PNHP

HJM Wants to Hear from You

HJM Wants to Hear from You

We regularly discuss the latest news and research on problems with health insurance and prospects for single payer. We’ll keep doing that. But we also want to understand what you’re observing, contemplating, and striving for. So today we ask you to chime in.

Three open-ended questions; please provide your thoughts. Send responses to healthjusticemonitor@gmail.com.

1) What problems with current US health insurance do you find most vexing & motivating – i.e., causing the worst harms (health and/or financial), provoking the most intensive frustration with current insurance, boosting popular desire for universal public insurance?

2) How does the current broad political context harm or advance universal public insurance efforts? E.g., an aggressively conservative federal administration (including cuts to public insurance); a determined progressive response; shifting electoral terrain.

3) Your strategic / tactical ideas: What methods to promote reform will break the 60-year impasse on universal health insurance? E.g., federal vs state action; all-at-once vs incremental steps such as lowering the Medicare age or universal primary care; highlighting the moral imperative vs system design optimization?

We will summarize and synthesize the responses and report back to HJM readers. We’ll use respondent names only with permission.

Thanks!

https://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

Chicago City Council testimony in support of Medicare for All

By Claudia Fegan, M.D.
Chicago City Council, Committee on Health and Human Relations, March 10, 2026

My name is Dr. Claudia Fegan, I retired in December of 2024 after 12 years as the Chief Medical Officer of Cook County Health, and 24 years with the system. I am the National Coordinator of Physicians for a National Health Program, a national organization with over 25,000 members, based here in Chicago. I am grateful to all the members of this committee who have already signed on to Alder Cruz’s Resolution Supporting Medicare for All. While many people think access to health care is a national issue to be addressed by congress, this is a crucial issue for Chicago, and I’m thankful for the opportunity to address you today and explain why it is so important to address now, prior to the midterm elections.

As the resolution points out, the city of Chicago spends over $600,000,000 annually to provide health insurance to city employees. Think for a moment what the city could do with those funds if we had universal health care, if employers were no longer expected to pay for their employees to have access to health care. Employers are not expected to be responsible for the education of the children of their employees or guarantee their access to police or fire protection. What could Chicago do with an extra $600,000,000?

A poll of voters from November 2025 showed 90% of Democrats and the majority of independent voters support Medicare for All. Voters want to regain control of their health care and lower costs. We are the only industrialized country that does not guarantee access to health care for everyone living within our borders. Not just every citizen, everyone living here. We already spend enough on health care; we spend more money per person than any other country in the world. We allow patients to be denied access to care they need to maximize the profits of the insurance industry.

There has been a lot written about burnout among people in health care. This past year PNHP partnered with the Robert Wood Johnson Foundation to assess that burnout. Surveying over 1100 practicing physicians, we found what has been labeled as physician burnout is often moral injury inflicted by the financialization of the practice of medicine in this country. We found it has harmed the morale of the entire health care workforce, leading to increased shortages and decreased access to care as professionals retire early, cut back on their hours or leave the practice of clinical medicine altogether. Tragically, there are increasing totals of suicides among physicians. More and more, physicians are frustrated by their inability to offer patients the most appropriate care. They are stymied by required prior authorizations that issue inappropriate denials of care, make treatment recommendations their patients cannot pursue and create conflicts between health goals for their patients and the financial goals of the institutions that employ them.

It would be life-changing for Chicago to take the lead here and make a statement by supporting Medicare for All. If the city that sent the first Black woman to the Senate, that first sent Barack Obama to the Senate and then to the White House could send the message that health care is important for everyone, it would have a tremendous impact and continue our local tradition of initiating progress.

The tide is going to turn in this country. We need to build our power and be prepared to take what we need when the opportunity presents itself. We must be represented by people who have the courage to support our agenda. Medicare for All is something representatives have to be willing to fight for. We have a Congress that has acquiesced its power to a president who doesn’t believe in checks and balances. We will not get universal health care while Donald Trump is in the White House. We must be prepared for when Trump is gone. In 3 years, we must be prepared to seize the opportunity when it presents itself.

Last year, one-third of Americans delayed getting care they needed or skipped care entirely. That is the highest number since Gallup started asking questions about this 30 years ago.

I am reminded of a woman I admitted to the hospital one night a few years ago. Both of her breasts were rock hard. They were infiltrated with cancer with palpable lymph nodes in her axilla. She worked as a hairdresser, owned her own shop but had no health insurance. She was sitting at home waiting to die. She believed she had no other choice. She knew she could not afford her care. Her daughter made her come in. Remarkably we were able to get a dramatic response with treatment. No one should ever have to sit at home waiting to die in this country, when we have treatments that can be lifesaving.

Families are desperate for solutions to their everyday health care problems, skyrocketing drug prices, rising copayments and deductibles, surprise medical bills; and are tired of having to switch doctors because of the revolving door of job-based health insurance.

The United States has struggled with the effects of ‘For Profit” Health Care for decades. The country has never embraced access to health care as a basic human right.

In the United States, we know some 28 million people or 8% of the population are uninsured and that 45,000 people die each year as a direct result of not having insurance.

If there is a lesson for the rest of the world to learn from the United States, it is the lesson of the private insurance industry. The insurance companies have a fiduciary responsibility to make as much money as possible for their shareholders. They also determine which patients have access to which care. There is an inherent conflict of interest here. By eliminating the waste and greed of private insurance, we can afford to cover everyone in our country for all necessary care, and end the scourges of surprise bills, skipped medications, and medical bankruptcy. Medical illness or medical debt is the number one cause of bankruptcy in this country, even though the majority of people who declared bankruptcy had insurance at the time of their precipitating illness.

There will always be limitations on how much money is available to spend on health care. Those decisions need to be based on societal need, cost effectiveness and population health, not profits and financial yields.

We already spend enough money on health care in this country; we just allow too many people who do none of the work of delivering health care to take profit from it. I am asking the Chicago City Council to have the political courage to lead the way and to tell our nation that health care needs to be a right for everyone. Thank you so much.

Read the full Chicago City Council resolution HERE.

Sky High ACA Deductible Highlights Need for Universal Insurance

The Trump administration is dismantling financial protections offered by the Affordable Care Act, proposing a $31,000 family deductible. This attack on the economic integrity of families is registering, boosting support for single payer.

New A.C.A. Plans Could Increase Family Deductibles to $31,000, The New York Times, Feb. 26, 2026, by Reed Abelson

The Trump administration’s proposed new rules for Obamacare plans next year would shift more health care costs to Americans, with much higher deductibles that could lead to greater medical bills.

Under the proposal, people who rely on the Affordable Care Act for their health insurance coverage could choose plans with much lower monthly premiums. But that could leave them exposed to medical expenses totaling thousands of dollars more than A.C.A. plans do now before their insurance would kick in.

Dr. Mehmet Oz’s new proposal would allow one kind of health plan to raise the annual deductible to more than $15,000 for an individual and $31,000 for a family.

