On the Shambles of the American Health Care System and the Need for Medicare-for-All

I understand that there is a lot that is going on in this world today. We’re worried about climate change. We’re worried about the terrible war in Ukraine. We’re worried about inflation and the fact that wages are not keeping up with prices.

We’re worried about massive income and wealth inequality and the increased concentration of ownership that we see in our country – among many other things.

But the American people remain deeply concerned about an issue that by definition touches every single one of us – and that is our collapsing and dysfunctional healthcare system.

While it is not discussed much in the corporate media or here in the halls of Congress, we have today in the United States the most inefficient, bureaucratic and expensive health care system in the world. That’s not just what I believe. That’s what the American people know to be true because of their lived experience with that system.

I would hope that all Members of Congress take a hard look at a poll that was published yesterday by the Associated Press-NORC Center for Public Affairs Research. And this is some of what the poll disclosed:

At a time when I hear some of my colleagues tell us that we have the best healthcare system in the world, just 12% of the American people believe that health care in general is handled very well or extremely well in the United States. 12 percent.

At a time when we pay the highest prices in the world for prescription drugs, only 6% of the American people believe that prescription drug costs in the United States are being handled very well or extremely well. Six percent.

At a time when COVID has exacerbated the crisis, only 5% of the American people believe that the mental healthcare system in the United States is being handled well or extremely well. 5 percent.

And when so many older Americans have died unnecessarily in nursing homes, and when so many cannot even find nursing home beds, just 6% of Americans believe that the quality of care at nursing homes in the United States is very good or exceptional. Six percent.

The American people increasingly understand, as I do, that health care is a human right, not a privilege and that we must end the international embarrassment of the United States being the only major country on earth that does not guarantee health care to all of its citizens.

Again, that is not just Bernie Sanders talking. That is what the overwhelming majority of the American people believe.

According to this week’s AP poll: 66% of the American people believe it is the federal government’s responsibility to make sure all Americans have health insurance coverage. 66 percent.

Over 86% of the American people understand that it is absurd that millions of seniors lack dental care, hearing aids and vision care and they believe that Medicare should be expanded to cover these basic healthcare needs. 86 percent.

At a time when our long-term healthcare system is in shambles, 81% of the American people believe that Medicare should cover the outrageous cost of long-term healthcare for senior citizens and people with disabilities. 81 percent.

It is hard for me to imagine how anyone could defend a system in which over 70 million people today are either uninsured or underinsured. As we speak, there are millions of people who would like to go to a doctor but cannot afford to go to a doctor because they cannot afford the outrageous cost of a doctor’s visit or a stay in a hospital.

Frankly, I am tired of talking to doctors who tell me about the patients who died because they were uninsured or underinsured, and walked into the doctor’s office when it was too late. And we are talking about some 68,000 Americans who die every year because they are uninsured or under-insured. This is America. This is truly beyond comprehension.

I am tired of seeing working class families and small businesses pay far more for healthcare than they can afford which forces more than 500,000 Americans to declare bankruptcy each year because of medically related expenses. Families should not be driven into financial ruin because someone became seriously ill. How insane is that?

I am tired of hearing from Americans who lost loved ones because they could not afford the unbelievably high cost of prescription drugs, or hearing from constituents who are forced to cut their pills in half due to the cost. Today, almost 1 out of 4 patients cannot afford the prescription drugs their doctors prescribe.

You want to hear about crazy? Crazy is that people get sick. They go to the doctor. They get diagnosed and medicine is prescribed. But they can’t afford to buy the medicine. So they end up in an emergency room or a hospital at great expense to the system. That is crazy.

I am tired of talking with people who are struggling with mental illness but cannot afford the mental health counseling they desperately need. Last year, a record-breaking 100,000 people died of drug overdoses and I will tell you that in my office we get desperate calls from family members looking for affordable mental health counseling and, far too often, that help is not there.

It’s not there because in this system, geared toward the profits of the insurance companies rather than to the needs of the American people, we don’t have enough psychologists, counselors or social workers.

Unbelievable, despite spending far more per capita on healthcare than any other nation, we don’t have enough doctors. We don’t have enough nurses. We don’t have enough dentists. We do not have enough medical providers in general. We have more than enough people who bill us, and more than enough debt collectors who hound us to pay for a bill we cannot afford, but we just don’t have enough people to provide the healthcare that we desperately need. And, by the way, that crisis is only going to become worse as our society continues to age.

At a time of declining life expectancy, in the wealthiest country on earth, your health and your longevity should not be dependent on the amount of money that you have. It is an absolute outrage and grossly un-American that the number of years you live in this country is dependent upon your income. Studies have shown that the top one percent of Americans live 15 years longer than the poorest people in our society.

Healthcare is a human right that all Americans, regardless of income, are entitled to and all Americans deserve the best healthcare that our country can provide.

As Chairman of the Budget Committee, it is not acceptable to me that we end up spending over twice as much as virtually any other major country on health care, while our life expectancy and other healthcare outcomes lag behind most other countries.

