A Single-Payer Healthcare System for All Americans

KISS - Keep It Simple, Stupid

K.I.S.S. – Keep It Simple, Stupid. (I got this cartoon on Facebook and decided to share.)

For most of us, getting healthcare in this country is way too hard, as the video at the end shows. So to those in Congress who would make it even harder, I say, “Keep It Simple, Stupid,” with a single-payer healthcare system for All Americans.


Isn’t single-payer just another way to pay for care with nothing to improve care delivery or reduce the need? This question is why I say, Medicare-for-All is Not Enough, although it sets the stage for effective reform.

EFFICIENCY – Medicare administrative overhead is extremely low, at 2% versus >20% for private insurers. Medicare also has no profit motive, shareholders to satisfy, or exorbitant executive salaries to pay. Compare that to an insurance industry that profits from higher premiums as healthcare costs go up. They have a financial incentive to deny coverage but not to contain overall healthcare costs. Reducing the number of payers can reduce administrative waste, and strengthen bargaining power and public oversight of public health benefits.

COVERAGE – With a nationwide insurance pool for basic health care, everybody is in and nobody’s out. Such a system can replace welfare programs like Medicaid and CHIP. Basic health care would be universal, even for members of Congress; but just like Medicare today, people could still buy supplemental insurance for expanded coverage.

PREVENTION – Wellness programs have been popular in employer-funded health insurance plans, but insurers can’t justify investing in such programs when people change jobs or insurance providers frequently. That’s not an issue with Medicare, so the incentive is to improve focus on wellness, prevention, and worker productivity.

SIMPLICITY – Yes, a single-payer system complies with the KISS principle – it’s simpler. You can choose your physician and not be limited to your payer’s network. And common sense budgeting can offer fair reimbursements applied equally.


I responded to an article in The Guardian that critiques Democrats’ healthcare arguments, and another article in The New York Times that criticizes Republicans. The NY Times article describes a structural flaw in modern capitalism, where tremendous income gains have gone to those at the very top while prospects have diminished for those in the middle or bottom.

Both polarized political parties seem to lack a clear vision for America, and without a strong vision, Republicans have been separating themselves from traditional conservative policy. Even the term “compassionate conservatism” has vanished. I voted for Bush, but without compassion and goals I can believe in, I can no longer call myself a Republican.

As a consumer advocate working to Help Others, rather than Help Myself, I must oppose policies that seem to be, “for us to win, you must lose.” That mean selfishness is why I now call myself a Progressive. It’s why I founded Modern Health Talk five years ago, why I voted for Obama, why I supported the Affordable Care Act (ACA), and why I still advocate long-term for a single-payer universal healthcare system like Medicare-for-All. It’s also why I endorse a public option as a path toward that objective.

Unlike modern Republicans (and many Democrats), I have a vision for America where government and citizens cooperate in a functioning society and share both responsibility and benefits. We collectively invest in public education, public defense & safety, public infrastructure, public utilities, and a skilled, healthy and productive workforce to drive innovation, profit, and GDP. You see, like Republicans, I value capitalism, but I also see benefits in public-sector organizations and initiatives. And I know that no individual or company “makes it” on their own. With that in mind, one of my first articles here described a hybrid public/private healthcare system that recommended blending the best of socialism and capitalism.


I like most of the populist message of Bernie Sanders and Elizabeth Warren, but I worry that they both are too far to the left and may scare away moderates. I’m not sure they share my vision for America, because their rhetoric seems to blame wealthy corporations and individuals, and capitalism, and their plans seem intent on punishing with high taxes and strong regulation.

Sure, Progressive policies and tax reforms are needed, but the Democrat’s message needs to be simpler, gentler and more inclusive. Make the case that we as a nation must share both the responsibility and benefits, and invest strategically – i.e. work together.

