PNHP

Dr. Mike Needs to Use His Mic for Single Payer

Dr. Mike Needs to Use His Mic for Single Payer

A hugely popular YouTube doctor persuasively calls out prior authorization denials as an insidious tactic of profit-focused insurers. His remedy is … for-profit appeals software. With access to 30 million listeners, he should instead use his powerful microphone to advocate for the real solution – single payer!

Insurance Companies Are Going To Hate Me For This, Doctor Mike, 14.8M subscribers, YouTube (13 min), May 6, 2026 (417,000 views by May 10)

From the transcript:

0:25 – You most likely won’t be paying for your healthcare out of pocket. No, you’ll be relying on America’s hybrid health care system. You see, many countries around the world offer what’s known as a single payer system where the government provides health care to its citizens free of charge, usually funded by taxes.

The US is a bit different, running a hybrid system in which government funded health care covers some people and others are paid for by employers, individuals, or a combination of the three. It’s rarely simple.

And who manages all those claims? mostly for-profit health insurance companies.

I’m not saying healthcare outside the US is perfect. … But the US health insurance system is deeply and uniquely flawed. …

2:49 – Stephanie [needs] therapy to keep fighting her cancer and relieve her joint pain with a drug called Infiximab. Unfortunately, Stephanie’s insurance provider denied the medication, saying Infiximab didn’t meet guidelines for coverage and was experimental. …

6:28 – But let’s look at this at a bigger scale. Zoom out to what we actually see in the United States. What if my care had millions of customers and millions of stockholders who own pieces of my now publicly traded health insurance company? Well, on one hand, I’d be very rich from owning that stock. And as CEO, my responsibility would not actually be to provide solely good healthcare. It would be to provide a strong financial return to my shareholders and my end-of-year bonus. There would be incredible pressure to raise premium costs, deny coverage, or at the very least make it harder to get approvals. You know, shady stuff.

So, as CEO of my care, I have an idea. What if I build an AI supercomputer to oversee the whole thing and tell it to just increase the rate of denials by just a few percentage points? You know, random rejections left and right, even if the patient is genuinely sick and our policy is supposed to cover them.

Well, patients would file appeals, hire lawyers, and sue me for failing to hold up my end of the bargain, right? Actually, yes, that is right. But it only works if patients actually do it.

This is the bet insurance companies are making. They’re gambling that you will be overwhelmed, confused, defeated, and not bother filing an appeal. In fact, they’re just following basic statistics and human psychology. The more hoops they make you jump through, the less money they’ll have to spend. Health insurers routinely deny 850 million claims a year in the US, and less than 1% of people appeal a denial. That’s a lot of profit that is likely not legitimate. But get this, when patients do appeal, they win over 50% of the time. This is why you’ll hear me say, “Always argue the bill.” Okay, Dr. Mike. So, I’m ready to appeal my denial.

How do I do that? Let me give you a list of everything you need to get your money. Stick with me through the end here, and I’ll also give you a shortcut that can make this much easier. First, find the specific reason you were denied. Whether that’s not medically necessary, experimental, or step therapy required. Then, build your evidence file. This is all the documentation of what you’ve been through so far. doctor’s notes, prior authorizations. … Writing a personal impact statement conveying to the insurer what kind of difference in your life this care will make can have a huge impact on the decision.

Once you have everything together, send it to multiple recipients at once. Not just the insure. Send it to your state department of insurance, attorney general, department of labor, your employer’s leadership, and your congressional representatives.”

[ Then, Dr. Mike recommends “Claimable” – a for-profit company that facilitates these appeals. He emphasizes that he is taking no money for this video. ]

Comment:

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

Dr. Mike is a highly successful social media presence. According to Wikipedia, “Dr. Mikhail “Mike” Varshavski, DO, is a … board-certified family medicine physician and hugely popular YouTuber known for making medical education entertaining and accessible. … He has over 30 million followers across platforms, where he debunks health myths, explains medical cases, and promotes health literacy.”

Great gig. Power to him – extremely effective communicator, and for what I’ve seen accurate.

But in this video he misses a huge opportunity. He has a massive audience, and he identifies how poorly US health insurance functions compared with single payer in other nations. So: Please Mike, endorse single payer. Use your powerful voice, your microphone, to advocate for a real solution.

Don’t shill for an improvised, for-profit solution (Claimable) for a problem which arises from our misguided for-profit insurance “hybrid.”

HJM readers: If you can, share this post (or the sentiment) with Dr. Mike. And let me know if you have a way I can reach him.

https://healthjusticemonitor.org…

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US global health assistance destroyed by DOGE

A new book by a US government whistleblower reveals the truth of early Trump administration elimination of the lead US agency for global health assistance: slashed funding, destroyed programs, millions of added deaths

Into the Wood Chipper, A Whistleblower’s Account of How the Trump Administration Shredded USAID, Simon & Schuster, 2026, by Nicholas Enrich

It had started on Inauguration Day, when President Donald Trump signed an executive order pausing all foreign assistance. Elon Musk, the tech billionaire and social media tycoon, had set out to destroy the agency as a test case to demonstrate the power of The Department of Government Efficiency, or DOGE, his new quasi-governmental creation. He didn’t know what USAID [U.S. Agency for International Development] did, or why it existed in the first place, and he didn’t seem to care. All he knew was that he intended to feed USAID, in his words, “into the wood chipper.”

Even as the administration publicly claimed that lifesaving programs were continuing, behind closed doors they forged ahead on their single-minded mission to destroy USAID. Funding was frozen. The workforce was slashed. Systems crumbled. Contracts were terminated. They even removed USAID’s name from the entrance to its headquarters.

I watched Musk flagrantly lie. Standing next to Trump in the Oval Office, he assured the gathered journalists and their live TV audiences that USAID’s programs to prevent the spread of deadly diseases were still operating. They weren’t. Trump then piled on, pushing absurd lies about our work.

