We spend more for fragmented healthcare than comparable countries do for universal care, and get far worse outcomes.
“Medicare for All” is a phrase with a lot of political baggage, so set it aside. What it describes is simpler: extending a system Americans already built to the rest of the population. This piece uses “universal healthcare” from here on, because that’s what it is.
Medicare works. It covers every American over 65, regardless of employment status or health history. It operates with administrative overhead of roughly 2%, compared to 12-15% for private insurers. It negotiates prices, it pays claims, and it has done so for sixty years. We know how to do this because we already do it.
Healthcare doesn’t work like a normal market.
You can’t comparison shop during a cardiac event. You don’t choose when to have a stroke. Every wealthy country that looked honestly at these conditions reached the same conclusion: healthcare cannot be organized around market competition.
The American system has grown around a different goal. The administrative apparatus — prior authorizations, claim denials, billing complexity — exists to protect revenue, not deliver care. The clinical judgment of a trained physician is overruled by a clerk or algorithm with no medical expertise and every financial incentive to deny.