As for healthcare, quit complaining about Republican efforts to repeal & replace Obamacare, because that’s what they campaigned on, and your arguments are landing on deaf ears. And quit trying to save Obamacare as it stands, because it does have flaws, and Republicans know how to break it. Take the high road and the initiative by reaching across the aisle with a better plan – a plan that has broader objectives that both sides can support, like saving over $1.5 trillion each and every year in overall healthcare costs, while also improving outcomes and developing that skilled, healthy, and productive workforce.


Republicans had 7 years to step back, ask the right questions, and work stakeholders to craft a workable Obamacare replacement, but they didn’t do so. They could claim victory and satisfy campaign promises by replacing the Affordable Care Act with a system like Medicare-for-All. Just don’t call it Single Payer or Socialize Medicine, because polling shows that how you call it determines whether it’s viewed positively or as a negative.

Medicare for All versus Single Payer

Medicare-for-All could gain support among Republicans if their politicians avoid  lies, misleading claims, and rhetorical “slight of hand,” like they did when calling the Affordable Care Act “Obamacare.” Make it clear that, as a government-run health “insurance” program for the elderly, Medicare is only about how care is paid for, not how it’s delivered. As for efficiency, this government insurance program is proven to be more efficient than private insurance for several reasons.

  • Medicare Has Controlled Costs Better than Private Insurance;
  • Medicare Has Lower Administrative Costs;
  • Medicare is Publicly Accountable while Private Plans are Not; and
  • Medicare has No Profit Motive.

I find it ironic that Republicans still claim to be the party of fiscal responsibility but still have failed so poorly to see the immense savings potential of a single payer (oops, I mean Medicare-for-All) system. There’s still time to change course, knowing that their own hastily & secretly prepared plan is opposed by over 80% of the nation.


As the latest Republican attempt to repeal Obamacare stalls in the Senate, Democrats like Bernie Sanders and Robert Reich argue that basic healthcare should be a right and guaranteed for all Americans. They too support a Medicare-for-All system, so it should be easy to reach across the aisle and get their help.


The U.S. now spends over $3.3 trillion/year on healthcare – in total, including insurance premiums, deductibles, out-of-pocket expenses, and government subsidies. That’s more than 17% of GDP, and it’s going up with 11,000 people turning age 65 every day and needing more care in old age.

The big savings potential is because our total spending is twice as much as what the other advanced nations pay, yet we still live sicker and die younger. Those other nations also struggle to constrain rising costs, but they have simpler and more-efficient single-payer systems that make coping with aging populations easier. Their incentives better align with goals.

To reach the savings potential, politicians must go beyond universal healthcare, because Medicare-for-All is not enough. It’s just another way of paying for health care. Although it’s far more efficient than any private health insurance, it doesn’t reduce the need for care in the first place. For that we need to focus on health, wellness and prevention, because as Benjamin Franklin said 250 years ago, “An ounce of prevention is worth a pound of cure.”

To better understand what can be done to save our broken healthcare system, I encourage you to watch Escape Fire: The Fight to Rescue American Healthcare. This documentary film examines powerful forces that maintain the status quo in a medical industry that’s quick to fix, not prevent, and to profit, not care for.


Moore’s Law and the FUTURE of Health Care” is an article I wrote from the perspective of a retired IBM technologist and futurist. It looks at the convergence of information science (processors & networks), biology (chemistry, genes & proteins), cognitive & neuroscience (neuron signaling), and nano technology.


While I’m guardedly optimistic that tech innovation will greatly improve care delivery, I worry about misaligned incentives that promote profit from disease management rather than health & wellness, and about special interest lobbying. In his TIME Magazine report, “Bitter Pill: Why High Medical Bills Are Killing Us,” Stephen Brill describes the Medical Industrial Complex, which spends 3-times as much on lobbying as the military industrial complex. They obviously don’t want to lose $1.5 trillion/year in revenue and will oppose any of the reforms I suggest. Unfortunately, Brill’s article is now behind a subscriber pay-wall, but I posted a summary and a video interview with the author.