On February 26, the malaria director told us that the primary contractor responsible for USAID’s malaria drugs and supplies was reporting that its contract had just been terminated. This was our flagship malaria contract, essential to continue life-saving drugs and services that protected millions of people from deadly disease, one of the world’s top killers of children under five.

The same day, the head of the tuberculosis team received an email from our partner who implemented our flagship TB contract. It, too, had been terminated. Tuberculosis is the world’s leading infectious disease killer.

Within the hour, I heard the same story from our maternal and child health team.

Those three critical contracts were not the only ones terminated that day. Nearly every Global Health contract received a termination letter, including the ones needed to provide lifesaving services for HIV, polio, neglected tropical diseases, family planning, emerging infectious diseases, and nutrition.

Whatever else we faced over the past weeks, we knew how to write a memo.

The first memo was titled, “Documentation of Challenges and Impediments to Implementing the Lifesaving Humanitarian Assistance Waiver for the Pause on Foreign Assistance.”

The second memo was titled, “Documentation of Bureau Global Health Workforce Reductions.”

The third memo, “Risks to U.S. National Security and Public Health: Consequences of Pausing Global Health Funding for Lifesaving Humanitarian Assistance,” was our official warning to the administration of the impact of halting critical global health programs. This memo presented modeling compiled across each of USAID’s global health programs and documented how the cuts to our programs “will lead to increased death and disability, accelerate global disease spread, contribute to destabilizing fragile regions, and heightened security risks – directly endangering American national security, economic stability, and public health.”

Overall, the modeling and analysis concluded that a staggering 2.6 million additional people would die per year due to the cuts to USAID’s global health programs.

We had the unfortunate distinction of being the first agency on DOGE’s hit list, but the callousness, dishonesty, and ineptitude we experienced offered a preview of how the rest of the Trump presidency was likely to unspool.

  • Step 1: Fabricate and spread false stories of waste and abuse to win public opinion against the work the agency is doing.
  • Step 2: Infiltrate and immobilize IT and financial systems to prevent the provision of services.
  • Step 3: Terminate contracts to ensure that the damage cannot be reversed.
  • Step 4: Vilify, demoralize and ultimately eliminate the staff.

Comment:

By Don McCanne, M.D.

The first day of Trump’s second term in office, I was shocked by his executive order to shut down USAID. My life has been devoted to health care, not only as a practicing physician, but also as an advocate for comprehensive, affordable health care for everyone. Although my advocacy activities have been limited to the health care system in the United States, I have always been thankful for the role of USAID in providing care for those most needy in other parts of the world.

I originally thought that it would not be problem convincing the people of the United States that we could easily design and implement a system that would work for everyone in our nation. I had hopes that I could then go on and provide help in some of the more needy nations in the world.

On reading this book, my dreams were clobbered. I was often brought to tears realizing that some of the most powerful people in our nation believed that the public’s health was of so little value that we could dump it “into the wood chipper.”

We need a reset. I believe this book will help do that.

Addendum:

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

I’ve spent much of my 37-year academic career analyzing the health benefits and costs of programs that reduce death and illness in low and middle income countries (LMIC). These are exactly the activities which USAID enabled, and were sabotaged by recent abrupt funding slashes. Colleagues and I repeatedly found that spending to prevent and treat AIDS, malaria, TB, and other killer diseases in poor countries is astoundingly cost-effective (less than $50 per added year of life), or even cost-saving by reducing future medical care needs or increasing the ability to work. These programs also generated massive goodwill from supported nations toward the US. Expanding global health assistance was the signal achievement of George W. Bush, and subsequent presidents of both parties built on that. Dismantling this activity is cruel and short-sighted, the epitome of deadly cynicism.

https://healthjusticemonitor.org…

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TrumpRx Drug Price Flimflam

While Medicaid and Affordable Care Act funding streams spiral down and health care costs spiral up, the President’s policy fix is TrumpRx – elusive & imaginary drug price reductions. Sen. Elizabeth Warren pointedly reveals this scam in a US Senate hearing.

At RFK Hearing, Warren Exposes TrumpRx Scam, YouTube – Senator Elizabeth Warren, April 22, 2026

Sen. Elizabeth Warren: After President Trump and the Republicans slashed health care for millions of families, the President pitched his TrumpRx website as the answer for Americans are worried about health care costs. It claims that TrumpRx has reduced prices by as much as 600%, which I think means companies should be paying you to take their drugs. But let’s do some real math here. Take one drug, a 30 day supply of this medication costs $200 on TrumpRx but there is an identical generic version of this pill. Do you know how much it costs for a 30 day supply of the generic drug at Costco?

Sec. Robert F. Kennedy, Jr: No, but i would say that — President Trump has a different way of calculating percentage. If it was a $600 drug and you reduce it to …

Warren: $16 at Costco. TrumpRx charges $200 for the drug and Costco charges $16.

Let’s do another one. A treatment for heart arrhythmia costs $336 on TrumpRx or you can get the generic at Cost Plus Drugs for $12. Are patients better off paying $336 on TrumpRx or $12 at Cost Plus Drugs?

Kennedy: You are comparing apples to oranges. You’re comparing the brand drug to the generic drug.

Warren: To the exact same drug. Tell me, Mr. Secretary, do you think people ought to be paying $336 instead of $12?

Here’s the thing, if you are buying a drug on TrumpRx, there is a more than one in four chance that Trump’s discount is actually a price hike. And for an anti-big pharma guy, you don’t seem worried about steering patients to more expensive drugs that are going to pad big pharma’s profits.