The proposal involves a type of plan known as a catastrophic or skinny policies. Amitabh Chandra, a Harvard health economist who has studied high-deductible plans, said, “It’s going to be a really cheap product that nobody wants.”

“There’s no doubt that we have an affordability crisis. As we move forward to shifting more of the burden to patients, there’s a chance to really exacerbate the crises,” said Dr. Joseph R. Betancourt, the president of the Commonwealth Fund.

The proposal could also erode other consumer protections. Overall, the rules could result in up to two million people dropping coverage in 2027, according to the administration’s own estimates.

Selected quotes from the NYT reader comments:

  • “This won’t work without price controls for health care, which is best achieved by a universal health care system run by the government.”
  • “
it is time for universal health care.”
  • “Grow up USA – figure out how to do a nationalized health care.”
  • “Medicare for All please.”
  • “— we need UNIVERSAL HEALTH CARE.”
  • “America desperately needs universal health care.”
  • “Can’t we just provide single payer health care
”
  • “There’s no winning the health insurance battle until we get universal health care.”
  • “Why not look at other countries that have universal health care and build our own similar system?”
  • “Medicare for All, now.”
  • “I’m a 75 year old retired Canadian who hasn’t paid out of pocket for any of my medical care and several surgeries over the years. Health care in my opinion is a human right.”

Comment:

By Don McCanne, M.D.

What is the leading health care concern in the United States? It is high costs + high deductibles + copays, which translates to 
 unaffordability and family economic risk.

Those least worried are the wealthy who comfortably pay for quality health plans and out-of-pocket costs. Also, those of us who remain healthy and don’t require much care are generally protected from growing personal expenses, though we all still pay taxes for public programs, such as Medicare, Medicaid, and the VA. Plus there is no guarantee that the healthy won’t eventually face truly expensive medical problems. In fact, that’s a likelihood.

The very poor may be eligible for public programs such as Medicaid. However, this is no longer assured, with recent federal cuts to coverage for the near-poor. Also: some states have declined federal funds for state Medicaid programs, and some areas lack providers who are willing to accept Medicaid. On top of this, Medicaid often underfunds essential health care services, shifting costs to the rest of us.

Moderate-income individuals and families may have employer-sponsored plans, but these costs are paid for by reductions in salaries. The costs of premiums, deductibles, and copays continue to increase. As workplace plans became less affordable, many were able to obtain plans through the Affordable Care Act. Government subsidies, especially during the Covid pandemic, made these plans more affordable. However, recently Congress split in continued support of the subsidies, and they were allowed to expire. Millions are losing ACA insurance simply because they can’t afford the premiums and cost-sharing. Thus we have an increasing crisis in the funding of health care.

Since it was primarily the Republicans who ended the COVID ACA subsidies, we should ask about their proposals to address this funding problem. However, they have been quite vague on what they do propose. President Trump mentioned very modest cash distributions to citizens so that they can place their funds in health savings accounts and use them to purchase their own insurance plans or pay for care directly. Any reasonable analysis of this proposal shows that it would be grossly inadequate to pay for the health care of anyone with significant needs. Thus, it would defeat the concept of health insurance – pooling funds to make essential, expensive health care accessible to those who need it.

This latest ACA scheme, from Dr. Oz and colleagues, would greatly increase the deductible before care is paid for. This would force funding of most routine care to come out of the pockets of most Americans – mainly individuals with low and moderate incomes. The proposed amount for the deductible for a family would be $31,000. With all other essential costs rising, how would $31,000 be handled by a family with an income of, say, $60,000? We already have the tragic answer to that: severe financial hardship and bankruptcy.

Keep in mind that a universal health care system funded with equitable, progressive taxes does not produce financial hardship for anyone.

People increasingly understand the need for broad reform. Many readers responding to the NYT article advocate for universal health care. Recent polls indicate that a clear majority support Medicare for All, especially among Democrats, but also increasingly among Independents and even Republicans. Truly, what Republican wants to see a child in bankruptcy court because a beloved grandchild was unfortunate enough to develop a serious and expensive disorder? Even $31,000 for a young family that is launching its blissful voyage through life can be a profound hardship. Surely we can agree on a program that will take care of all of us!

https://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

It’s the Prices and More

A blog post in Health Affairs highlights high US prices as the cause of massive healthcare costs. There is truth in this view. However, the problems plaguing US health care are far beyond prices. And, the price problem itself would be mitigated with single payer.

The US Health Spending Problem Is Still About Prices, Health Affairs Forefront, Feb. 18, 2026, by Irene Papanicolas, Jonathan Cylus, and Luca Lorenzoni

For more than two decades, debates about why US health care spending is so high have been shaped by the insight articulated by Gerard Anderson, Uwe Reinhardt and Peter Hussey: that the United States does not use more health care than other high-income countries but pays much higher prices for it. The original “It’s the Prices, Stupid” argument was fundamentally about price levels, not price growth. That central insight remains as true today as when it was first articulated: across services, drugs, and inputs, the United States consistently pays substantially higher prices than its peers for comparable services, drugs, and inputs.

Recent estimates of US national health expenditures, produced by the national health expenditures (NHE) team at the Centers for Medicare and Medicaid Services, have reignited debate about what is driving spending growth, which is a related but distinct question. In his recent Health Affairs Forefront piece, “It’s Not the Prices, Stupid,” Michael Chernew argues that utilization and intensity, rather than prices, are the primary explanation for recent expenditure growth.

While we agree that understanding what drives expenditure growth is essential for sound policy, we worry that this framing risks conflating growth dynamics with the underlying reason the United States spends so much on health care in the first place: price levels that are far higher than those paid in other high-income countries.

Health care spending reflects the interaction of prices and volume. In practice, when researchers decompose spending growth, volume typically encompasses both the use and the intensity of care delivered, with intensity referring to changes in the mix or complexity of services per episode.

Although it is lumped together with use, changes attributed to intensity may reflect shifts in service mix, coding practices, payment design, or the adoption of new technologies—many of which operate through higher prices per episode rather than greater quantities of care.

While the NHE estimates do account separately for the administrative spending incurred by payers and insurance, they are not able to do the same for provider-facing administrative costs, such as billing, coding, and prior authorization compliance; instead, these administrative costs are embedded in estimates of provider spending.

There are real consequences of erroneously focusing policy attention on the use and intensity of care as the driver of exorbitant expenditure growth. By suggesting the use and intensity of care as the culprit, decisionmakers may perceive coverage reductions and higher co-payments as the solution to reduce demand. This will result in less access to care and worsen health outcomes, when the real cause of high spending growth is that the prices paid for care exceed the value they provide.

Health Affairs Online Comment:

By Don McCanne, M.D.