Unbelievably, according to the Center for Medicare and Medicaid Services (CMS), we are now spending $12,530 per capita on healthcare. This is an outrageous and unsustainable sum of money.

In comparison, the United Kingdom spends just $5,387 per capita on healthcare while France spends $5,468, Canada spends $5,905, and Germany spends $7,382 while providing universal care to everyone.

The question that we should be asking is how does it happen that we spend so much money for healthcare, but get so little in return.

Let’s be clear. The current debate over healthcare in the United States really has nothing to do with healthcare. Frankly, it is hard to defend this dysfunctional system.

This debate has everything to do with the unquenchable greed of the healthcare industry and their desire to maintain a system which fails the average American, but which makes the industry huge profits every single year.

While ordinary Americans struggled to pay for healthcare during the pandemic, the six largest health insurance companies in our country made over $60 billion in profits last year, led by the UnitedHealth Group, which made $24 billion in 2021.

While millions of Americans cannot afford soaring healthcare costs, the top executives in the insurance industry receive huge amounts of compensation.

In 2020, the CEOs of 178 major health care companies collectively made $3.2 billion in total compensation – up 31% from 2019 – all in the midst of the pandemic.

According to Axios, in 2020, the CEO of Cigna, David Cordani, took home $79 million; the CEO of Centene, Michael Neidorff, made $59 million; and the CEO of UnitedHealth Group, Dave Wichmann, received $42 million in total compensation.

In terms of the pharmaceutical industry, last year Pfizer, Johnson & Johnson and AbbVie – three giant pharmaceutical companies – increased their profits by over 90 percent to $54 billion.

Meanwhile, the CEO of Moderna got a $926 million golden parachute after his company received $2.5 billion in taxpayer dollars from the Trump Administration to develop its COVID vaccine.

And, while over 330,000 Americans died during the pandemic because they could not afford to go to a doctor on time, the CEO of Regeneron Pharmaceuticals made over $450 million in total compensation last year.

The current system is failing the American people. And the American people want change, real change.

In March, I was proud to introduce Medicare for All legislation with 15 Senate co-sponsors. Companion legislation in the House now has 122 co-sponsors.

This legislation would improve and expand Medicare to cover, over a 4-year period, healthcare to every man, woman and child in this country.

That comprehensive health care coverage would end out-of-pocket expenses and, unlike the current system, it would provide full freedom of choice regarding health care providers.

No more insurance premiums, deductibles or co-payments. No more “networks” which deny you your choice of doctors.

And when I talk about Medicare for All being comprehensive it would cover dental care, vision, hearing aids, prescription drugs and home and community-based care. In other words, M. President, it would do precisely what the American people want us to do.

Would a Medicare-for-all health care system be expensive? Yes. But, while providing comprehensive health care for all, it would be significantly LESS expensive than our current dysfunctional system because it would eliminate an enormous amount of the bureaucracy, profiteering, administrative costs and misplaced priorities inherent in our current for-profit system.

Remember: We currently pay twice as much for healthcare as do the people of virtually any other country – all of which provide universal healthcare. So, yes, we can provide quality of care for all at a much lower cost per person.

Under Medicare for All there would no longer be armies of people billing us, telling us what is covered and what is not covered and hounding us to pay our hospital bills. This not only saves substantial sums of money but will make life a lot easier for the American people who would never again have to fight their way through the nightmare of insurance company bureaucracy.

In fact, the Congressional Budget Office estimated that Medicare for All would save Americans $650 billion a year.

Now, trust me. I know the 30-second ads from the insurance and drug companies have told us that if Medicare for All becomes law, your taxes will go up. But what they won’t tell you is that under Medicare for All, you will no longer be paying premiums, deductibles and co-payments to private health insurance companies.

And what they certainly won’t tell you is that Medicare for All will save the average family thousands of dollars a year. In fact, a study by RAND found that moving to a Medicare-for-all system would save a family with an income of less than $185,000 about $3,000 a year, on average.

Now, if Medicare for All was so great, you might ask, why hasn’t it been enacted by now? Why hasn’t the United States joined every major country on earth in guaranteeing health care for all?

Well, the answer is pretty simple. Follow the money. Since 1998, in our corrupt political system, the private health care sector has spent more than $10.6 billion on lobbying and over the last 30 years it has spent more than $1.7 billion on campaign contributions to maintain the status quo. And, by the way, they are “bi-partisan.” In fact, their contributions go to many members of both the Democratic and Republican parties.

But, you know what I believe, M. President?

Maybe, just maybe, now is the time for Congress to stand with the American people and take on the powerful special interests that dominate health care in the United States. Now is the time to improve and extend Medicare to everyone.

This article is adapted from Senator Sanders’ senate floor speech on Sept. 13th.

Bernie Sanders is a US Senator, and the ranking member of the Senate budget committee. He represents the state of Vermont, and is the longest-serving independent in the history of Congress.