Comment:

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

I’ve always wanted to use “flimflam” in my public writing. Thank you Donald Trump for providing the opportunity. A flimflam is “deceptive nonsense, a scam, or a confidence trick used to swindle someone, often involving clever manipulation to steal money or property”. That’s exactly what TrumpRx is. You can pay the discounted price for the few covered drugs, or you can buy a generic equivalent for far less. The claimed “600%” discount is, of course, nonsensical, innumerate nonsense.

Meantime, huge cuts to Medicaid and ACA subsidies will punish millions of Americans in two areas: finances and health. Medical providers will lose income.

There is a solution, proven in scores of countries around the world: broad identical health insurance, administered by a public agency, with minimal cost-sharing. (Not-for-profit private adminstrators could work too.)

Two-thirds of voters support this idea. Everyone would have excellent access to care, and with progressive financing 90% would save money (new taxes < averted premiums & cost-sharing). Let’s keep demanding the only reasonable, efficient, humane solution.

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.

People are dying. Virginia’s vote on April 21 can help change that.

By Bruce A. Silverman, M.D.
Richmond (Va.) Times-Dispatch, April 2, 2026

I have looked into the eyes of patients who skipped their insulin because they could not afford it. I have watched otherwise preventable cancers progress because someone had no insurance and no way to get a screening. I do this work as a volunteer physician at Goochland County’s free clinic — and I need you to understand something: what happens at the ballot box on April 21 will show up in my exam room.

Vote yes on the redistricting referendum. Here is why:

The science is unambiguous: Lack of coverage kills

This is not a political talking point. It is peer-reviewed medicine.

Researchers at Yale University’s School of Public Health estimate that a Medicare-for-All system could prevent 68,000 unnecessary deaths per year simply by guaranteeing coverage to everyone. That figure, published in The Lancet, does not even count lives lost among the underinsured — people who technically have coverage but skip care because they cannot afford the copays and deductibles.

Now those same Yale researchers have turned their models on the One Big Beautiful Bill — the legislation Congress recently enacted. Their Big Beautiful Bill — the legislation Congress recently enacted. Theirconclusion is staggering: more than 51,000 preventable deaths could occur annually because of its Medicaid cuts and ACA coverage rollbacks. The Yale team projects that Medicaid cuts alone would cause over 20,000 additional deaths per year, climbing above 51,000 when ACA coverage losses and the repeal of nursing home staffing requirements are factored in. That is more Americans than die each year in car accidents.

And it is about to get worse. Roughly one in 10 people who had ACA marketplace coverage last year are now uninsured — because theenhanced premium subsidies that made coverage affordable for millions expired on Dec. 31, and Congress let them die. Virginia insurers have requested premium increases of 20% or higher for 2026, citing the elimination of enhanced subsidies as the primary driver. In Virginia alone, an estimated 47,000 residents are projected to remain uninsured because they simply cannot afford coverage without those subsidies.

As a physician, I know what that means clinically. Uninsured patients don’t vanish. They delay. They deteriorate. They arrive in emergency rooms with conditions that were entirely manageable six months earlier — and they arrive sicker, more expensive to treat, and sometimes too late.

So, what does this have to do with redistricting?

Right now, Republican-controlled legislatures in Texas, Florida, North Carolina and Missouri are redrawing congressional maps mid-decade — not because a census demanded it, but to lock in a congressional majority before you vote this November. The Congress that results from those maps will control Medicaid funding, ACA subsidy restoration, rural hospital reimbursement rates and prescription drug policy for years to come.

Virginia’s referendum is different in every important way. It puts the decision directly to voters — not legislators in a backroom. And it is explicitly temporary: after the 2030 Census, our bipartisan redistricting commission resumes full authority. This is not abandoning the principle of fair maps. It is defending it under fire.

As legislative chair of the Virginia Chapter of Physicians for a National As legislative chair of the Virginia Chapter of Physicians for a NationalHealth Program, I track federal health policy the way I track a patient’s vital signs — because it is one. The 51,000 deaths Yale projects annually from the OBBB are not an abstraction. They are patients. They are your neighbors. Many of them are mine.

What free clinics know that Congress doesn’t

Our free clinic drove over 35,000 miles in a single year just to get our patients to their appointments — because they have no other way to get there. We provide medical, dental and mental health care, all free of charge, because the system failed these patients and someone must catch them.

But free clinics were never designed to replace a functioning system. We are the net beneath the trapeze. And right now, the trapeze artists are being told to let go with no net in sight.

When Medicaid contracts and ACA subsidies lapse, the uninsured surge into clinics like ours — already strained, already underfunded. When uncompensated care overwhelms hospitals, those costs get shifted to private insurers, driving up premiums for people who do have coverage. There is no version of this crisis that is good for anyone.

The bottom line

I took an oath to do no harm. Staying silent while democracy is manipulated and my patients lose their health coverage — and their lives — would be a harm I am not willing to accept.

Yale’s researchers have given us the number: 51,000 deaths per year — every year. That is the human cost of the policy path we are currently Yale’s researchers have given us the number: 51,000 deaths per year — every year. That is the human cost of the policy path we are currentlyon. Virginia has a chance on April 21 to send a congressional delegation shaped by Virginia voters — not by maps drawn in Tallahassee and Raleigh — to fight against that trajectory.

Vote yes. Your neighbor’s life may depend on it.

Dr. Bruce A. Silverman is a retired physician and the volunteer medical director of a free clinic serving uninsured residents of Goochland County. He is also the legislative chair of the Virginia Chapter of Physicians for a National Health Program. The views expressed are his own.

https://richmond.com…

Single Payer Resurgence in Dem Primaries

Single payer / Medicare for All has been highlighted by Democrats winning recent primaries. Its far-reaching financial advantages for families must be explained to general election voters.