Of course, prices, utilization and intensity all play some role in the cost of health care. But limiting attention to such factors, as we now do to some extent, has resulted in the most expensive health care system in the world with performance of the system ranking near the bottom of industrialized nations. What we really need is structural reform. A single payer financing system can control costs while maintaining high performance through much lower administrative costs, stronger negotiating power, limiting profit from basic coverage while covering costs, universal risk pooling, and emphasis on primary and preventive care. It’s astonishing that we are not supporting reform that would work well for everyone and instead we support reform that enables enrichment of superfluous passive investors and private equity through diversion of our health care dollars. Isn’t it time for Health Affairs to expand its coverage to such patient-friendly models that would greatly improve efficiency and value for our health care spending?

https://disqus.com…

Comment:

By Don McCanne, M.D. and Jim Kahn, M.D., M.P.H.

The renewed emphasis on prices in medical care brings back thoughts of free markets in health care as preached by Milton Friedman. But in a previous HJM post we highlighted that a universal, publicly financed and publicly administered program, as advocated by Kenneth Arrow, will bring us universal coverage, low administrative waste, removal of excess profits, and protected health care access as a social good – features not found in a free-market based system.

The Arrow model relieves us of the need to be concerned about prices because the legitimate costs are already built into the health care delivery system. Thus price shopping is an unnecessary feature that can be omitted from consideration when accessing health care. Rather than being concerned about prices in the marketplace, the patient’s concern is only about access since the payment has already been made through progressive taxes based on the ability to pay. Thus health care is always readily available to everyone without having to face the potential hardship of market prices since they will have been addressed by our public negotiators, as the growth in utilization and intensity will have been similarly addressed on our behalf. After all, negotiators representing all of us should certainly have a greater impact than any of us negotiating on our own. And for those worried about government negotiated expenses, remember that the savings come from reducing waste that is currently going to the investors, private equity and superfluous administration.

P.S. from Jim: The article states “NHE estimates 
 are not able to [quantify] provider-facing administrative costs, such as billing, coding, and prior authorization compliance 
”. Hence costs attributable to administrative bloat imposed by complicated insurance are not highlighted. However, provider billing and insurance-related (BIR) administrative costs have been quantified. I’ve done much of that work with colleagues. The excess (and hence avoidable) provider BIR burden is ~10% of all spending. E.g., see a 2014 review here. It seems to me that if we need to discuss prices (and we do), we must highlight the wasteful BIR portion, which of course disappears with single payer.

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Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

When Oh When Real Reform?

Health insurance reform has taken a decades-long, winding, and pot-holed road. Most recently, Obama’s Affordable Care Act grew private insurance & Medicaid, yet affordability worries are worse than ever. 2025 saw cuts to these modest gains. Are conditions coalescing for real reform?

How Much Longer Will Americans Wait for Real Health Reform?, Health Care un-Covered, Feb. 20, 2026, by Trudy Lieberman

Kudos to Merrill Goozner, former editor of Modern Healthcare, for spotlighting a grim but important story on his Substack column GoozNews. “A year spent degrading health” is a damning picture of the U.S. health care system 


Below is an excerpt:

  • Two snapshots of a health care system in precipitous decline: First, the latest Kaiser Family Foundation tracking poll shows Americans’ number one pocketbook concern is now the cost of health insurance and out-of-pocket health care expenses. Fully two-thirds of the public are more worried today about health care costs than food, housing, utilities or gasoline.
  • Second, the Centers for Medicare and Medicaid Services reports that 1.2 million households dropped health insurance coverage during the 2026 sign-up season, a direct result of the Republican Congress ending the enhanced premium subsidies for Obamacare plan purchasers. The missing 1.2 million came from just 30 states that use the federal exchange.


 Now Medicaid, which was passed in the mid-1960s along with Medicare for the elderly, is in jeopardy because of provisions in President Trump’s One Big Beautiful Bill Act that reduced funding for the program.


 Will Americans pay medical bills for the rest of their lives while the profit concerns of big companies continue to overshadow the needs of ordinary Americans who just want a health system that takes care of their medical needs?

Comment:

By Jim Kahn, M.D., M.P.H.

This is, as a colleague aptly characterized it, a “cri de coeur” – a painful and plaintiff cry from the heart, lamenting our dire situation. Who could have foreseen that Obama’s reforms and expansions to public and private insurance would leave hundreds of millions so deeply worried about health care costs? Many single payer advocates (myself included) said that the ACA tweaks were insufficient, costly and complex. But we (or at least I) failed to anticipate the worsening of health care financial woes.

As we’ve often written in HJM, other wealthy nations (in the OECD) use a well-proven and clear strategy: a standardized comprehensive benefit package, with affordable cost-sharing, overseen by a public payer or a network of private insurers acting under not-for-profit rules. That’s the formula. It works.

Why don’t we follow that model? As Trudy Lieberman writes, because of the interests of large corporations. They make tens of billions in profits, and impose many times that in administrative complexity. Hence decades of insurance tweaks at the margins. And with the new administration, retrenchments. More people are uninsured, and many more are under-insured, with sky-high deductibles and cost-sharing.

Yet, I’m optimistic. The pain so many of us feel with high health care costs and worsening insurance is registering widely as evidence of the abject failure of our current system. The collaborative response to the current administration’s excesses is building coalitions and empowerment. Progressive political candidates are surging. Several states are designing universal health plans.

This isn’t a post about technical insurance details (always time for that later). Instead, it’s about staying the course, seeking and creating action openings. Health care reform bringing affordable universal coverage is in our future. It is for us to manifest through values and determination. And change strategy – another technical topic, coming soon.

https://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

The Birth and Death of Single-Payer in the Democratic Party

In 1988, Jesse Jackson ran for president on a platform of uniting workers and pushing universalist policies like single-payer. His success terrified neoliberals in the Democratic Party.

By Vicente Navarro
Jacobin, May 5, 2020 (accessed Feb. 17, 2026)

In 1984, I became the health adviser to Jesse Jackson’s presidential campaign after Dr Quentin Young, one of my best friends and a well-known progressive physician in Chicago, suggested that the three of us meet. Quentin knew Jesse very well. Besides serving as Jesse’s personal physician, Quentin had developed a close working relationship with Jackson. Jesse had (and has) a very engaging personality, and Quentin was known for his persuasiveness. I accepted their proposal to advise Jesse in the Democratic Party primaries — an experience that became my baptism of fire in American politics (I had arrived in 1965 as a political exile from Franco’s Spain).

Health Insurance Compromise – Virtue or Vice?

Today is a special and long HJM. Chen et al propose an insurance reform middle ground between a fully free market and universal coverage. Yet with compromise comes complexity – a tough lesson surely learned in the US. Following Uwe Reinhardt’s vision that poor & rich have equal access to health leads us to single payer: care for everyone, while saving money overall. On Valentine’s Day, this seems a powerful message of love for America.

