The Ultimate Weakness of Medicare For All

Looking at the bill for my supplemental Medicare coverage, I came to the inconvenient realization that most of the people demanding “Medicare for All”—let’s call it MFA—couldn’t afford to pay it. Those promoting “Medicare for All” in Congress may not have thought this angle through. 

In fact, there is much they have not thought through, despite having a decade to do so. It was in 2017 that Vermont’s Sen. Bernie Sanders first introduced his Medicare for All bill. Said Sanders at the time, “Right now, if we want to move away from a dysfunctional, wasteful, bureaucratic system into a rational health-care system that guarantees coverage to everyone in a cost-effective way, the only way to do it is Medicare for All.”

Living in Vermont, Sanders may have forgotten how wildly heterogenous the rest of America is. Homogeneity makes a difference. On Sept. 3, 1947, Sweden halted all traffic at 4:50 a.m. Ten minutes later, all traffic resumed, but on the opposite side of the road. The Swedes switched from driving British-style to driving American-style with scarcely a fender bender. But in 1967 Sweden was even more homogenous than Vermont. Everyone played by the same rules.

In America, the land where “the customer is king,” we play by our own rules. Or at least we would like to think we do. As of now, some 26 percent of Americans get their health care through Medicaid. And 20 percent get theirs through Medicare. Most others get theirs through a variety of employer-sponsored or union-negotiated plans. Others still get health-care coverage by throwing themselves on the mercy of a nearby hospital.

At University Health in Kansas City, for instance, some 22 percent of those who receive care have no health-insurance coverage at all; 65 to 70 percent are covered by either Medicare or Medicaid. The current health-care delivery system is, as Sanders claims, a “dysfunctional, wasteful, bureaucratic” mess.

That said, some 82 percent of all U.S. adults claim to be satisfied with their health insurance overall, including 77 percent of those with private insurance. To paraphrase Winston Churchill’s take on democracy, ‘Ours is the worst form of health care except for all those other forms that have been tried.’

Messy or not, the rational mind cannot encompass how massive a train wreck it would be if on Sept. 3, 2027, the nation switched all 340 million Americans, at least 250 million of whom are happy customers, onto a plan they did not choose for themselves. Think of the hassle we go through changing cable TV providers. Even when we initiate the action, it’s a drag on our time and patience. Now, try that with your health-care plan.

On Sept. 4, 2027, the “satisfied customer” percentage would start dropping and within a year, it could be near zero. We aren’t Sweden. We’re not even Vermont. We are an assembly of proudly ornery individuals who carved out a nation in resistance to unwilled taxation.

Speaking of which, the health-insurance costs that private companies had been absorbing would now be passed on to the MFA administration. Over a 10-year period, MFA managers would require an estimated $34 trillion in new revenue to pay for the implementation of the program. In recent years, the upper 50 percent of income owners pay some 97 percent of income tax. The upper 10 percent may not notice, but the rest of this cohort will be paying much more in taxes and getting much less in care than they have been used to.

At least if they still have jobs. About a million people whose work involves the management of private health insurance would be looking for new jobs. Government would likely be hiring new Medicare administrators, but adding new government employees has solved no known problem anywhere. Ever. The belief that this transition would result in a “rational health-care system that guarantees coverage to everyone in a cost-effective way” should qualify the believer for MFA-subsidized psychiatric care.

Even the best single-payer systems, in Canada and the UK, for instance, are plagued by long wait times for elective procedures and specialized care. These systems inevitably control costs by restricting access to new technologies and limiting certain services. In Canada, the most responsive division of its national health-care system goes by the tragically euphemistic acronym MAID, Medical Assistance in Dying.

To make the MAID service even more efficient, Canada recently scrapped its mandatory 10-day reflection period. A godsend for the accountants, more than 16,000 Canadians cut their health-care costs considerably in 2024 by choosing the MAID option, roughly 5 percent of all Canadians who died.

In reading these numbers, I am reminded of my early years in Kansas City when, through an odd set of circumstances, I found myself as the Director of Management for the city’s Housing Authority. On one occasion, I was called upon to intervene in a threatened rent strike at the city’s then most notorious housing project, Wayne Miner.

Unlike any other urban administrator anywhere ever, I saw the taxpayer as the ultimate shareholder in this enterprise, the one whose interests I was there to safeguard. As I explained to the ladies—the government had long since driven their men away—most of them did not pay any rent. Factoring in utility subsidies, we actually paid most of them to live there.

From our perspective, I told them, you would do the Housing Authority a favor by going on a rent strike in that we would not have to pay you each month. In fact, I continued, the Housing Authority would benefit most if you moved out. We’d save money. If the ACLU didn’t like my message, the ladies understood it. They had skin in the game—not much, but enough. There was no rent strike.

If in public housing the ideal client is one who moves out, in Medicare for All the ideal client is one who moves on.  

PUBLISHED OCTOBER 2026