This Bernie Sanders-backed idea is connecting Democrats winning midterm primaries, CNN, April 12, 2026, by Ronald Brownstein

Replacing private health insurance with a universal coverage system funded and run solely by the federal government has long been a priority for the Democratic Party’s left wing. But the push for a single-payer plan, also known as Medicare for All, appeared to be on life support among Democrats after its leading advocates, Sens. Bernie Sanders and Elizabeth Warren, struggled to defend the idea during the party’s 2020 presidential primaries. Under President Joe Biden, a single-payer skeptic, Democrats focused instead on substantially expanding health coverage through the Affordable Care Act.

Now, though, a new generation of Democratic House, Senate and even gubernatorial candidates are resuscitating the single-payer idea. “I do think that there is a resurgence in interest in single payer,” says Joseph Geevarghese, executive director of Our Revolution, the organizing group founded by Sanders. “We’re in a moment where people are starting to feel the affordability crisis when it comes to health care in a very real way.”

Like Geevarghese, most Democratic operatives believe the idea’s revival reflects growing frustration over rising health care costs at a moment when voters are especially stressed about their overall cost of living. The paradox for single-payer advocates is that while higher health care costs make the idea more attractive in theory, they also make it more daunting in practice.

One principal reason the idea lost momentum in the 2020 Democratic presidential race was that its supporters could not convincingly explain how they would fund a complete government takeover of the health care system. Because of the nation’s rising health care spending, the 10-year bill for a federal single-payer plan would be nearly twice as high now as it was in 2020, according to a broad projection of possible costs shared exclusively with CNN by John Holahan, a fellow at the Urban Institute, a center-left think tank.

Single payer is receiving renewed attention among Democrats because “costs have risen and there are no obvious solutions on the horizon to deal with that,” said Larry Levitt, executive vice president for health policy at KFF, a think tank that focuses on health issues. “But the political liabilities of Medicare for All, like having the government exercise more control over health care and needing a big tax increase to pay for it, are all still there.”

Single payer sees a new surge among Democrats

Proposals to replace the existing health care system with a single-payer government-run system have sprouted in Democratic primaries this year. In Illinois, Lt. Gov. Juliana Stratton, who decisively won the Democratic Senate primary last month, forcefully touted the idea and attacked her opponents for taking contributions from health industry interests. In Maine, progressive first-time candidate Graham Platner has stressed his support for a single-payer system while opening a consistent lead in polls for the Democratic Senate nomination over Gov. Janet Mills.  …

Similarly, in a closely contested New York City primary, Rep. Dan Goldman and both of his challengers have endorsed the idea. So has Bob Brooks, the former firefighter and president of the state firefighter union who is running against Republican Rep. Ryan Mackenzie for a northeast Pennsylvania seat. …

But the revival of single payer hasn’t been confined solely to deep blue places. Former Rep. Jasmine Crockett pushed it in the Texas Senate primary ultimately won by State Rep. James Talarico in March. The issue is also a major point of division in the Democratic primary to oppose Republican Rep. David Valadao, whose Central Valley district remains a toss-up even after California Democrats redrew the state’s Congressional maps. Randy Villegas, who is running as a populist insurgent, is a full-throated single-payer supporter, while state Assembly member Jasmeet Bains, a physician whom Democratic leaders prefer, talks instead about strengthening existing programs.  …

The revival of interest in single payer from so many Democratic candidates this year virtually guarantees the party will face another version of that 2020 debate in its 2028 presidential primaries. “Just based on what we are seeing in the midterms,” says Geevarghese of Our Revolution, “there’s no doubt in my mind there will be a fight over single payer in ‘28.” …

What “further” means, though, remains a matter of intense dispute. Last week, the Center for American Progress, a leading liberal think tank, released a “Patients’ Bill of Rights” to try to immediately reduce health care costs through new regulatory restraints on insurers and hospitals. “The public is hungry for polices that will lower their costs now and the debate about health care system change — whether it’s single payer or a public option – are going to take a decade or so to happen,” said Neera Tanden, the CAP president and CEO and former chief domestic policy adviser for Biden.

Many Democratic candidates, though, want deeper changes in the system. Geoff Garin, a Democratic pollster who has extensively studied health care attitudes, said rising health care costs have made single payer more politically viable than in 2020. “There is a lot of anger about what many voters see as a badly broken health insurance system, more than when Medicare for All was last litigated in 2019 and 2020,” Garin said. “And for that reason, voters are more open to the idea of moving to a single-payer system, including some blue-collar Trump voters.”

But, Garin added, “the cost and tax implications” remain a big hurdle for single-payer proposals, “especially for voters who are used to having an employer pay for most of their insurance costs.” …

Comment:

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

The message on health insurance in recent primaries is clear: Democratic voters support candidates who endorse single payer / Medicare for All, in varied geographic settings.

Yet, if CNN is correct, single payer will stumble in general elections on concerns about its “high cost”. Which, to be precise, refers to the large increase in government budgets as premiums and cost-sharing are shifted from families to the public coverage system.

But budget size is the wrong issue. The proper framing is: How will families do, on net? How will increased taxes compare with avoided premiums and cost-sharing (including deductibles)?

We have an answer, and it’s favorable for single payer. The Medicare for All Household Savings Calculator makes this precise comparison. Based on the first 1,500 users, 89% result in saving money with single payer, with median annual savings of $5,900. Nine out of ten families would do better financially. Poorer and sicker individuals and families would benefit even more.

Is that a “high cost”? Nope. It’s a “cost reduction”. It arises from ridding the system of profit-taking and administrative bloat to contain overall costs, and then using progressive taxes to fairly distribute the burden.

The net gains to most Americans means that single payer is not only the right thing to do – assuring universal health care – it is eminently affordable.

Not everyone is on board. The neoliberal Center for American Progress recently offered a “Patient Bill of Rights” to tweak our current insurance approach. Provisions include limiting premium increases; lowering deductibles; and banning prior authorization. These steps seem quite appealing, on the surface. However: no guarantee they can be implemented. And, as with all tweaks to current insurance, they fail to eliminate insurer profits and administrative waste (>20% of all spending) inflicted by our insanely fragmented insurance.