In this satirical video, American mountain man Gus Porter gets mauled by a bear, but he won’t let the socialist Canadian health care fix him up. He’d rather hike back to America because of his misguided ideology, which eventually costs him his life.


This satirical video makes fun of our overly complex healthcare industry, looking at what the airline industry might be like if it worked the same way.

Medical Errors versus Malpractice Lawsuits

Medical Errors versus Malpractice Lawsuits

With every legislative session, lawmakers seem to further reduce the rights of people injured by medical errors and malpractice.

Often described as a form of corporate welfare, Tort Reform makes it more difficult for people to file lawsuits and caps any award they get for damages. Some states even require the losing party to pay the court costs of the opposing party, making malpractice lawsuits extremely risky for individuals facing opponents with deep pockets. Read More …

Why Republicans Want to Repeal Obamacare

Robert Reich on Why Republicans want to Repeal Obamacare

Here’s what Reich says about an Obamacare repeal:

  • 32 million people will lose coverage, [UPDATE: 24M per Congressional Budget Office]
  • Tens of thousands of American’s will die as a result (over 50 times as many as killed by terrorists),
  • Medicare and Medicaid will be left in worse shape, and
  • The rich will get richer in a massive redistribution of wealth.

Missing from this list, and discussed after the video, is how Republicans can use the repeal to maintain control of Congress, the Presidency and the Supreme Court, even as a demographics shift works against them. Read More …

Influencing Healthcare Policy – Lobbying, Incentives & Insurance

Benjamin Franklin is credited as saying, "An ounce of prevention is worth a pound of cure," but policymakers seem more influenced by the money he's pictured on.

Ben Franklin said, “An ounce of prevention is worth a pound of cure,” but policymakers seem more influenced by the money he’s pictured on.

By Wayne Caswell, Founding Editor, Modern Health Talk

As President Trump’s administration transitions from the Obama era, a conservative ideological shift will influence healthcare policy, but so will other factors. They are discussed here, based on my response to “The Past, Present and Future of Healthcare Policy” at ReferralMD.

Influencing Healthcare Policy

Although The Patient Protection and Affordable Care Act, more commonly known as ObamaCare, has flattened the curve to the lowest annual cost increase in decades, it still has not reduced overall costs for many reasons. These include (1) special interest lobbying to protect industry revenues & profit, (2) misaligned incentives, and (3) an insurance middleman that adds more cost than value. It is unlikely that any “repeal and replace” strategy can live up to Trump’s promises because of these three factors. Read More …

US Healthcare System has Cancer. Can Trump Fix it?

By Wayne Caswell, founding editor, Modern Health Talk

Dr. Sudip Bose says, "The epicenter of health care is the doctor-patient relationship."

Opening his January 16, 2017 Huffington Post article, Dr. Sudip Bose said, “One thing is certain about the future of Obamacare, and that is that it will change under a Donald Trump presidency.“ Given his public statements, Trump will clearly make sweeping changes sooner than later, but what those changes will be is anything but clear. That’s why today’s article describes what I hope for, if not what I expect.

The US healthcare system has cancer – a malignant form that started way before Obama became President, and it has taken decades to grow to its current condition, where our very existence is threatened. It’s my hope (remember Hope & Change?) that healthcare reform under Trump will not just treat the symptoms of a growing healthcare cancer, like the lack of insurance competition or price transparency. I hope Trump will recognize the need to treat our healthcare system’s cancer aggressively, naturally and holistically. Will he? Read More …

Medical Marijuana Lowers Prescription Drug Abuse

Medical Marijuana Lowers Prescription Drug Abuse

Research Shows That Medical Marijuana Lowers Prescription Drug Abuse

Guest article by Helen Smith

The abuse of prescription opioids such as heroin, morphine and prescription painkillers is a global problem affecting up to 36 million people worldwide. Opioid addiction is of particular concern in the United States, with over two million people abusing prescription medications and around half a million addicted to heroin. The consequences of opioid abuse are immense; the Centers for Disease Control (CDCP) and Prevention notes that deaths via the overdose of prescription medications have risen four-fould since 1999; almost half of all opioid overdose deaths involve prescription medications. The most common medications which contribute to so many needless deaths, are methadone, oxycodone and hydrocodone. The CDC notes that around 1,000 people are treated daily in emergency rooms following the abuse of prescription drugs.

