Medicare for All
The Democratic Socialists of America (DSA) party has been quiet since its inception in 1982 and the Senatorial win for Bernie Sanders in 2007. However, in 2025 and 2026, the DSA have scored several well-publicized wins including Zohran Mamdani mayoral win in New York City, Abdul El-Sayed, a non-official DSA member, and Angie Nixon’s Democratic nomination for Senate wins in Michigan and Florida, and U.S. Democratic primary wins for the House of Representatives in Colorado (Melat Kiros) and New York (Claire Valkdez and Darializa Avila Chevalier). While the general elections for Senate and the House of Representatives have not yet taken place, the primary victories have created alarm among established Democrats who fear DSA members will cost the Democratic party valuable seats in the general elections. Brookings recently reported that “43% of Democratic Socialists of America-backed candidates have won races this cycle”, but that the DSA wins account for less than 1% of elections, are primarily statewide office versus national wins, and are primarily limited to blue states with a heavy concentration in California and New York.
The DSA political platform ranges from public ownership of housing and industries to guaranteed tuition-free public college to higher taxes on corporations and wealthy individuals, to eliminating the U.S. Senate and the Electoral College, to universal amnesty and voting rights for illegal immigrants. However, the cornerstone of their healthcare policy is a comprehensive, singular federal government run, Medicare for All health system. While Universal Healthcare allows for a mix of public and private options, Medicare for All eliminates all private for-profit employer insurance systems and current government based public options. Medicare for All would provide comprehensive health coverage that is entirely free with no co-pays, deductibles, or premiums for all U.S. residents including non-citizens thereby effectively shifting healthcare costs entirely to a public tax funded model. It is important to recognize that predominantly single government run healthcare is by far the most common healthcare system employed outside of the U.S. However, most such countries allow for a mix of public and optional supplemental private options.
In April of 2025, DSA member and Senator Bernie Sanders and Democratic progressive representatives Pramila Jayapal and Debbie Dingell introduced legislation entitled the Medicare for All Act of 2025 which is technically a misnomer for Universal Healthcare and would provide free universal, comprehensive healthcare government run coverage for all U.S. residents. Under the bill, private insurers and employers may only offer coverage that is supplemental to the benefits provided under the federal government run program. The act has been referred to committees of jurisdiction and no floor votes or committee hearings have been scheduled. While the passage of the Medicare for All Act of 2025 is highly unlikely, if the DSA were to get several elected members in the Senate and House of Representatives, their inclusion could be the difference between a Democratic or Republican majority. In such situations, history has shown that such small coalitions can be much more influential than their number of votes would indicate. Examples of small federal coalitions having an important impact on legislation are plentiful and include the small conservative house coalition that led to spending caps and work requirements in the Fiscal Responsibility Act, the small bipartisan coalition of senators that passed the Infrastructure Investment and Jobs Act, and in 2022 when the Senate was split evenly and a two Senator fiscally oriented coalition (Joe Manchin and Kyrsten Sinema) effectively scaled back the multi-trillion-dollar Build Back Better Act. The fact is in narrowly split congresses, small federal congressional coalitions are capable of maybe not complete, but significant legislative change. Hence, it is probably worthwhile dusting off some of the pros and cons of DSA’s Medicare for All.
Advocates for Medicare for All assert that a single, government run payer system would:
Reduce administrative costs,
Protect against high medical debt,
Ensure that the roughly 27 million Americans who, even with Obama Care, do not have medical insurance would receive care,
Place the focus on disease prevention not treatment,
Be a fairer healthcare system for Americans,
Be affordable for the U.S. given the fact that the nation already spends far more on healthcare than any other developed country,
Result in most patients paying far less in increased taxes than they currently do in healthcare premiums, deductibles, and copays,
Eliminate profiteering within the U.S. healthcare system, and
Free American workers from depending on employers for health benefits.
Opponents for Medicare for All maintain that it will:
Shift trillions in cost from private insurance to the federal government leading to significantly increase taxes for individuals and businesses and thereby harm U.S. economic growth and expand the federal budget deficit,
Lead to significant job losses in the private healthcare insurance and intermediary provider segment,
Result in a massive spike in healthcare demand for services that now have zero patient deductibles and out-of-pocket expense and thereby further fuel existing healthcare provider burn out and drop-out rates and lead to significantly longer wait times for healthcare services,
Delay access to new and innovative treatments, reduced investment in the healthcare segment, and stifle healthcare research and development,
Lower all current reimbursement rates for doctors and hospitals to lower Medicare rates, leading to shortages of healthcare professionals and facilities, especially for rural healthcare,
Lead to the government dictating treatment rules, further limiting physician autonomy and patient choices, while simultaneously eliminating private insurance patient options that offer expanded and more rapid access to healthcare for those who could afford it,
Lead to government-run bureaucracies and inefficiencies, which will lead to higher cost and poorer quality of care,
The results of provider surveys on Medicare for All vary dramatically based on when they were conducted, the questions asked, who is being surveyed, and potential ownership bias. Nonetheless, they tend to indicate that ~50% of doctors support a single-payer or Medicare for All health system, with that percentage growing to ~60% of primary care doctors and pediatricians. Studies from the PEW Research Center and John Hopkins indicate that 55-70% of Americans support Universal Healthcare, but data from PBS shows that this support drops off significantly (down to 30-40%) for Medicare for All when private insurance options are eliminated.
Projecting the incremental U.S. federal budget with the shift to a Medicare for All system is challenging and requires projecting changes in patient demand for healthcare resources, the identification of previous and new federal budget and patient costs, as well as the differences and interdependencies between those healthcare expenditures. Most of the projected savings comes from reducing administrative overhead and forcing provider reimbursement down to standard Medicare payment rates, and the majority of increased costs stem from the lack of employer funding and increased utilization of healthcare resources stemming from the elimination of premiums, copays, and deductibles. According to the Urban Institute, Senator Bernie Sanders’ Medicare-for-All plan would add $34 trillion to federal spending over a decade. The bipartisan Committee for a Responsible Federal Budget, a DC-based public policy think tank, estimated to cost the federal government costs to be $25 trillion to $35 trillion over a decade, and CBO’s estimate was $15-30 trillion over 10 years. Meanwhile, a study by Yale University suggests that administrative savings, reduced healthcare fraud, and improved preventive care associated with a single-payer model could reduce overall U.S. national healthcare expenditures by more than a $1 trillion annually.
Significant concerns and political and financial hurdles in Congress and the current private healthcare market make it unlikely that we will see Medicare for All soon. Nonetheless, it is important to monitor the upcoming and future general elections to see if the DSA can win sufficient seats in the Senate and House to determine Democratic majority and control. If they can achieve this, it is not impossible to believe that we could see a legislative push that takes the U.S. closer to a Universal Healthcare system. While both sides of the MfA debate have strong viewpoints, the one thing that all parties can agree is that such a change could dramatically change the way U.S. healthcare is funded, the quality and extent of the care provided, demand for healthcare resources, and the incentives for healthcare providers, patients, investors, and the pharmaceutical industry.
For more information about the political potential and impact of Universal and Medicare for All health systems, please do not hesitate to contact either myself or Rita.