Candidates such as Abdul El-Sayed and Bernie Sanders treat “Medicare for All” as a simple slogan. It is not. The phrase describes a specific set of bills that would eliminate private health insurance, employer-sponsored coverage, Medicaid, and the existing Medicare program, then replace them with a single federal insurance system covering every resident. The government would set the prices providers receive. Patients would face no premiums, no deductibles, and no copayments for covered services, with only limited exceptions for some prescription drugs. Dental, vision, and long-term care would be included. Private insurers could sell only plans for services the government does not cover, such as cosmetic surgery.
Current Medicare is not that program. People on Medicare pay monthly premiums for Parts B and D. They pay deductibles and coinsurance. The hospital portion of the program is financed by a dedicated payroll tax. That trust fund is projected to run out of money in the second quarter of 2033. At that point the taxes coming in would cover only about 89 percent of hospital costs, forcing an automatic cut in payments to providers. Parts B and D already rely on general tax revenue and beneficiary premiums. Expanding the current program to everyone would not make those costs disappear. It would multiply them.
This whole Medicare for all is such BS – anyone with half of a brain know that when Obamacare was passed healthcare cost increased by over 50% – this legislation was a complete disaster. Next time someone promotes Medicare for all also ask them how they’re gonna pay for it
— SCGirl (@saltlife2010) October 28, 2026
What the Numbers Actually Show
Estimates of the additional federal cost vary with assumptions about provider payments, utilization, and administrative savings. Analyses that take the proposals as written place the net increase in federal spending in the range of $25 trillion to $35 trillion over ten years. More recent assessments that update those figures for current prices and the full benefits package put the ten-year addition near $47 trillion. One analysis of a comparable plan found net federal costs of $2.5 trillion in the first full year, rising to nearly $6 trillion annually by the end of the decade. Even after counting the taxes proposed by supporters of the plan, large annual shortfalls remain. Those shortfalls would have to be closed with still higher taxes, deeper cuts elsewhere in the budget, or additional borrowing.
The taxes required would not be limited to the wealthy. Financing a program of this size would require broad-based increases—higher payroll taxes, higher income-tax rates, a new value-added tax, or some combination. Middle-income households would pay more in taxes than they currently pay in premiums and out-of-pocket costs for many families, even if the new taxes were structured to be progressive. Providers would be paid at rates closer to current Medicare rates, which are lower than commercial rates. Historical experience shows that lower payment rates lead providers to reduce the volume of services they offer or to exit certain markets.
Full story here.
https://t.co/QTak9dKBLs— David Dayen (@ddayen) October 28, 2026
Why It Has Never Passed and Will Not
The plan has been introduced repeatedly since 2017. It has never received a floor vote in either chamber. The reason is arithmetic and politics. Taking over an industry that accounts for roughly 18 percent of the economy, terminating the insurance arrangements of more than 150 million people who receive coverage through work, and replacing them with a single government payer produces immediate disruption and a permanent increase in federal obligations measured in the trillions of dollars per decade. The existing Medicare trust fund is already on a path to insolvency under current law. Expanding the same financing structure to the entire population does not solve that problem. It accelerates it.
Supporters argue that administrative savings and lower drug prices would offset much of the cost. Those savings appear in some models. They do not appear in sufficient size to eliminate the need for large new taxes or to prevent provider shortages. The political constituency for the plan consists of people who would gain coverage or lower out-of-pocket costs. The political constituency against it consists of people who would lose their current insurance, face higher taxes, or lose access to providers who stop accepting the lower rates. That second group is larger and better organized. Until that arithmetic changes, the slogan will continue to be used and the bills will continue to go nowhere.
Help American Liberty PAC in our mission to elect conservatives and save our nation. Support – American Liberty PAC