There may be a light at the end of the tunnel, though, with research showing that medical marijuana may curb the rate of prescription drug abuse. Read More …

Why Medicare-for-All is Not Enough

Doctors Prescribe Single-Payer Health Care Reform

Doctors Prescribe Single-Payer Health Care Reform

Dr. David Himmelstein speaks at a news conference about the new Physicians’ Proposal for Single-Payer Health Care on the steps of City Hall in New York, May 6. Photo: Annette Gaudino

Well before Bernie Sanders entered the presidential race, a nonpartisan group of 39 leading doctors set out to fix the glaring problems in the Affordable Care Act (ACA, or Obamacare). The single-payer plan they proposed, essentially Medicare-for-All, has since been endorsed by over 2,000 physician colleagues and published in the American Journal of Public Health, according to this article in Huffington Post.

The HuffPost article generated lots of reader comments, and I just had to respond because this is the sort of debate I love to jump into. It brings together many different perspectives, especially those of consumers who too often aren’t heard from by politicians. Here’s a summary of my responses and answer to the question, “Is Medicare-for-All enough?” Read More …

Getting Disability Benefits as a Caretaker

Getting Disability Benefits as a Caretaker

By Bryan Mac Murray, Outreach Specialist, Social Security Disability Help (Not affiliated with Social Security Administration)

Applying for Disability on Behalf of Someone Else

The Social Security Administration (SSA) knows that disability applicants are not always physically or mentally able to complete the application themselves. For this reason, there are processes in place that allow a caretaker to apply for Social Security disability benefits for someone else. Read More …

Chipping Away at Healthcare Special Interests Yet?

Is it just “One Step Forward and Two Steps Back?” or is something bigger happening?

Last week I read an excellent article in Huffington Post by Charles Francis, and it inspired today’s post about public interests versus special interests. In this article I’ll reflect on the healthcare progress consumers are making despite politicians working against them. But first, more on the obstacles we face.

Special Interests Pull Puppet Strings

In How Mindfulness Meditation Can Transform Health Care, Charles examines the need to change consumer behavior toward healthier lifestyles, so I thought about the role of incentives and awareness education. I’ve written about that before, but today I’ll take a broader look at the many factors influencing the health and productivity of our nation’s workforce and why I remain guardedly optimistic that we’ll overcome political corruption. Included are links to many related articles and this list of over 130 past articles on healthcare policy. Read More …

Texas has the Highest Uninsured Rate

Uninsured Residents - Red States versus Blue StatesThe data is in from a WalletHub analysis of 2015’s States with the highest & lowest uninsured rates, and as an Austin resident, I’m again embarrassed to say that Texas has the highest uninsured rate.

Having insurance is vital to the health of your family and your wallet. It can significantly reduce your out-of-pocket medical expenses, the leading cause of personal bankruptcy in the U.S. Today, however, 11.7 percent of all Americans — many of whom earn a low income — remain without coverage.

For the second year in a row, WalletHub’s analysts drew upon the most reliable data to estimate the rates of uninsured pre- and post-Obamacare for the 50 states and the District of Columbia. For a broad perspective of those rates, they broke the national figures down to the state level and other categories, including age, race and income level. A summary of their findings are included below. Read More …

The Financial Costs Of Moving Home

The Financial Costs of Moving Home

By JP Adams

Many family caregivers consider moving close to a loved one or parent as they become older. There they can help with cleaning, getting groceries, and driving to doctors’ appointments. Most importantly, this gives them and their loved ones an opportunity to connect.

