" for 110 Years, But Still)

Here's where we are:

The richest country in human history
Spending twice as much on healthcare as comparable nations
Getting worse outcomes
Leaving millions uninsured
Driving families into bankruptcy
Letting people die from preventable diseases
All to protect insurance company profits

This is insane.

We've been debating this for 110 years. Every other developed country figured it out. We have the money, the resources, the medical expertise, and the technology.

What we lack is the political will.

So here's what needs to happen:

Pass Medicare for All. Full stop. No more half-measures, no more "public options" that get watered down, no more means-tested programs with coverage gaps.
Tax the wealthy. They can afford it. They'll be fine. Nobody needs a billion dollars.
End healthcare lobbying. Get money out of politics. Publicly fund campaigns. Make politicians represent voters, not donors.
Vote. Especially in primaries. Support candidates who actually support Medicare for All, not politicians who give lip service and then take insurance money.
Organize. Join groups pushing for healthcare reform. Make noise. Make it politically impossible to oppose universal healthcare.

The moral case is clear. Healthcare is a human right. Full stop.

The economic case is clear. Medicare for All saves money while covering everyone.

The practical case is clear. Every other developed country has done this. We can too.

The only question left is: Do we have the courage to finally do it?

EPILOGUE: A Letter to Future Americans

Dear Future Americans,

If you're reading this from a time when the United States has universal healthcare, congratulations. You finally joined the rest of the developed world. I hope you look back at this era the way we look back at child labor and lead paint—with horror and confusion that it took so long to fix an obvious problem.

If you're reading this from a time when we still don't have universal healthcare... I'm sorry. I'm sorry we failed you. I'm sorry we let insurance companies and billionaires and cowardly politicians prioritize profits over people. I'm sorry we had the resources and the knowledge and the moral imperative, and we still couldn't get it done.

But it's not too late. It's never too late to choose humanity over greed, dignity over profit, and life over death.

The question has never been whether we can afford Medicare for All.

The question has always been: Can we afford not to?

The End (But hopefully, also The Beginning)

This article is dedicated to every American who has ever rationed medication, skipped a doctor's appointment they couldn't afford, stayed in a job they hated for health insurance, or watched a loved one suffer because our healthcare system values profits over people. You deserve better. We all do.

Big Education Ape: "WELL, THERE YOU GO AGAIN": A TRAGICOMIC HISTORY OF AMERICA'S ETERNAL HEALTHCARE DEBATE https://bigeducationape.blogspot.com/2025/11/well-there-you-go-again-tragicomic.html

Thursday, December 11, 2025