Ep 97 - You’re Already Paying for It: Medicare For All

My college-age son was bitten by a dog while making a delivery for an app-based food service. He did what any reasonable person would do. He went to the emergency room, had blood work done, received medication through an IV, and went home. No major surgery. No extended hospitalization. No medical drama worthy of network television. Then the bill arrived. More than $58,000.

A medical bill can be negotiated, adjusted, or denied, but every dollar still comes from somewhere, and Americans are already paying for all of it.

To be precise, that was the amount billed. It does not necessarily mean the insurance company will pay $58,000, and it does not mean my son will personally owe that amount. Because the injury happened while he was working, the company’s occupational coverage is supposed to handle the claim. The final payment may be negotiated down. The hospital may accept far less. The number on the page may turn out to be more opening bid than actual price.

And somehow, that is supposed to make the whole thing feel less insane.

We have built a healthcare system in which the price may not really be the price, the patient is not told the price beforehand, and two corporations can later disappear behind a curtain and decide what the service was supposedly worth. The person who was actually treated is left wondering whether the number on the bill is a cost, a threat, a typo, or a negotiating tactic.

In American healthcare, the price is not a number. It is the opening bid in an argument the patient may not even be allowed to witness.

This is the system we are told represents freedom. This is the system we are told is efficient. This is the system we are told must be protected from the radical danger of guaranteeing healthcare to everyone.

The great distortion at the center of the Medicare for All debate is the pretense that universal healthcare would create a gigantic new expense out of thin air. Opponents love to announce the trillions of dollars in public spending that such a system would require, pause dramatically, and wait for everyone to collapse onto the nearest fainting couch.

Yes, Medicare for All would require enormous public spending. Healthcare costs money. Doctors must be paid. Nurses must be paid. Hospitals, laboratories, medications, equipment, research, and emergency services all require funding. Nobody serious is arguing otherwise.

The real question is not whether healthcare costs money. The real question is how the money is collected, where it goes, how much is wasted, who is allowed to profit, and whether access to care should depend on your employer, your income, your age, your network, or the mood of an insurance company.

Americans are already paying for healthcare. We pay through premiums, deductibles, copays, coinsurance, prescription costs, employer contributions, Medicare taxes, Medicaid funding, ACA subsidies, workers’ compensation, public employee plans, medical debt, and wages that never reach our paychecks because employers are using that money to buy insurance instead.

The comparison is not taxes versus nothing. It is taxes versus everything we already pay.

Employer-sponsored insurance is not free. It is compensation wearing a name tag. When a company spends thousands of dollars a year on an employee’s health coverage, that money is part of the total cost of employing that worker. It is money that cannot be used for wages, retirement benefits, hiring, investment, or lower prices.

Then come the deductibles. The premium has been paid. The insurance card is active. The patient is covered. And the plan may still require thousands of dollars out of pocket before it begins paying much of anything. Then come the copays, prescriptions, exclusions, and out-of-network charges. Health insurance is the bill you pay for the privilege of possibly receiving another bill.

Even people with good jobs and supposedly good insurance delay treatment because they cannot afford to use the coverage they already have. They postpone tests. They skip prescriptions. They hope pain will go away. They stay in jobs they hate because leaving could mean losing insurance. They delay retirement, avoid starting businesses, or remain tied to a spouse’s plan because healthcare follows employment rather than the person who needs it.

That is not freedom. That is dependency with a benefits portal.

Medicare for All would not make healthcare free. It would change the financing. It would replace much of the fragmented private system with one public insurance program covering everyone. Doctors, hospitals, clinics, pharmacies, and medical practices could remain private. The government would become the principal payer, not the owner of every stethoscope in America.

That distinction matters because opponents constantly blur public insurance with government-run medicine. Traditional Medicare already pays private physicians and hospitals. Medicare for All would expand that basic model while offering broader benefits and far less cost-sharing. It would cover the person rather than the job.

A person would not lose coverage because of a layoff, divorce, reduction in hours, early retirement, change of employer, or decision to start a small business. Coverage would not be an employment perk. It would be part of living in the country.

And then there is the bureaucracy. Americans are often warned that public healthcare would drown them in government paperwork, as though private insurance has delivered us into a serene administrative garden.

Private insurance did not eliminate bureaucracy. It privatized it.

Every insurer maintains its own networks, contracts, formularies, billing rules, claims systems, prior-authorization procedures, appeals departments, marketing operations, executive structure, and profit expectations. Hospitals and medical practices then hire armies of employees to communicate with all of them.