Failure to Account for Real-World Complexities in Health Policy, JAMA Health Forum, Feb. 5, 2026, by Lanhee J. Chen, Erin Duffy, and Atul Grover

Congress could focus on incremental reforms to enhance the affordability of health care. Both parties have members who would instead like to return to bigger arguments about how to completely restructure the health system and reduce health care costs for all individuals in the US. Long-standing policies based on ideological, polarized positions are again being proposed as the fix for affordable health insurance. On the left, some progressives are arguing for national health insurance or single-payer, universal coverage. On the right, some conservatives are arguing that US health care can only be fixed by scrapping much of the federal government’s involvement in health care and letting a free market with a less prominent role for insurance solve continuing problems with affordability and access.

But the ideological purists on both sides are missing the point.

It would be useful to keep in mind 3 important realities of US health policy. First, the affordability question most patients and their families ask is “Can I afford health care?” For many, the answer is, “No.” Those who want major reforms to US health care often aim to reduce the aggregate cost of care to taxpayers through major changes such as creating a single insurer or eliminating most insurance from health care transactions. Although most US individuals are relatively satisfied with their own health care coverage, which is similar to other nations, individuals believe their own health care costs are the most urgent health care problem.

A second reality is the unique view of health care in the US. Individuals in the US disagree with the premise that health care is a pure social good that must be available to all. Advocates for more government intervention and support for health care hold up examples from other high-income countries (especially western European of Nordic countries); however, almost all of these nations have long established health care as a basic right; in fact, many countries (including Belgium, Finland, Germany, Iceland, Italy, Luxembourg, Spain, and Sweden) have enshrined the right to health care in their constitutions. The US Constitution does not include health care as an inalienable right. Academics can argue the merits of single-payer universal coverage proposals, but implementing such policy change in the US is unlikely.

Third, the US has a health care financing system that is more complex and varied than the nations and would be administratively, financially, and politically difficult to unwind. Revenue is distributed beyond many parts of the health care system, and both large publicly traded companies and private investors are heavily invested in its complexity. What scholars often refer to as excess costs in US health care spending accrue to both nonprofit and for-profit insurance companies and administrators, health facilities, health professionals, and prescription drug companies; all entities have a stake in the current financing and delivery system. Federal and state governments enjoy lower administrative costs, but also pay clinicians below commercial market rates. These lower rates can have an impact on the availability of clinicians, care accessibility, and the quality of care available – particularly in parts of the country where there are clinician shortages.

What do these realities mean for the current standoff in US health care policy? If policymakers approach the debate over health care affordability from the hard right or left, no remedy is likely to be found for those likely to lose their insurance coverage this year as a result. It is also unlikely that a solution to concerns about affordability will be found through a major national overhaul of health care financing and delivery in the next several election cycles.

Policymakers should consider a solution that includes elements drawn from what both Republicans and Democrats have asked for during this debate. Thus, help for those impacted by the expired [ACA] subsidies will not come through sweeping change but rather through incremental adjustments that continue to build on center-left or center-right approaches. Minimum, small-dollar premium contributions have been proposed by some Republicans as a mechanism to mitigate fraud, though with the potential to create administrative barriers for some individuals with low incomes.

Making health care costs more affordable for families and for the country is likely to occur only through careful, incremental changes in multiple aspects of the health financing and delivery system rather than ideologically driven sweeping change. In the short term, policymakers should focus on the realistic adjustments to existing policy that enable more individuals to access the care that they need.

The ongoing debate over US health reform, as with other issues, has gotten entangled in both political polarization and ideological extremism. Although partisans on both sides are unlikely to admit it, the best solutions to enhancing affordability and access lie in the middle – taking  ome ideas from each side and balancing the trade-offs to maximize the benefits to patients. Policymakers ought to keep in mind that the understanding of health affordability among US individuals is based on their personal economics, that there is no right to health care in the US, and that sweeping change for the left or right is unlikely given the political situation the country is in today. Compromise and incremental adjustments feel unsatisfying, but they are the realistic path to addressing the health system affordability challenge in the US.

Priced Out: The economic and ethical costs of American Health Care, Princeton University Press, 2019, by Uwe E. Reinhardt

This book seeks to shed light on important and often bizarre and curious facts and realities about the many facets of our mysterious and expensive health care system.

Unfortunately, we are too shy in this country to debate forthrightly the ethical precepts we would like to see imposed on our health care system. It can fairly be said that this shyness is particularly evident on the right of the ideological spectrum – among Americans who would prefer to see health care rationed at least to some extent by price and ability to pay, that is, by income class.

In 1997, I published in the Journal of the American Medical Association:

“As a matter of national policy, and to the extent that a nation’s health system can make it possible, should the child of a poor American family have the same chance of avoiding preventable illness or being cured from a given illness as does the child of a rich American family?”

Remarkably, but not surprisingly, all five physicians who wrote letters to JAMA on my article failed to answer my simple question. Instead, they furiously went ad hominem, writing me off as a “socialist propagandist” – merely for raising a question that every thoughtful person should be able to answer.

From the Foreword by Nobel Laureate Paul Krugman:

“As Uwe says, the crucial question is one that he stated in a Journal of the American Medical Association article after the failure of the 1993 Clinton health plan: Should the child of a poor American family have the same chance of receiving adequate prevention and treatment as the child of a rich family?”

From the Forward by Senate Majority Leader William H. Frist, MD:

“But throughout his life you could sense his dismay, and he comes back to it again and again throughout this work. How could a nation so wonderful and so powerful and so full of resources not have consensus, or at least a majority view, as to a more rational social compact for those less fortunate?

“Was Uwe conservative or liberal, a Republican or a Democrat? I could never figure it out. For a while after I left the Senate, people would have us speak at conventions as a contrast, me (the former Republican Majority Leader) representing the “right” and Uwe (the German Canadian Ivy League professor) representing the “left.” That didn’t last long. Halfway through the debate, he would be outarguing me from the right with market-based principles and choice, leaving me holding the center-left position demanding universal access – just the opposite of where we started the debate!

“He says the proposals of Democrats for the most part are most consistent with the values of health care as a “social good,” and those of Republicans are most consistent with health care treated as a private consumption good subjected to pricing and the ability to pay.

“What I can say for certain is that Uwe’s unwavering central organizing philosophy [was]: ‘Should the child of a poor American family have the same chance of avoiding preventable illness or of being cured from a given illness as does the child of a rich American family.’”

From the Epilogue by Tsung-Mei Cheng, Uwe’s widow and, herself, a health policy analyst:

“The issue of universal coverage is not a matter of economics. Little more than 1 percent of GDP assigned to health could cover all. It is a matter of soul. — Uwe E. Reinhardt

“On universal health coverage. First, there can be no argument that Uwe passionately believed in universal health coverage (UHC), that is, health insurance that provides affordable and timely access to needed health care for all regardless of the individual’s ability to pay, as a moral imperative. Deeply troubling to Uwe since coming to America and studying health care was seeing so many hard-working and less fortunate Americans not getting their fair share in so rich a nation with so luxuriously endowed a health care system as the American system. Time and again, Uwe pronounced: What have we Americans become as a people to allow so much callousness and outright cruelty in a health system that is abundantly endowed with resources – in many instances excessively well endowed – and, as most Americans must know, is home to much human kindness and excellence?