After decades of rising financial burdens on families, it’s time to do what works around the world: identical insurance for everyone, with no profit-taking.

It’s time for single payer, Medicare for All. Voters are ready.

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.

Medicare for All Is an Electoral Winner

Working-class voters already back Medicare for All. Framed like Social Security — as a benefit earned from work, not a handout — it can reach two-thirds support.

By Jared Abbott
Jacobin, April 9, 2026

Medicare for All (M4A) is back. Juliana Stratton, who just won the Illinois Democratic Senate primary, pledged in her victory speech to “fight for Medicare for all.” Graham Platner, the populist veteran and oyster farmer running to unseat Susan Collins in Maine, has made universal health care a centerpiece of his platform. Abdul El-Sayed, running for Michigan’s open Senate seat, is one of the policy’s most prominent champions — he literally wrote the book on it. In California, single-payer has become a near-universal fixture of Democratic gubernatorial platforms, with Katie Porter, Tony Thurmond, Betty Yee, and Xavier Becerra all declaring support. And Rep. Pramila Jayapal has been presenting polling directly to House Democratic colleagues arguing the electoral merits of Medicare for All, even in battleground districts the party must win to flip the House.

But whether M4A is a winning issue or an electoral liability for progressives depends — particularly for those running in red and purple districts — on how the issue is framed to voters.

Polling data makes the framing problem clear. Depending on how you ask, Americans’ support for universal health coverage lands at anywhere between nearly 70 percent to just over 30 percent. When the question leads with outcomes, coverage, access, and affordability, large majorities say yes. Indeed, when you poll Americans on whether the federal government should make sure everyone has health care coverage, 66 percent say yes.

But how you talk about the mechanism government should use to guarantee universal coverage has an enormous impact on how favorably the idea is received.

Simply asking Americans if they favor or oppose Medicare for All tends to land between 55 and 60 percent support. Tell people that the plan would require voters or employers to pay more in taxes, and support drops into the 40s. Further highlight that a M4A model could entail a single national health care system that would not allow people to buy private insurance, and support declines to the 30s.

That swing is not a verdict on the policy idea itself. It is a warning about framing: When M4A sounds like a government handout or restraint on individuals’ freedom to choose, working-class voters tune out. When it sounds like something they’ve paid for, something they’ve earned and deserve, they don’t.

Working-class voters are not opposed to bold health policy. What our research at the Center for Working-Class Politics (CWCP) finds consistently, however, is that they are skeptical of programs that feel like government handouts rather than something they’ve earned.

Consider that Social Security regularly sits at 80 percent support or higher, despite the fact that it is a massive government redistribution program to help the elderly and those who can’t work. Workers don’t experience it that way. To them, it’s a program they’ve paid into, a benefit they’ve earned — it’s a return on decades of contributions. The moment a health care policy sounds like something the government is giving to people, rather than something people have already paid for and deserve, you’ve lost the working-class voters you need most.

Taxes Over Premiums to Fund Single Payer

Health care costs and worries are surging, as is economic inequality. Recently HJM readers proposed paying for single payer with premiums (which we’re used to) instead of taxes (which many reflexively dislike). But only taxes permit the progressive financing approach needed for affordable universal health care.

National Health Expenditure Projections, 2024-33: Despite Insurance Coverage Declines, Health To Grow as Share of GDP, Health Affairs, June 25, 2025, by Sean P. Keehan, et al, Centers for Medicare and Medicaid Services (CMS)

Each year for the full 2024–33 projection period, national health care expenditure growth (averaging 5.8 percent) is expected to outpace that for the gross domestic product (GDP; averaging 4.3 percent) and to result in a health share of GDP that reaches 20.3 percent by 2033 (up from 17.6 percent in 2023).

From the Conclusion

Although the projections presented here reflect current law, future legislative and regulatory health policy changes could have a significant impact on the projections of health insurance coverage, health spending trends, and related cost-sharing requirements, and they thus could ultimately affect the health share of GDP by 2033.

Healthcare Reclaims Top Spot Among U.S. Domestic Worries, GALLUP, March 31, 2026, by Lydia Saad

Healthcare has reclaimed its position as Americans’ foremost domestic concern, returning to the top tier after several years when economic matters commanded more attention. While the percentage highly worried about the availability and affordability of healthcare hasn’t increased over the past year, ongoing public concerns about healthcare costs, including personal challenges in affording care, make this a perennial concern.

Income Inequality Is Surging in the U.S., New Oxfam Report Shows, Forbes, Jan. 8, 2026, by Josie Cox

The richest 1% of households in the United States have accumulated almost 1,000 times more wealth than the poorest 20% over the last three and a half decades, and economic inequality is getting worse at a rapid pace, new research shows.

The analysis, published by Oxfam, found that between 1989 and 2022, a household in the top 0.1% gained an average of $39.5 million in wealth, while a top 1% household gained $8.35 million. By contrast, a bottom 20%-household gained less than $8,500 during the same period.

Over the past year alone, Oxfam noted, the wealth of the 10 richest U.S. billionaires soared by $698 billion. That means that the top 0.1%’s share of total wealth is now at a record high of 12.6%.

“The data confirms what people across our nation already know instinctively: the new American oligarchy is here,” said Abby Maxman, president and CEO of Oxfam America. “Billionaires and mega-corporations are booming while working families struggle to afford housing, healthcare, and groceries.”

Comment:

By Don McCanne, M.D.

Recently, HJM’s editor Jim Kahn asked readers for their input. Readers responded thoughtfully about current problems, views on political context, and a profusion of strategic and tactical ideas.