Someone must verify coverage. Someone must determine whether the doctor is in-network. Someone must submit the proper code. Someone must explain why the claim was denied. Someone must correct it, resubmit it, appeal it, and inform the patient that a physician working inside an in-network hospital somehow existed outside the network at the exact moment care was provided.

We did not escape government paperwork. We replaced it with corporate paperwork, separate portals, different rules, higher executive salaries, and hold music.

Traditional Medicare operates with far lower administrative expenses than the broader private insurance system, though the exact comparison depends on how costs are measured. Medicare benefits from scale and serves an older population with higher medical spending, which can make administrative expenses look smaller as a percentage. But the larger point remains undeniable: one public system does not need hundreds of competing networks, marketing campaigns, benefit packages, broker arrangements, and denial procedures.

A unified public program would still require administration. Claims would still be processed. Fraud would still be investigated. Providers would still be paid. Medical standards would still exist. Medicare for All is not a paperwork-free utopia. It is a proposal to stop paying hundreds of institutions to duplicate the same administrative machinery while competing, marketing, negotiating, denying, appealing, and generating profits along the way.

The strongest objections to Medicare for All deserve serious answers. The transition would be enormous. Workers in private insurance and medical billing could lose jobs and would need retraining, income support, and placement assistance. Provider payment rates would have to be designed carefully so rural hospitals, small practices, and safety-net facilities were not pushed into crisis. More people seeking care would require more doctors, nurses, clinics, therapists, and medical training.

Taxes would rise. Supporters should say that plainly. The public deserves specifics about who pays more, who pays less, and which existing expenses disappear. A badly designed tax could hurt working families. A well-designed progressive system could reduce total costs for many households while shifting more of the burden toward wealthy individuals and large corporations.

A higher tax bill does not automatically mean a higher healthcare bill. If a family pays several thousand dollars more in taxes but eliminates premiums, deductibles, copays, and prescription costs worth far more, the tax increased and the family saved money. Both things can be true.

The relevant number is not the tax. The relevant number is what leaves the household altogether.

Wait times and government competence are legitimate concerns, too. A national program could be mismanaged, underfunded, politically sabotaged, or weakened by future administrations. But the current system already makes people wait. They wait for prior authorization, in-network appointments, the deductible to reset, the next paycheck, or the pain to become unbearable.

The current system rations healthcare. It simply rations it through money, insurance status, restricted networks, deductibles, and fear. A waiting list is visible. A person quietly postponing a colonoscopy because they cannot afford it is easier to ignore.

The Affordable Care Act made the system better. It expanded coverage, protected people with preexisting conditions, created subsidies, expanded Medicaid in participating states, and gave millions of people access to insurance. Those achievements were real and important.

But the ACA expanded access without replacing the machinery. Americans still face premiums, deductibles, narrow networks, prior authorization, annual plan changes, complicated billing, and employer dependence. The law helped more people enter the system without fundamentally changing the system they entered.

That is why the debate remains unresolved. The question is not merely whether more people can obtain an insurance product. The question is whether the product itself is standing between people and care.

Private insurance is not the same thing as choice. Your employer may choose the insurance company. The company chooses the network. The network determines which doctors are affordable. The formulary determines which medications receive favorable coverage. The insurer decides which treatments require approval and which claims deserve payment.

You may be allowed to choose among insurance companies, and then the insurance company gets to choose your doctors, hospitals, medications, and treatments. That is a peculiar definition of freedom.

The problem is not that every insurance worker is cruel or that every company employee is conspiring against patients. The problem is structural. A private insurer collects premiums, pays claims, covers administrative costs, and is expected to generate profit. The patient wants care approved. The insurer has a financial interest in controlling what it pays.

No secret meeting is required. The incentive is already sitting in the spreadsheet.

What medical service does an insurance company provide while a patient is lying in the emergency room? It does not draw the blood. It does not administer the IV. It does not clean the wound, diagnose the infection, prescribe the medication, or monitor the patient. Its role is to decide how much of the resulting bill it will recognize and how much it will pay.

Insurance is supposed to be a financing mechanism. In America, it has become a powerful industry standing between the patient and the care.

My son may never personally pay the amount on that emergency-room bill. The occupational insurer may negotiate it down. The hospital may accept a fraction of the amount. The final number may look nothing like the original one.

That would be a relief. It would not make the system rational.

The hospital still created the bill. Someone still coded it, submitted it, reviewed it, challenged it, negotiated it, adjusted it, and processed it. Every step costs money. Every office costs money. Every system costs money. Every middleman takes a turn.

