Medicare-for-all: The time has come


By Don McIntosh

When Medicare passed Congress in 1965, its authors thought it would be the first step toward universal national health insurance. Medicare is the public health insurance program that covers Americans 65 and older. It’s sponsored by the federal government and paid for with payroll taxes, general revenues, and participant premiums — currently $134 a month for most enrollees. Medicare negotiates with health care providers over prices, to limit costs.

Amy Chesbrough is a registered nurse at the Portland VA Medical Center, a member of American Federation of Government Employees, and a believer in universal health care. On Aug. 23, she and 100 others protested Oregon Congressman Greg Walden for his support of a bill that would have left 22 million more Americans uninsured. But that’s in addition to the 28 million who are still uninsured even under the Affordable Care Act. As the AFL-CIO said in a July 26 statement, “although the ACA has made it possible for many more people to buy comprehensive health plans from insurance companies, it has not guaranteed everyone could afford the health care they need. Instead, many people face steep deductibles, copayments and coinsurance that create overwhelming barriers to care.”

But proposals to expand it to all Americans have fared poorly in Congress. Democratic Congressman John Conyers of Michigan has introduced a “Medicare for All” bill in every session of Congress since 2003, but it has never made it out of committee. When then-Senator Max Baucus (D-Mont.) held a 2009 hearing on the bill that later became the Affordable Care Act (ACA), he barred any discussion of a universal program.

ACA greatly expanded Medicaid (the state-administered federal health insurance program for the poor), and it created state-level exchanges for otherwise uninsured individuals to purchase coverage with the help of income-dependent subsidies and tax credits. But four years after the exchanges opened for business, 28 million Americans are still without health insurance, and premiums continue to rise. In 2017, premiums reached an average of $1,564 a month for employer-sponsored health insurance that covers an employee and family, according to the Kaiser Family Foundation.

Enter Vermont Sen. Bernie Sanders, who called for extending Medicare to all Americans during his 2016 campaign for president. Sanders lost the Democratic primary, but today polls say he’s the most popular politician in America, and his Medicare for All bill has more co-sponsors than ever. When Sanders introduced his Medicare for All bill in 2013, not a single U.S. senator co-sponsored it. Introduced again Sept. 13, his bill had 16 cosponsors. Meanwhile, the House version, introduced once again this year by Conyers, has 120 Congressional cosponsors, up from 62 in 2015.

Polls show 53 to 60 percent of Americans are now in favor of Medicare for All, compared to 23 percent who oppose the idea. The percentage in favor has been steadily increasing for the last 20 years.

Medicare for All is not expected to pass while Republicans control the House and Senate, but it could if Democrats win back Congressional majorities and the White House.

Organized labor, which was instrumental in passing Medicare in the first place, has long supported its expansion into a universal program. More than a dozen international unions and hundreds of local unions and central labor councils have endorsed the concept of Medicare for All. And the national AFL-CIO Executive Council reiterated the labor federation’s support for it in a July 26, 2017, statement: “Our core goal … is to move expeditiously toward a single-payer system, like Medicare for All, that retains a role for workers’ health plans and in which access to quality, affordable health care is indeed a right for everyone in this country.”

The Sanders and Conyers bills don’t say what would happen to union-sponsored multiemployer health trusts that cover more than 10 million union members and their dependents. In Canada, where everyone is covered by public health insurance programs administered at the provincial level, unions negotiate with employers to provide supplemental health benefits.

Unions have fought hard to secure health insurance benefits for members, but the ever-increasing burden of paying for them has become the number one source of conflict with employers. Health insurance also eats up employer resources that could otherwise go to raises or other benefits. Taking health care off the bargaining table could relieve employers of a burden that their foreign competitors don’t have.


  • U.S. Sen. Jeff Merkley
  • U.S. Rep. Earl Blumenauer
  • U.S. Rep. Suzanne Bonamici
  • U.S. Rep. Peter Defazio

How the Sanders bill would work

  • Lower the Medicare eligibility age, in phases: Year 1 to age 55; Year 2 to 45; Year 3 to 35; Year 4 to everyone
  • Expand Medicare coverage to include dental and vision care
  • End the prohibition on the government using its bargaining power to get better drug prices from pharmaceutical companies


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