At the same time, the decision to move home can be challenging. I often hear mixed feelings from families – “I’m not sure if it’s something I want to do,” OR “I want to be with her but I don’t really like the area where she lives.”

One thing is overwhelmingly clear.  Moving home is a significant financial decision. There are costs and benefits.  It’s important to go through each and make a rational decision.  Read More …

Consumers Screwed with Insurance Loopholes

Insurance Loopholes & Master Pricing:
How Surprise Medical Bills Knock Consumers Down

Medical Records (photo courtesy of CX2)

Most of us know which local hospitals and doctors are covered by our insurance providers, but even when we make sure that we only see an in-network physician or surgeon, nearly one-third of privately insured Americans are still hit with higher-than-expected medical bills, often because their in-network hospital brought in or contracted out to an out-of-network service provider. How did we get to the point where so many consumers have so little information about what to expect when their hospital bill arrives? (read full article)

Consumers Screwed with Insurance Loopholes

As explained in this excellent article, even though Obamacare intended to address rising prices by promoting prevention, price transparency, and competition among payers & providers – and there has been progress – the system remains hopelessly complex and in need of serious and more aggressive reform.

I’m more convinced than ever that we need to move toward a single-payer system like Medicare-for-All, modeled after other nations that pay half as much and have better outcomes. Meanwhile there may be a role for the new Consumer Protection Agency, because complexity always allows the greedy to find loopholes and screw consumers, while it makes it more difficult for consumers to protect themselves. But if we rely too much on that, the agency could grow immense.

Most consumers, I think, are willing to assume more personal responsibility and Want to seek the best value in care, but that’s difficult to impossible under America’s current and convoluted Sick Care system, which has perverse incentives to view patients as paying customers and treat their symptoms, thus keeping them coming back, paying.

Republican Alternatives To The Affordable Care Act?

What Would Republicans Do Instead Of The Affordable Care Act?

By John McDonough and Max Fletcher

A new spate of proposals from Republican presidential candidates to repeal and/or replace the Affordable Care Act (ACA) raises the important question: Given an unobstructed opportunity, what would Republicans really do with the Affordable Care Act? Would they repeal the law wholly or just in part? With what might they replace it?

Some suggest that Republican Congressional leaders only advance full repeal to placate their Party’s conservative base, knowing well that repeal cannot survive a certain veto while Barack Obama is President. In January 2017, that obstacle will vanish if Republicans control the White House and both branches of the U.S. Congress. What then? Read More of this excellent article at HealthAffairs.org.

Patient Choices in the Used Car Lot of Healthcare

Used Car Salesman

Guest essay by Chris Oldenburg [with editor’s comments at the end]

In America we love our choices. Drive by any car lot and you might see 10 models that only differ in exterior color. We also love simplicity and service. Those cars had better have a clear cost taped to the windshield right next to a list of what’s included. Read More …

Another Essay on Health Reform and Insurance

Why is Health Insurance So Expensive?

By Jon N. Hall, 8/13/2015 (see full article)

“If insurance actuaries could predict with certainty that every year every house in Kansas would be destroyed by a tornado, how much would a Kansan be charged to insure his house against tornado damage? … After all, insurance is a business, not welfare; businesses exist to make profit.”

American Health Care is Snake Bit
The article makes the point that insurance always costs more than paying out-of-pocket if what is being insured is a certainty, and it argues that that’s what health insurance has become – essentially prepaid medical care. It concludes by saying, “If America wants to preserve the private health insurance business, then private health insurance policies need to revert back to being ‘catastrophic insurance,’ just as in the days of old. That means we’d all be paying more out-of-pocket.

Beyond that, the author offered no recommendations, so I chimed in with my own. Read More …

How can we make healthcare more productive?

How can we make healthcare more productive? was the topic of a LinkedIn discussion started by Joe Flower, author of the book, “Healthcare Beyond Reform: Doing It Right For Half The Cost.” It generated some lively discussion and prompted me to respond as well.