Americans finance all of it through premiums, wages, taxes, deductibles, copays, higher prices, medical debt, delayed treatment, and fear.

Medicare for All would be difficult. It would require legislation, taxes, competent administration, workforce planning, provider payment reform, and a major confrontation with some of the most powerful industries in the country.

But difficult is not the same thing as impossible. And difficult is not a defense of what we have now. The current system is also expensive. It is also complicated. It also rations care. It also contains bureaucracy. It also depends heavily on public money. It also disrupts lives. It also fails.

The question is not whether America can afford to provide healthcare to everyone. We are already spending the money.

The question is how much longer we are willing to pay insurance companies, billing departments, brokers, consultants, executives, shareholders, and entire administrative empires for the privilege of deciding who receives care and who receives the bill.

My son was bitten by a dog. The hospital produced a bill for more than $58,000. And somehow, Medicare for All is the idea we are told is financially unreasonable.

SOURCES

Medicare for All Act introduced by Representatives Pramila Jayapal and Debbie Dingell and Senator Bernie Sanders - https://jayapal.house.gov/2025/04/29/jayapal-sanders-dingell-hundreds-of-health-care-workers-introduce-medicare-for-all/

U.S. national healthcare spending reached $5.3 trillion, or $15,474 per person, in 2024 - https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/nhe-fact-sheet

Gallup and West Health report that only 49% of Americans can consistently afford needed healthcare and medicine - https://news.gallup.com/poll/710942/adults-ability-afford-healthcare-five-year-low.aspx

Gallup and West Health report that one-third of Americans cut spending or delayed major plans because of healthcare costs - https://news.gallup.com/poll/702596/one-third-americans-cut-back-cover-healthcare-expenses.aspx

Gallup report on Americans borrowing money and struggling to afford care and medicine - https://news.gallup.com/poll/658148/inability-pay-care-medicine-hits-new-high.aspx

KFF 2025 Employer Health Benefits Survey covering premiums, deductibles, and employee contributions - https://www.kff.org/health-costs/2025-employer-health-benefits-survey/

KFF analysis of traditional Medicare administrative expenses and program financing - https://www.kff.org/medicare/what-to-know-about-medicare-spending-and-financing/

Peer-reviewed analysis of potential reductions in billing and insurance-related administrative costs under single-payer models - https://pmc.ncbi.nlm.nih.gov/articles/PMC8313956/

Official Medicare comparison of Original Medicare and Medicare Advantage - https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/your-coverage-options/compare-original-medicare-medicare-advantage

Official Medicare explanation of the parts and coverage structure of Original Medicare - https://www.medicare.gov/basics/get-started-with-medicare/medicare-basics/parts-of-medicare

Congressional Budget Office comparison of commercial insurance and Medicare payment rates for physicians and hospitals - https://www.cbo.gov/publication/57778

KFF review of how much more private insurers pay physicians than Medicare - https://www.kff.org/medicare/how-much-more-than-medicare-do-private-insurers-pay-a-review-of-the-literature/

CMS report showing 23.1 million Marketplace plan selections for 2026 - https://www.cms.gov/files/document/health-insurance-exchanges-2026-open-enrollment-report.pdf

KFF analysis of 2026 ACA Marketplace enrollment, premiums, and deductibles after enhanced tax credits expired - https://www.kff.org/affordable-care-act/what-we-know-so-far-about-2026-aca-marketplace-enrollment-premiums-and-deductibles/

KFF explanation of the expiration of enhanced ACA premium tax credits - https://www.kff.org/faqs/faqs-health-insurance-marketplace-and-the-aca/help-paying-marketplace-premiums-the-basics/what-kind-of-recent-changes-to-the-marketplace-premium-subsidies-have-happened-that-i-should-know-about/

Pew Research Center polling showing 66% believe the federal government is responsible for ensuring healthcare coverage - https://www.pewresearch.org/short-reads/2025/12/10/most-americans-say-government-has-a-responsibility-to-ensure-health-care-coverage/

Gallup polling on preferences for a private insurance system versus a government-run healthcare system - https://news.gallup.com/poll/699770/cost-leads-americans-top-mind-healthcare-concerns.aspx

Data for Progress polling on support for Medicare for All after respondents were told it would raise taxes and replace most private insurance - https://www.dataforprogress.org/blog/2025/11/medicare-for-all-is-popular-even-when-put-up-against-attacks