“On a single-payer Medicare-for-All system for America. In 1989, Uwe recommended the single-payer system to Taiwan when Taiwan’s government was seeking to implement universal health insurance.

“Uwe wrote this as early as 2007 in an article for the Milken Institute Review: I don’t view the Canadian health care system as a model for the United States for at least two reasons. First, the highly egalitarian precepts in the Canadian approach do not seem compatible with Americans’ preference for letting money talk when it comes to health care – or, for that matter, education or the administration of justice. Second, single-payer government-run health systems are especially difficult to administer well in a political system so open to influence through campaign contributions. By the same token, though, I don’t buy the argument that government-run single payer systems are inherently less efficient than market-oriented health systems. In the end, each nation must decide which style of rationing – by the queue or by price and ability to pay – is most compatible with its culture. Mantras about the virtues of markets are no substitute for serious ethical conviction.”

Uwe Reinhardt’s Conclusion: A Novel (My Own) Reform Proposal: Give Rugged Individualists Their Freedom

I propose that by age twenty-six all Americans must choose either to a) join an insurance arrangement that forces on them community-rated premiums or, alternatively, b) take a chance on being uninsured or relying on a health insurance market with premiums based on the individual’s health status. If they choose the rugged individualist route, however, they could never later on join the social solidarity pool. That scheme would accommodate Libertarians who do not wish to be told by the government what to do about their health insurance.

To the objection that age twenty-six is too young an age to have to make such a monumental lifetime decision, I would respond that we ask young Americans entering the military service to make a far more serious choice, one that may risk their limb and life.

Comment:

By Don McCanne, M.D.

Today’s HJM has unusually long excerpts & commentary – to highlight several pivotal messages. 1) A position of political “compromise” for health care reform is in fact extreme – resulting in higher costs and poorer clinical performance. 2) Repetition of a simple symbolic message, like the rich/poor kid contrast, can help doubters realize what a health care system that serves all everyone is really about. 3) For those who nonetheless insist that the libertarian view must be accommodated, they will simply have to learn what the roar of the lion is all about!

We start with a JAMA blog by Lanhee Chen et al. explaining that the single payer model and the free market solution represent the two political extremes for health reform, and that advocates of either position are missing the point. The authors conclude that the optimal paths to enhancing affordability and access lie in the middle: blending ideas from each extreme and balancing trade-offs to maximize benefits to patients.

Not meaning to be unduly facetious, but isn’t that what we have been doing for over half a century, resulting in the most expensive yet among the poorest performing health care systems among wealthy nations? In fact, HJM in December addressed this matter when we used AI to describe the battle of two Nobel Laureates: Milton Friedman and free markets, which work only for those who have the resources vs. Kenneth Arrow and the need for universal public funding if we are to provide everyone with the health care that they need.

It’s interesting that the authors of the JAMA article chose Uwe Reinhardt’s ”Priced Out” as the first of three references. Reinhardt’s primary theme in his book and throughout his career as a health economics educator, was to pose the question to his students and to us, “Should the child of a poor American family have the same chance of receiving adequate prevention and treatment as the child of a rich family?”

Think about that. Obviously a single payer system that provides access for everyone to all necessary care regardless of ability to pay allows us to answer in the affirmative. In contrast, a system that requires financial resources that patients may lack forces us to say “no”. Though our current system offers some exceptions (e.g., Medicaid), high rates of cost barriers to care and resulting financial hardships (even bankruptcy) prove that free markets for health care in the US often fail the Reinhardt test. As Uwe says, they are also frequently lacking in soul.

After my years of studying Uwe’s work and speaking with him, I know that when he declines to take a position on the specifics of health care reform, in his heart he has only one position: health care for everyone.

We frequently counter those who insist that incremental reform should place us in the comfortable center, for it could never work if we believe that everyone should have affordable health care. That is what is interesting about Uwe’s unexpected conclusion in “Priced Out.” Others cite his conclusion as proof that Reinhardt is a moderate, preferring the middle road to reform. But if you really listen to the lessons that he has given us, how could he ever advocate for a system that divides us into a choice of community-rated premiums that many of us could never afford, or becoming a rugged individualist who excludes himsefl forever from joining the social solidarity pool?

Those who read this recommendation and think that this is a moderate position must be deaf. When these words by Uwe Reinhardt are exposed to an ethically functioning brain, you cannot possibly escape hearing the very loud roar of the lion in Uwe’s soul.

Uwe and I were born the same month. We both devoted our lives to studying and teaching on health care justice: he as a distinguished professor and me as a practicing physician involved in health care activism. Sadly, we have lost Uwe and his great talents. I have significant medical disorders, topped by heart failure, so I will likely also soon be leaving, but when I do, I pray that the entire nation will be able to hear my loud roar as I depart.

https://healthjusticemonitor.org…

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Twin Cities health care workers describe ‘fear,’ ‘intimidation’ due to ICE in hospitals

By Erica Zurek
MPR News, Feb. 11, 2026

As L finishes her workday at Hennepin County Medical Center in downtown Minneapolis and makes her way to the parking lot where her car is, she cannot shake the fear that someone might grab her and take her away.

She also detects this same tension among other HCMC staff members who tell her they are afraid to come to or leave work.

L has requested that her real name not be used because she does not feel safe.

“I understand that DHS is doing their job, but others are just grabbing anyone they can grab, and that’s created a fearful environment for everybody. It just doesn’t feel safe anymore,” L said. “It puts us in a very vulnerable position.”

Health care workers have voiced their concerns about patient safety during “Operation Metro Surge.” Many of them are also worried about their own well-being and that of their colleagues. Six hospital employees spoke with MPR News and shared their feelings of anxiety and fear about going to work with U.S. Immigration and Customs Enforcement agents present in their facilities and stationed at patients’ bedsides.

MPR News has verified the identity of the hospital employees and is granting them anonymity due to their fears of retribution.

They said that the stress and trauma they experience stems from being targeted based on their immigration status or skin color.

L mentioned that she has been hypervigilant lately. At work, she said, federal agents are appearing in plainclothes, which makes her feel uneasy. When traveling to and from work, she uses the camera in her vehicle and is constantly on the lookout for any unusual activity.

“It really feels like we’re all just living on survival mode,” L said. “I never thought I’d find myself in this position, and that fear is having real consequences for all of us health care workers.”

Staff mental health and sense of safety

The Department of Homeland Security said ICE officers do not carry out operations in hospitals.

“Law don’t conduct operations in hospitals, so those fears are unfounded and probably just ginned up by the media,” DHS spokesperson Tricia McLaughlin said in a statement to MPR News.

But the statement contradicts employees’ observations.