My response to How can we make healthcare more productive?

MotivationCHANGE THE TERMINOLOGY – America has excellent MEDICAL Care, if you can afford it, but we have a horrible HEALTH Care system and desperately need to focus more on health & wellness. We spend twice as much as other nations but still live sicker and die younger, per the WHO. That means we “should” be able to cut costs in half at least while simultaneously improving care quality, patient satisfaction, worker productivity, and GDP.

START WITH EDUCATION – We now teach new doctors how to diagnose and treat illness & injury, not how to prevent it, and that feeds into our fee-for-service SICK Care system that profits from doing more – more tests, more procedures, more drugs. Little time is spent teaching medical students about public health and the pillars of health (exercise, nutrition & sleep), because that doesn’t fit into our for-profit business models. Read More …

Supreme Court upholds Affordable Care Act… Again


Supreme Court says, "ACA OK"

The U.S. Supreme Court this morning ruled on the landmark King v. Burwell case about the legality of federal insurance subsidies. In their 6-to-3 ruling they saved coverage for more than 6M Americans.

According to FierceHealthPayer, Chief Justice John Roberts said, “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them. If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter.”

Here at Modern Health Talk, we applaud the Court’s decision.

Insurance Cost = Premiums + Deductibles + Copays

Obamacare Enrollment Drive

MIAMI, FL – FEBRUARY 05: Aymara Marchante (L) and Wiktor Garcia sit with Maria Elena Santa Coloma, an insurance advisor with UniVista Insurance company, as they sign up for the Affordable Care Act, also known as Obamacare, before the February 15th deadline on February 5, 2015 in Miami, Florida. Numbers released by the government show that the Miami-Fort Lauderdale-West Palm Beach metropolitan area has signed up 637,514 consumers so far since open enrollment began on Nov. 15, which is more than twice as many as the next large metropolitan area, Atlanta, Georgia. (Photo by Joe Raedle/Getty Images)

OPINION by Wayne Caswell, founder & senior editor, Modern Health Talk

This is an obvious opinion piece that I posted on Huffington Post in response to another opinion piece, It’s Not Just You — Those Health Insurance Deductibles Are Getting Scary.


The article was well written but misleading because it failed to acknowledge that Total Insurance Cost = Premiums + Deductibles + Copays. Instead, it focused almost exclusively on high deductibles. Read More …

Telemedicine as good as a Doctor visit?

Video ConsultationVirtual doctor visits via video conference are starting to go mainstream, with some people putting them on par with a regular trip to the doctor’s office. UnitedHealthcare, announcing that they’ll cover virtual doctor visits through American Well, Doctor on Demand, and NowClinic, is the latest to jump on the telemedicine bandwagon.

While these consultations previously would cost $40-50 per call, United members will only be charged a regular co-pay, making virtual medicine more affordable for more people. Coverage of the virtual visits will only be available only to UnitedHealth’s self-funded customers, as opposed to those with employer-funded plans, but the feature will expand next year to most members, showing just how fast telemedicine is taking off. Read More …

Top Ways Our Healthcare System seems Evil

America is Snake Bit“A Lot Of People In This Industry Are Just Evil”
(Jeff Kushner, founder Of Oscar Health)

That provocative quote from Josh Kushner at the 4th annual Clinton Health Matters Initiative, was aimed at the healthcare industry and reported by Forbes contributor Dan Munro. Josh was one of four panelists in a 90‒minute opening Plenary Session moderated by Former President Bill Clinton.

Clinton opened by lamenting that technology adoption in healthcare can take as long as 17 years and sarcastically said, “By all means let’s wait 17 years and let people die in the meanwhile.” He then asked Josh to begin a discussion of the issue. But what’s behind his claim of excessive greed or evil? I can’t speak for Josh directly, but here are the top 10 ways our healthcare system seems evil.

Excessive greed (evil?) is natural for an industry that:

Read More …