Medicare for all — a very difficult sell

M4A (Medicare for All) is far superior to the health coverage that most Americans now have. It works well in just every other developed country. Conceptually it isn’t so hard to imagine it being adopted here, just as universal government-supported education through high school is taken for granted. In fact, until recently there were excellent state-supported tuition-free colleges such as the City University of New York, so extending free education through college is not such a great stretch.

But M4A is different here because it would displace an entrenched system of healthcare. In other countries, it didn’t have that obstacle because people usually paid for medical care out-of -pocket before it was introduced. Bernie Sanders’s idea of substituting M4A for our current system in one giant step is just infeasible politically, though getting there through an intermediate step might well succeed.

The opposition to M4A will come from three sources.

First, there are many people, perhaps 40% of the population, who are satisfied with their health care and wouldn’t want to exchange something they know for something they don’t know. That group includes in particular the members of large and powerful unions such as auto workers, teachers, and municipal workers. Some defects of Medicare as it stands would be a step backwards for many unionized workers,

Second, there are the employees and owners of the organizations that comprise the existing system. These include hospitals, insurance companies, private medical practices, companies that provide administrative services, and of course the very powerful and profitable pharmaceutical companies. Their livelihoods depend on the existing system.

Third, there are those who oppose it for philosophical or political reasons because they oppose socialism in general. They often see socialism as a form of communism, which they find totally abhorrent.

We got here because of events decades ago during World War II. In 1942 the Roosevelt administration decided that medical care provided by employers to their employees would be a nontaxable benefit. That came about in response to the economic pressures of paying for World War II. It enabled companies to raise the compensation of their employees without visibly adding to wartime inflation.

Many things have changes since then. The medical benefit assumed the model of a nuclear family with a working husband holding a full-time job, a non-working wife, and several children. Employer paid insurance was a family benefit. That model no longer applies to most Americans.

Divorce scrambles the association of children to their parents as well as the association of husbands and wives. Single people and cohabiting couples are numerous. Many people work for themselves, or hold several jobs, or work only part-time. For an employer, it is obviously far more expensive to insure a family than to insure an individual. We now have a situation where there are two segments of the population: those who have health insurance and those who don’t.

Medicare covers people over 65 years of age, but it has major gaps, most notably dentistry. Dental problems can easily lead to more general health problems. Going to the dentist is expensive, so many older people simply don’t go. Out-of-pocket medical care is very expensive, especially because medical providers compensate for the limited revenue from insured patients by charging exorbitant fees to uninsured patients.

Government-provided healthcare will arrive eventually, despite these difficulties. But unfortunately it will be a long time in coming.


Paul Abrahams is a retired computer scientist living in Deerfield, Massachusetts. President of ACM from 1986 to 1988, he now writes philosophical essays.

Get the Medium app

A button that says 'Download on the App Store', and if clicked it will lead you to the iOS App store
A button that says 'Get it on, Google Play', and if clicked it will lead you to the Google Play store
Paul Abrahams

Paul Abrahams is a retired computer scientist living in Deerfield, Massachusetts. President of ACM from 1986 to 1988, he now writes philosophical essays.