Employees report that federal agents scope out staff. One nurse at HCMC said that a federal agent approached staff members who were attending to patients and asked them about their backgrounds, specifically inquiring about their places of origin. The employees chose to ignore the agents’ questions and did not respond.

Another employee at HCMC, who asked to remain anonymous for fear that their immigration status might single them out, shared a written statement with MPR News through a colleague.

They expressed feeling scared to go to work because of possible encounters with ICE agents. They are worried that if a federal agent finds their paperwork insufficient, they could be detained.

“Not all ICE agents are knowledgeable in immigration status, especially in my case,” they wrote. “We just started to build our small family and started to be financially stable. Am I going to be deported? What about my husband? What about our goals? What will happen to us? That is my question every single night before going to bed. It really affects me mentally and emotionally. This is like a nightmare.”

Hospital worker said concerns led her to carry proof of identity

A health care worker — who is Native American and prefers to be identified as M — said she and her community are experiencing targeted actions. She is frightened by the presence of federal agents at HCMC and said the agents have requested immigration documents from some staff members.

M has been carrying her documentation in a Ziploc storage bag since February 2025.

“I have my blood papers. I have my tribal papers. I have my birth certificate,” M said. “I’m literally Indigenous to this land, but I have to carry all my documentation because I know that they will take me, too.”

M has worked at the hospital for 34 years, but she feels conflicted about going to work due to the associated risks she faces as a person of color. She mentioned that the anxiety she has encountered while working at HCMC during this time surpasses anything she has dealt with before, even though she has never been completely comfortable in certain environments.

“I don’t have a safe space at work right now. I don’t know how far this is going to go. I don’t know what the repercussions will be for me as a person of color, working there,” M said. “I don’t know what the hospital will do for me if something happens to me.”

M said her focus is on caring for her patients, but she nearly experienced a panic attack. She had to pull herself off the floor and talk herself through the situation.

During the height of the COVID-19 pandemic, M observed that hospital staff felt terror over the potential effects of the disease on themselves and their families, as well as concerns about what they might bring home. She said that the current situation in America is worse because there is nowhere safe for people to go. This instability is affecting M both mentally and physically. She is losing sleep because she is worried about what is happening in Minnesota.

MPR News reached out twice to Hennepin Healthcare, the nonprofit that runs HCMC, about its ICE protocols and the safety of staff and patients. A spokesperson acknowledged the inquiries and indicated that they would follow up soon and also shared the frequently asked questions section on their website for additional information. At the time of publication, MPR News had not yet received a response.

Hospital employees report patient injuries and disrupted care amid ICE encounters

An employee at M Health Fairview Southdale Hospital, who asked to remain anonymous, said that patients are being admitted to the emergency room with broken arms and concussions after interactions with federal agents. One person was chased off a building and their knee was shattered. Another person was running from federal agents and ran themselves into tachycardia and was admitted to the hospital.

A protestor was brought in because they were pepper sprayed by federal agents. The protestor told hospital staff that ICE agents also reached down their shirt and pepper sprayed the skin on their chest.

The employee said that these types of interactions between community members and ICE officers greatly affect them.

Many patients do not speak English and are afraid, according to the employee. If ICE is present in the room, patients are less likely to disclose personal information to health care workers. When ICE leaves, these patients are begging for help and asking to call their families.

“We are supposed to be providing the best patient care regardless of race, gender, class, sexuality, citizenship status or any other protected reason,” they said. However, as a person of color, this employee said that they feel uncomfortable in a room where ICE officers are present, noting that it seems as if the officers are “shopping” around.

ICE officers took a photo of one of their coworkers, who subsequently took a leave of absence. They said some employees have chosen to take family medical leave for their own protection, while others have decided to quit.

Additionally, a direct manager at the hospital allowed staff members to stop wearing their badges to prevent ICE officers from seeing their names.

A spokesperson for Fairview Health Services explained that their policies for handling ICE are the same as those for local law enforcement. M Health Fairview’s website emphasizes that staff and patient safety are the priority, that hospital leadership is monitoring the situation and will update staff as needed, encouraging them to share any concerns.

SEIU Healthcare Minnesota and Iowa, a union of over 50,000 health care workers, said it opposes the presence of federal agents in hospital and clinical settings. In a statement to MPR News, the union said it is disappointed by the lack of action from health care systems and urged health care leaders to establish clear boundaries to protect patient privacy and ensure the safety of both patients and staff.

“All patients deserve to seek medical care without fear, and all healthcare workers should perform their duties without interference or intimidation,” SEIU said in a statement.

L, who works at HCMC, said she hides her fear and puts her emotions aside to stay focused on her patients.

“Our diversity at HCMC is one of our greatest strengths. Our mission has always been to provide care for everybody with dignity and respect, regardless of their background or circumstances,” L said. “At this point, everything is out of my control. So, I can sit here and worry about things that I can’t control, or just continue to live and try to make a difference in people’s lives.”

https://mprnews.org…

University of Minnesota changes class after accusations of UnitedHealth ‘propaganda’

The university is changing an elective course while still working with the Eden Prairie-based health care giant after students raised concerns.

By Christopher Snowbeck
The Minnesota Star Tribune, Feb. 10, 2026

The University of Minnesota is revising a Medical School class financially supported by UnitedHealth Group after critics argued the for-profit insurer shouldn’t have a role in educating future doctors.

The course covers a topic called “value-based care,” an umbrella term used by the federal government and health insurers to describe programs and contracts that promote improved health care quality at a lower cost.

In November, U Medical School leaders touted the class as an innovative partnership, where the university and the prominent Eden Prairie-based health care company jointly developed and delivered a four-week elective course on an important trend that they said could substantially improve health care.

But Dr. Allison Leopold, a recent U graduate, argued in a December op-ed article the course was a platform for UnitedHealth executives to present “corporate propaganda” without a means for “counterpointing or fact-checking the company’s claims.”

In December, a petition started circulating that’s drawn more than 400 signatures from students, faculty, staff and alumni at the U who say they’re “deeply alarmed by the growing entanglement between our institution and UnitedHealth Group.”

In a statement this week, the U said it will continue to consider input from UnitedHealth Group as it makes changes to the class, which the medical school says is part of how it teaches students on the operational, administrative and financial aspects of health care.

“Based on student feedback, instructors are refining the content to focus more broadly on health system science, including value-based care,” the U said in a statement to the Minnesota Star Tribune.

Dr. Margaret-Mary Wilson, the chief medical officer and executive vice president at UnitedHealth Group, said the company valued its partnership with the university to support medical students learning about real-world applications of value-based care.

“As with any partnership, we are constantly evolving to meet the needs of the university and its students,” Wilson said in a statement.

While the U says it’s refining the course, the replacement class scheduled for next fall is “fundamentally different,” argued Miranda Harris Martinez, a fourth-year medical student and petition organizer.

“We were explicitly told by medical school administration that the replacement elective will not include any sessions led or run by [UnitedHealth Group],” Harris Martinez said.