One suggestion by two readers was that the system should be funded by premiums, not taxes. This is understandable in that most people are generally anathema to taxes, and have been amenable to paying health insurance premiums when they were less expensive and especially if employers paid a significant portion.

Let’s take a close look at whether taxes or premiums should pay for our health care.

A critical consideration is that health care consumes one-fifth of our GDP, and far more than one-fifth of income for the economically less well-off. Assuming that we want to cover everyone’s essential medical care, we need to include them in the risk pool. If each person or family were asked to pay an equal fraction of health care costs as a premium, all low- and most middle-income individuals would be unable to comply, or would do so only by compromising other of life’s necessities – housing, food, or education.

With the recent surge in economic inequality, those at the top would be much more capable of paying, painlessly, into a common pool for health care. Obviously, this would require progressive funding, based on the ability to pay, to subsidize or entirely cover expenses for lower-income individuals and families. Making premiums progressive would be anathema to the idea of premiums, as well as quite complex, adding to our already excessive administrative expenses. On the other hand, we are already accustomed to progressive taxes. We could easily expand these taxes, beginning with zero taxes for the impoverished, expanding to much higher taxes for those who can readily afford them. That applies not only to income but also to wealth taxes — which are naturally attuned to progressive funding. Billionaires might not like the higher taxes, but they could certainly afford them.

The recent Gallup survey shows that health care is now Americans’ foremost domestic concern. We can fix this problem. Even if we dislike taxes, a progressive tax approach would cause us much less concern than widely unaffordable insurance premiums. Making health care accessible and affordable for all is certainly a situation that we could get used to, taxes be damned. It’s the norm in rich nations, so we know how it works.

To my health care justice friends: Please keep reflecting on how we should pay for health care. And elect candidates for Congress and president based on the policy positions you support. And forthrightly communicate to candidates what you believe those positions should be!

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.

City Council and pope concur: Medicare for All is a common-sense solution

By Monica Maalouf, M.D., Winnie Lin, M.D., and Alec Nicolas Angelo Jotte, M.D.
Chicago Sun-Times, Letters, April 4, 2026

While it didn’t make headlines, Chicago recently became the largest city in the U.S. to pass a resolution calling on Congress to support Medicare for All. The resolution was adopted the same day that Pope Leo XIV, a Chicago native, called upon nations to enact universal health care as a moral imperative.

As physicians practicing in the Chicago area, this moral imperative couldn’t be clearer. Every day, we witness how our health care system prioritizes profits over patients. We see and live the gaps, inefficiencies and devastating consequences of this fragmented system.

While a city-level, nonbinding resolution might seem trivial, this unanimous vote supporting Medicare for All is a declaration that the status quo is no longer acceptable. It’s a rejection of small-scale reforms that force our patients to lose limbs because they chose paying rent over buying insulin. It’s a cry against systems that force us to stand by as women die prematurely of breast cancer because they can’t afford a biopsy.

Chicago’s resolution reflects a growing recognition that incremental changes and new direct-to-consumer price reductions (such as TrumpRx) are simply not enough. It also signals an important shift: Medicare for All is no longer a fringe proposal but is now recognized as a common-sense solution. That recognition was echoed just one day prior to the City Council vote when Illinois Democratic primary voters chose Juliana Stratton, who made Medicare for All central to her campaign for the U.S. Senate nomination.

There is a growing consensus that the federal government should ensure all Americans have health care coverage. Medicare for All represents a solution to providing that coverage while building upon ongoing efforts to reduce health care costs and, per the words of Pope Leo XIV: “Universal health coverage is … a moral imperative for societies that wish to call themselves just.”

It is time to move beyond the complicated, inadequate reforms of the Affordable Care Act. There is a growing clarity, and now an increasingly prominent insistence, that a universal, national health program is the best next step. The rest of the Illinois Democratic coalition should take heed and find the courage to move in step with this rising public will.

https://chicago.suntimes.com…

It’s not burnout — it’s something worse

By Paul Gordon, M.D., M.P.H.
The (Tucson) Arizona Daily Star, April 3, 2026

MA, my 66-year-old patient, was so happy with her Medicare Advantage plan. She could continue seeing me as her doctor and the premiums were ridiculously cheap. Then the unexpected — she developed lupus and her life changed. The referrals I made for various procedures, medications and work-up all required prior authorization. Hours were spent on the telephone trying to speak with someone who could authorize MA’s necessary care. This was all evidence-based, necessary care. Some might call this “cost-saving through the hassle factor”. If you deny it often enough, maybe I’ll just give up.

These perverse profit motives are undermining my profession and making it challenging for me to practice medicine.

A new national study from Physicians for a National Health Program, conducted in partnership with the Robert Wood Johnson Foundation, surveyed over 1,200 physicians and found this experience isn’t rare, but rather the norm. 62% of physicians reported moderate or very high distress caused specifically by administrators’ or insurers’ cost-cutting priorities overriding their clinical judgment.

For years, we’ve been told that healthcare workers are “burning out.” That framing is wrong, and it’s wrong on purpose. What we experience is not burnout, it is moral injury. It is the distress that comes from knowing exactly what your patient needs and being blocked from providing it by a system designed to extract profit. Burnout blames the worker. Moral injury names the system. Burnout implies clinicians can’t handle the job. Moral injury identifies that the job has been restructured to prevent ethical practice.

A landmark study on physician moral injury found that 69% of physicians had contemplated leaving or had actually left a position due to the experience of moral injury.

This is not the profession I entered when I finished my residency training as a family physician.

Imagine you’re the physician being overruled. You feel betrayed, and you are unable to realize the values that led you to this career.

44% of surveyed physicians said that lack of insurance approval or service availability often or always prevented them from delivering medically necessary treatment. In turn, physicians must make the impossible decision of choosing an inferior therapy or spending time and energy they often don’t have on fighting what is frequently a losing battle; 35% of surveyed physicians reported being required to care for more patients than they could safely manage. This inevitably leads to risk of harm, a risk created by the system but imposed upon physicians, violating our moral codes.