Controlling costs

The dust-up illustrates ambivalence in Minnesota about UnitedHealth Group, the health care giant that’s been at the center of controversy over everything from allegedly excessive claims denials to operations that one Congressional critic called “a monopoly on steroids.”

Value-based care is a phrase that company officials constantly use when describing their business to investors, but Wall Street wasn’t the first to start hawking the idea, which aims to reverse financial incentives for wasteful services.

In the late 2000s, academics started promoting the idea of value in health care, which they defined as good patient outcomes per dollar spent on health care. With the Affordable Care Act in 2010, the federal government’s Medicare health insurance program doubled-down on the concept, pushing programs where health care providers could share savings with the government when they provided better care at lower cost. The arrangement inspired similar “risk sharing” agreements among private companies as well.

Economists think the adoption of value-based care principles could help explain why the health care spending growth rate in the United States has declined over the past two decades, with health care spending as a proportion of total national spending holding steady at about 17% from the late 2000s until 2023.

That means health care costs haven’t been going down, but their growth rate hasn’t been exceeding that of the national gross domestic product, which is the measure of the value of all goods and services produced in the U.S. in a year.

Medical schools want to teach students about value-based care, but they’ve struggled to find the resources and expertise to do so, U faculty leaders wrote in November in a medical journal article about the class.

“One of the greatest challenges to implementation is the absence of a physician workforce with the knowledge, skills and attitudes to practice effectively in a system that rewards quality and cost-effectiveness over quantity and revenue maximization,” they wrote in NEJM Catalyst.

Harvard Medical School has partnered with its business school to teach value-based care, the U faculty leaders wrote, but the UnitedHealth Group partnership is apparently a first-of-its-kind partnership.

They started talking about the collaboration in early 2023. No decisions on course content and direction were made unilaterally.

The first class was offered in fall 2024 with students visiting UnitedHealth Group’s Optum campus in Eden Prairie. Eleven company leaders met with students to discuss everything from care delivery and contract negotiation to medical group leadership and pharmacy benefits. These visits were followed by reflection sessions back on campus.

In their write-up, U faculty leaders noted the idealistic nature of medical students was an issue.

“Collaboration with a for-profit company prompted skepticism for some,” they wrote. “At the same time, others aspired to executive roles within the for-profit industry. Naming this friction early … was critical to maintaining a productive learning environment.”

The company employs or contracts with thousands of health care providers. Its Optum Health division includes more than 2,000 clinics and 370 ambulatory surgery centers across the U.S. plus more than 700 home health agencies and 265 hospice centers.

‘Company-approved slideshow’

Leopold, who graduated from the U Medical School in 2025, said she participated in that first offering of the course. Over time, she became concerned the partnership between the U and UnitedHealth represented “the insidious seedling of an unholy matrimony,” she wrote in her op-ed article, which was published in January by a newsletter run by Wendell Potter, a prominent health insurance critic.

Value-based care can be good, Leopold wrote, for upholding evidence-based recommendation about virtuous health reforms such as investing in primary care and focusing on disease prevention. But because insurers can profit more when patients receive less care, that shifts the bias toward withholding care rather than providing it, she wrote. This benefits patients when a recommended treatment isn’t needed, but is otherwise harmful.

Leopold said she was told the U’s Medical School dean had negotiated to make sure the class would present a balanced picture. The sessions at Optum’s campus primarily consisted of UnitedHealth employees presenting a “company-approved slideshow,” she wrote, filled with vague corporate jargon and optimistic messaging about the future of health care.

The bulk of the learning occurred when students would “challenge the corporate newspeak,” she wrote. But she questioned why there wasn’t an expert voice challenging UnitedHealth Group’s model, particularly considering the many controversies surrounding the company.

“While this course may encourage students to think critically about the health care system, it also welcomes an onslaught of UnitedHealth corporate propaganda without a feasible means of counterpointing or fact-checking the company’s claims,” Leopold wrote.

UnitedHealth gives at least $250k

Since 2024, UnitedHealth Group and its subsidiaries have made gifts to the University of Minnesota Foundation totaling between $250,000 and $500,000. Neither the school nor the company described the extent to which contributions were connected to the class.

In the medical journal article, U faculty leaders wrote that UnitedHealth Group covered faculty costs, but did not specify a dollar value.

As word spread of Leopold’s op-ed article, the U’s chapter of a group called Students for a National Health Program started circulating a petition.

At a “listening session” on Dec. 9, U officials said UnitedHealth had approached the university about launching some sort of collaboration and then agreed to give a large general donation to make the course happen, said Harris Martinez, the fourth-year medical student and petition organizer.

“Organizers, petition signers and listening session attendees shared the common concern that UnitedHealth Group should have no role in our education or in directly instructing students on healthcare financing, given its track record of prioritizing profits over patients,” she said.

https://startribune.com…

Burdensome Out-of-Pocket Healthcare Costs: 1 in 4 Adults

Healthcare costs exceeding critical affordability thresholds or leading to skipped care directly affected 17% of US adults over 4 years, with 27% living in families with these problems. This includes out-of-pocket payments for uncovered care, deductibles, and cost-sharing (but not premiums).

Risk of Burdensome Health Care Spending in the U.S., JAMA Internal Medicine, December 22, 2025, by Adam Gaffney, Danny McCormick, Samuel L. Dickman, David Bor, Lenore Azaroff, David U. Himmelstein, Steffie Woolhandler

Key Points:

Question: How does the risk of incurring burdensome health care spending accrue over time for individuals in the US? [defined as OOP spending >10% of family income / >5% for low-income; >40% of post-subsistence income; and/or skipped care due to cost]

Findings: In this 4-year longitudinal cohort analysis of national survey data including 12 645 individuals, risk of burdensome out-of-pocket (OOP) costs for individuals in the US rose year after year: 6.5% of adults experience cost burdens after 1 year, 17.4% over 4 years. Lower income, lack of insurance, hospitalizations, chronic disease, and death were each associated with higher risks of facing heavy cost burdens. 
 Overall, 26.7% of adults experienced either foregone care due to cost or cost burden over 4 years.

Meaning: The US health care system imposes OOP cost burdens on a much higher share of the population than suggested by cross-sectional analyses; policies that reduce such costs could improve the well-being of individuals in the US.

Conclusion: 
 OOP health expenditures burden a large share of individuals in the US over time, rather than a relatively small and stable population who incur high costs year after year. Patients in the US bear more costs than patients in other nations, a difference that reflects policy choices, such as the use of high-deductible health plans to mitigate moral hazard, and fragmented health financing and complex Medicaid eligibility requirements that lead to frequent coverage lapses. Tommy Douglas (the architect of Canada’s universal Medicare system) nearly lost a leg to an infection as a child because his family could not afford care. Reflecting on that experience, he “came to believe that health services ought not to have a price tag on them, and that people should be able to get whatever health services they required irrespective of their individual capacity to pay.” Abolishing price tags for care, as most other high-income nations have done, might enhance the financial welfare and health of individuals in the US.

Taking the Long View on Health Care-Related Financial Hardship, JAMA Internal Medicine, December 22, 2025, by John W. Scott

Our health care system has an affordability crisis: more than 20 million people in the US hold medical debt exceeding $220 billion despite health insurance coverage for more than 90%, making health care-related financial hardship one of the most pervasive yet underappreciated threats to patients’ well-being. Yet, most studies measure financial hardship in only 1 dimension or at only a single point, obscuring how financial risk accumulates as patients navigate illness over months and years. 
 Gaffney and colleagues
 [measured] multiple domains of financial hardship (including cost burdens and foregone care) over an unprecedented 4-year period in the Medical Expenditure Panel Survey (MEPS). Their longitudinal approach reveals that prior cross-sectional studies captured merely the tip of the iceberg.

Three findings are particularly striking: first, rather than the 11% experiencing financial strain in any single year, nearly 26% of adults reported health care cost burdens or foregone care over the 4-year period. Second, even brief coverage lapses or continuous nongroup private insurance were associated with elevated financial hardship risk, highlighting the pernicious threat facing insured but underinsured families. Third, more than half of patients who died during the observation period experienced health care–related financial hardship, highlighting the deep interactions between poor health and financial hardship.

Policies and politics aside, physicians cannot remain passive observers to the financial adversity that increasingly accompanies illness and medical care in the US. The finding from Gaffney et al that more than half of patients who died experienced health care-related financial hardship adds to a growing body of evidence suggesting that financial hardship is not merely an unfortunate byproduct of illness, but also a clinical risk factor that directly threatens health.

Regardless of our political perspectives or views on health care reform, we share a common commitment to patients’ welfare. In the face of policy debates that seem to prioritize politics over patients, we should each work within our spheres of influence to ensure that patients’ pursuit of health does not come at the cost of financial ruin.

Comment:

By Don McCanne, M.D. and Jim Kahn, M.D., M.P.H.

Dwell on this sad fact: More than one in four US adults lives in a family experiencing burdensome out-of-pocket medical costs over a four-year period. This doesn’t even count premium contributions, nor how employer-paid premiums depress wages.

In spite of high mortality in the US, when compared with thoughtful health insurance systems in other industrialized nations, we have by far the highest costs – inherent to our fragmented approach.

Many believe that using market principles (making patients directly responsible for the costs of care via premiums, deductibles, and copayments) will help control costs by making the patients more sensitive to the cost of the care that they are consuming.

There are two fatal flaws with that line of reasoning. First: it has not worked. In spite of already forcing patients to bear a significant portion of costs, total US spending remains far higher than in any other nation. Second: as this study clarifies, needing health care often creates a serious financial hardship for the patient. This affects medical and other priority household spending, and can even cause bankruptcy. Other nations avoid this by not requiring patient cost-sharing at the time of medical need.

How can that be done? Well, you simply fund the entire health care system in advance so that no additional payments are needed at the time of service. The most equitable method would be through progressive income and wealth taxes. By making the taxes progressive, they would be based on ability to pay, and thus not unduly burdensome.

Income taxes are not a problem because that’s in place now. The health care expenses that we currently pay regressively through premiums would be moved into the tax system where a progressive scale would make them more equitable.

Wealth taxes are more controversial, but shouldn’t be. The nation’s wealth has been rapidly and excessively moving up to the wealthiest sector of our society. We now have many billionaires and will soon have trillionaires. This represents an unfair, excessive upward distribution of our nation’s productivity. Requiring the very wealthy to pay generously into the nation’s health care trust pool would be fair since they derive their funds from the productivity that most of us are responsible for creating. Besides, their wealth is so great that they would hardly miss these funds. Currently some billionaires are moving out of states that intend to assess a wealth tax, but that can be easily countered by making it a federal tax.

We live in an era of growing wealth concentration, with a president who seems intent on amplifying that inequality, in general and for his friends and family. Happily, there is strong and growing resistance from progressive forces in our society. Single payer is the health care financing approach that is truly progressive – and pragmatic, as proven around the world. It must be a central part of the progressive resurgence.

https://healthjusticemonitor.org…

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Medicare for All an investment in Mecklenburg County

By Laura Meier, Mark Jarrell and Susan Rodriguez-McDowell
The Charlotte Post, Feb. 3, 2026

In September, the Mecklenburg County Board of Commissioners took an important stand for our community’s health and economic stability by passing a unanimous resolution in support of the Medicare for All Act of 2025.

This was not a partisan gesture, but a reflection of our community values.

This decision was backed by doctors, nurses, faith leaders, labor unions, and residents across the County who see firsthand what happens when families cannot afford the care they need. Mecklenburg County now joins more than 135 local governments nationwide and five in North Carolina that have called for this essential reform, including Greensboro, Durham, Carrboro, and Orange County.

Less than two years ago, our state finally expanded Medicaid, a bipartisan success that extended health coverage to 650,000 of our neighbors. But progress is fragile. Recent actions at the federal level have rolled back healthcare and nutrition assistance while rewarding the wealthiest among us. Meanwhile, because of the failure to renew Affordable Care Act subsidies, nearly 900,000 North Carolinians, many of whom live and work in Mecklenburg County, will see an average rate increase of 30%. About 157,000 of those will lose coverage entirely.

When funding gaps and policy stalemates occur, local communities like ours pay the price. Clinics close, hospitals struggle, and families delay care, increasing the risk that minor health issues become major emergencies. Even nonprofit hospitals face razor-thin margins, forcing administrators to make decisions driven more by reimbursement formulas than by patient outcomes.

The current healthcare system is fragmented by design, creating a confusing web of programs, premiums, and paperwork that benefits insurers more than patients. Every year, rising administrative costs, drug prices, and coverage loopholes drain dollars that could instead be used to keep people healthy and productive. Medicare for All would drastically change that equation.

The proposed legislation would expand Medicare to cover everyone—from birth to old age—providing comprehensive care without copays, premiums, or deductibles. It ensures that hospitals are funded fairly and sustainably so they can keep their doors open and their staff supported. It simplifies the system, strengthens accountability, and guarantees that every person can choose and keep their doctor.

Medicare Advantage Is Breaking America’s Promise to Seniors

By Brenda Gazzar
Code Wack Podcast, Feb. 2, 2026

Privatized Medicare now covers more than half of older adults nationwide. But how do Medicare Advantage plans’ lower star ratings, narrow networks, and “paper benefits” hit seniors of color hardest—and why are hospitals dropping these plans, leaving patients scrambling for care?

Our guest is Dr. Belinda McIntosh, an Atlanta-based psychiatrist with more than 20 years of experience, Physicians for a National Health Program board member, and co-author of the PNHP report No Real Choices: How Medicare Advantage Fails Seniors of Color. This is part two of a two-part series.

Check out the Transcript and Show Notes for more!

https://heal-ca.org