This isn’t about physician feelings — it’s about patient harm. These aren’t just physician complaints. When clinicians are blocked from providing care, patients suffer, and the harm falls hardest on marginalized communities. The same study found that 41% of physicians felt complicit in structural racism perpetuated by their profession.

Patients in focus groups described the system as “convoluted,” “corrupt,” and “dysfunctional.”

We need structural change. Immediately, that means eliminating prior authorization barriers. Healthcare has been redesigned from promoting health to extracting wealth. Prior authorization, productivity quotas, and documentation demands are tools of financial control, not clinical quality. Ultimately, it means building a healthcare system where no insurer stands between a physician’s clinical judgment and a patient’s right to care.

If we can fix the structural problems in healthcare where profits are the main concern and institute a single-payer system removing the profit motive from care financing, MA can receive her necessary care, and I can practice the medicine I trained for to be singularly focused on caring for my patients.

Dr. Paul Gordon is a family physician in Tucson and a member of Physicians for a National Health Program.

https://tucson.com…

The Big Ugly Threat to Safety Net Hospitals

Analyzing the hospitals put most at-risk by the Republican tax and budget reconciliation bill

By Eileen O’Grady
Public Citizen, March 31, 2026

On July 4, 2025, President Trump signed a Republican budget reconciliation package into law that will decimate affordable health care for millions of Americans and risk the closure of rural hospitals. The One Big Beautiful Bill Act, which opponents of the law nicknamed the Big Ugly Law (BUL), will cut $911 billion in federal spending on Medicaid and CHIP over the next 10 years, according to estimates from the Congressional Budget Office. Draconian work and eligibility requirements for Medicaid recipients mean that millions of people will lose their Medicaid coverage.

The cuts will be devastating to many low-income and disabled individuals who rely on Medicaid. Moreover, they will have knock-on effects on hospitals that disproportionately serve these communities, deepening the financial strain already plaguing rural and safety-net hospitals and compromising their ability to deliver care, potentially leading many to close.

This report identifies and analyzes the hospitals that are most at risk of closing, reducing the medical services they provide, or laying off workers due to Medicaid cuts imposed by the Big Ugly Law.

Key findings:

  • 446 hospitals are at heightened risk of closing or reducing services due to Medicaid cuts.
  • These hospitals collectively have approximately 69,000 beds and served approximately 6.6 million patients in 2024. They employ approximately 275,000 direct patient care workers.
  • The communities served by these hospitals have a larger share of Black and Hispanic residents, as well as people living below the poverty line, compared to other hospitals. Nearly 20% of the at-risk hospitals (85) serve high-poverty areas.
  • 267 (60%) of the at-risk hospitals serve urban areas, and 176 (39%) are rural hospitals.
  • House Republicans who voted for Medicaid cuts have 196 at-risk hospitals in their districts collectively, and Senate Republicans (all of whom voted for Medicaid cuts) collectively have 146 at-risk hospitals in their states. Republicans also represent several of the congressional districts with the highest number of at-risk hospitals.
  • Five states now have over a quarter of all their hospitals at risk: Connecticut, California, New York, Massachusetts, and Washington.
  • Almost half of the at-risk hospitals have special Medicare payment designations that are typically associated with hospitals that are rural or financially vulnerable and play a critical role in the communities they serve, including Critical Access Hospital (19%), Rural Referral Center (16%), Sole Community Hospital (9%), and Medicare Dependent Hospital (4%).
  • In recent months, hospitals have initiated layoffs and reduced services like obstetrics and maternal care, citing financial strain imposed by Medicaid cuts.

The full list of at-risk hospitals is available here.

full report: https://citizen.org…

Trump May Seek Primary Care Help from Cuba

La Verdad, Trump floats “Cuba care corridor” to address U.S. primary care shortage, April 1, 2026, by Clara Desvarío

Palm Beach, FL — At a private dinner with donors last week, President Donald Trump reportedly suggested that the United States could address its growing primary care shortage by sending Americans to Cuba for routine care — perhaps as part of vacations — and recruiting Cuban primary care providers to practice in underserved U.S. communities.

According to a source present at the event, Trump raised the idea in a conversation with a Cuban American émigré donor, describing Cuba’s neighborhood-based care model as “very powerful.”

“They’ve got doctors on every block—almost,” Trump said, according to the attendee. “We could learn from that. Maybe we send some patients there – beach vacation plus doctor visits. People like vacations.”

The remarks come as the U.S. faces a projected shortage of up to 48,000 primary care physicians by the early 2030s, with rural and low-income areas disproportionately affected.

A policy analyst, Dr. Elena Márquez of the Institute for Comparative Health Systems, noted that Cuba’s system assigns a physician–nurse team to roughly 600–700 residents and emphasizes prevention and home visits.

“Cuba has one of the most intensive primary care models in the world,” Márquez said. “The question is not whether it works—it clearly does on many population measures—but whether it can be meaningfully translated across political and economic systems.”

No formal proposal has been released, and administration officials declined to comment on whether the idea is under active consideration.

Comment:

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

It is hard not to read this with a mix of fascination, irony, and sadness.

Fascination, because the underlying observation is not wrong: Cuba has built a primary care system that is deeply embedded in communities, prevention-oriented, and accountable for defined populations. For decades, health policy analysts have pointed to exactly these features as missing in the U.S. system.

Irony, because the same administration now entertaining “medical vacations” to Cuba has, in practice, supported policies that weaken primary care at home—through underfunding (eg of Medicaid), fragmentation, and persistent neglect of workforce development and payment reform.

And sadness, because the idea implicitly concedes a failure: that we might need to send Americans abroad to access the kind of continuous, community-based care that should be foundational in a high-income country. And sadness, too, that the US has in recent years sabotaged Cuba’s economy including health care through aggressive oil embargoes and other actions.

Would such a primary care initiative be worth considering? I’m ambivalent.

On one hand, expanding access – by any means – has appeal, especially for underserved populations. On the other, importing care from a country whose economy we have long viciously sought to undermine raises vexing ethical and geopolitical questions. Recruiting Cuban clinicians risks exacerbating health workforce pressures there, even as we fail to fix our own.

Ultimately, the proposal underscores a more basic point: we do not lack for strong medical care models worth emulating. What we lack is the political will to implement them. Is this the start of a stunning shift – improving the US by learning from other countries?

P.S. In finalizing today’s April Fools’ post, I saw recent NY Times reporting on the dire health consequences for Cuba’s people of US oil blockade policies. That is no laughing matter; indeed it is inexcusable.

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.

HJM Reader Ideas

Our recent request for input from HJM readers yielded varied and rich ideas. There was some consensus on current problems (costs, complexity, & profit-taking), varied views on political context (opportunities & barriers), and a profusion of strategic and tactical ideas (both contradictory and compatible). Trump got unexpected callouts for his full-speed-ahead m.o.

HJM readers are, unsurprisingly, well-informed and articulate. Our recent solicitation of ideas yielded a profusion of cogent observations and opinions. I did my best to organize them, without judgement. Thus, HJM readers can get a sense for the range of views, both widely shared and unique.

I summarize responses by category. If you want to scan all summarized comments, see below.

More input is welcome, but I can’t guarantee that I’ll report back. If you’re eager to connect with someone expressing a specific idea, I can explore linking readers …

For Most Vexing / Motivating Current Problems, the most common views were unsurprising: high costs, for individuals and employers; complexity leading to confusion and inefficiency; and widespread profit-seeking by insurers and others. The rich are doing fine, the middle class and especially the poor not so much. Critical provider capacity suffers and improvised solutions (eg value-based payment) don’t help. It’s shameful that the US lacks state-of-the-art insurance.

Current Political Context: Harm vs Advance Single Payer elicited the the central role of economic status: the governing GOP reduces taxes for the rich and cuts government programs intended to help the middle class and poor. There is some optimism in growing condemnation of this dynamic. On broader politics, some readers are pessimistic about both parties, with huge money in politics. More upbeat, one reader noted “collectivism” counteracting the famous US “rugged individualism”. For health care, the rising sense of crisis encounters extensive anti-SP efforts by the profit-makers.

And, finally, for Strategic & Tactical Ideas … strategic views run the gamut: step-wise (eg expanding Medicare age and state-based single payer) to all-at-once. Tactics can be summarized as lots & varied & mutually supportive, from mass movements to fireside chats, moral suasion and technical details. Trump’s chutzpah and audacity – his disrespect for normal process, get surprise mention as a model for aggressively pursuing single payer. Framing focuses on universality, cost savings, and ending profiteering. “Premiums” is preferred to “taxes”. Finally, technical suggestions focus on fee-for-service and a tiny role for private supplemental insurance.

Many thanks to the HJM readers who chimed in so thoughtfully. These views rounded out my understanding of options and choices we face on the path to health justice.

1) Most Vexing / Motivating Current Problems

Health Insurance Failures

  • High costs – for individuals & employers (esp public) – 7
  • Un- and Under-insurance
  • Difficulty navigating insurance and care
  • Care denials
  • Inequality – poor suffer, rich do well
  • Medicaid – prove poverty now 2x / year, low payments
  • Shameful US lacks state-of-the-art insurance
  • Key provider capacity loss

Causes

  • Complexity –> confusion & inefficiency – 6
  • Profit seeking (insurance, provider groups) – 7
  • Patients seen as widgets
  • False solutions eg value-based payment

2) Current Political Context: Harm vs Advance Single Payer

Central role of economic status

  • GOP cuts: taxes for the rich & government programs
  • Wealth to rich, others losing economic stability
  • Growing perception that oligarchy = theft
  • Middle / upper class must suffer to move the needle

Other political issues

  • Govt swings between extremes
  • However, both parties fail us
  • Money in politics
  • Dems in opposition must articulate vision
  • Wide fear of taxes, esp for the common good
  • The “rugged individualism” vs “collectivism” split is shifting
  • Trump shows: Exec Branch can get stuff done if it wants

Regarding Insurance

  • Growing perception of a health care crisis
  • Relative satisfaction with Medicare (& Soc Security)
  • Inevitable strong anti-SP marketing by profit-makers
  • Dem Congress may support SP

3) Strategic / Tactical Ideas

Strategy

  • None that will work (pessimism)
  • State-by-state if fed cooperation – 3
  • Lower Medicare age to 50 – 3
  • Start with universal capitated primary care
  • All-at-once, to reveal the savings – 2
  • What would employers like?
  • Inside-Outside (legislation + mass movement)
  • Outreach + marketing, fireside chats
  • Tactic (eg moral vs technical design) tailored to constituency
  • Role of SP in the broader Left
  • Trumpian chutzpah (audacity of audacity)
  • Charismatic president “ram SP down country’s throat”

Framing

  • Universal Coverage … One people, one plan – 2
  • Universal coverage costs less for families than now – 3
  • Americans trained to believe govt can’t deliver – 2
  • Affordability + Abundance
  • End profiteering
  • Contrast with war spending
  • Moral imperative currently weak argument
  • “Socialized medicine” trope losing shock value
  • Govt pays for health care, not for insurance – 2
  • Delink from work
  • “Premiums” not “”taxes”

Technical

  • Fee-for-service like Trad. Medicare
  • Medicare QMB for low income
  • Private Insurance – for supplemental coverage

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.