A Single-Payer Healthcare System for All Americans

Will Fisher Explains Single Payer With Jelly Beans

Watch Will Fisher Explain Single Payer With Jelly Beans (YOUTUBE)

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 system providing universal coverage and healthcare for all.

Because so few people know what single-payer is, Will Fisher uses jelly-beans to explain it. To begin with, single-payer is NOT where the government employs the doctors and directly provides the care. That would be single-provider care.

Will’s jelly-bean analogy shows how we currently Pay for care and the savings from a single-payer system. But read on to see why even Bernie Sanders’ Medicare-for-All plan, doesn’t go far enough to achieve the far greater savings potential I so often write about.

KISS - Keep It Simple, Stupid

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


Isn’t single-payer just another way to pay for care with nothing to improve care delivery or reduce the need? It does set the stage for more-effective reforms, but this question is why I say, Medicare-for-All is Not Enough.

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 charging ever-higher premiums as the cost of providing care goes up. They have a financial incentive to deny coverage but not to contain overall healthcare costs. Reducing the number of payers can both 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. Because that’s not an issue with Medicare, 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 described 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 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, which is exactly what Bernie has suggested.

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 may be too far to the left and could scare away moderates. They may not completely share my vision for America, because their rhetoric seems to blame wealthy corporations and individuals, and capitalism, and their plans seem intent on punishing the rich 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 in my view. 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, your arguments are landing on deaf ears. And quit trying to save Obamacare as it stands with its known flaws. Republicans seem intent to sabotage it, because they’ve been unable to replace it with anything suitable.

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 every year in overall healthcare costs, while also improving outcomes and developing that skilled, healthy, and productive workforce.


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

Medicare for All versus Single Payer

Medicare-for-All could gain support among Republicans if you avoid lies, misleading claims, and rhetorical “slight of hand,” like you 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 you Republicans still claim to be the party of fiscal responsibility but 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 your own hastily & secretly prepared plans are opposed by over 80% of the nation.


As the latest Republican attempts to repeal Obamacare failed, 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 for Republicans to reach across the aisle and get their help.


The U.S. now spends over $3.5 trillion/year on healthcare – in total, including insurance premiums, deductibles, out-of-pocket expenses, government subsidies, and more, as represented by Will Fisher’s colored jelly bean analogy. 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. And their incentives better align with goals.

To reach our savings potential, politicians must go beyond single-payer healthcare. 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 the powerful forces that maintain the status quo in a medical industry that’s quick to treat, 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. Combined with the growing need, the ability of disruptive technologies and business models to satisfy the need is what makes me guardedly optimistic about the future of healthcare in America. On the other hand, there’s our divided politics.


I worry about misaligned incentives that encourages a medical industry to profit from disease management rather than health & wellness. And I worry about the unlimited funds spent by special interest lobbying. In his TIME Magazine report, “Bitter Pill: Why High Medical Bills Are Killing Us,” Stephen Brill describes the Medical Industrial Complex that spends 3-times as much on lobbying as the military industrial complex. [I use a different term: medical cartel.] They obviously don’t want to lose $1.5 trillion/year in revenue and will surely oppose any of the reforms I suggest.


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 second 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.

2 thoughts on “A Single-Payer Healthcare System for All Americans


    Health Care Reform – Progress and Next Steps, by President Barack Obama

    Escape Fire: The Fight to Rescue America’s Healthcare – Features an EXCELLENT documentary film that won several awards at the Sundance Film Festival, and was described as “An Inconvenient Truth for the healthcare debate.”

    Searching for a Healthcare Unicorn – Healthcare is not the same as other markets. Capitalism and free-market incentives don’t work in healthcare. And fixing it is not as simple as shifting who pays. It’s like we’re searching for a magic Healthcare Unicorn.

    Bitter Pill: Why High Medical Bills Are Killing Us – In his 38-page TIME magazine special report, Steven Brill dives into our health care system to understand why things cost so much. Unfortunately, this important article is now behind a subscriber paywall, so I posted a summary and video introduction by the author.

    Ask the Right Questions about Healthcare – There’s still time for Congress to replace Obamacare with real health reform that saves over $1 trillion/year and satisfies President Trump’s campaign promise to make sure every American has access to health care that’s better and more affordable than what is available today, but they’ll need to ask the right questions.

    US Healthcare System has Cancer. Can Trump Fix it? – It’s my hope that Trump will recognize the need to treat our healthcare system’s “cancer” aggressively, naturally and holistically. But will he? Can he? Here are the challenges he faces.

    Why Republicans Want to Repeal Obamacare – Former Labor Secretary Robert Reich dives into what is driving repeal efforts, but he fails to mention the demographic shifts that threaten GOP political control, and how allowing tens of thousands of people to die without health care would benefit them.

    Universal Healthcare Opposition – What’s REALLY behind universal healthcare opposition? It seems to be an ideological fear of helping “LOSERS”.

    Why Medicare-for-All is Not Enough – Beyond just improving the efficiency of how healthcare is paid for and adopting the exceptionally efficient Medicare system for everyone, we need to address the NEED for medical care in the first place, with incentives that focus more attention on overall health and wellness.

    Influencing Healthcare Policy – Lobbying, Incentives & Insurance – Healthcare reform, whether it’s Obamacare or Trumpcare, seems to be influenced largely by these three factors to maximize profits.

    Chipping Away at Healthcare Special Interests Yet? – Revenue growth in the healthcare industry, driven largely by the corrupting influence of political lobbying, is unsustainable. Real health reform needs to resolve the conflicting motives of the public sector and private sector.

    HEALTH or SICK Care? – Unfortunately, fee-for-service healthcare incentives caused medical schools to focus almost entirely on diagnosing and treating illness and injury, not preventing it. Prevention goes against the business model of profiting from each patient’s visit, test, prescription and procedure – a model with the perverse incentive to do more and more, and charge more.

    The Unbreak Campaign – This MD-driven Declaration Of Independence seeks answers to the same questions I ask in the above editorial. One of the leaders of this movement is ZDoggMD, probably the ONLY healthcare speaker/rapper ever, who uses his gift of sarcasm to educate the public on important issues.

    Disrupting Healthcare with Functional Medicine 2.0 – Healthcare is shifting from a Blockbuster’s bricks & mortar model to a Netflix on-demand, anytime/anywhere model. What we desperately need is a new “operating system” for healthcare that is predictive, preventive, personalized and participatory.

    Wealth Inequality, Healthcare and the Economy – People, including Congressional Republicans and Democrats, have little real understanding of how wide the wealth gap has become and it’s impact on healthcare and the economy, so this article features an excellent video infographic on the topic and other statistics.

    Corporate Behavior and Rising Health Care Costs – The aging population adds to healthcare costs but is a global problem, so what makes our healthcare system the most expensive in the world by far and without the positive outcomes to justify it? I see problems with our politics, special interest lobbying, and societal beliefs. And I find it telling that public health officials can accurately gauge one’s average weight and BMI by zip code, and that longevity in poor neighborhoods can be over 20 YEARS LESS than in affluent neighborhoods on the other side of the same town.


    The Battles Ahead: Meet the Biggest Opponents of Single-Payer – WOW! This excellent piece is part of Fighting for Our Lives: The Movement for Medicare for All.

    ‘Single-Payer’ Healthcare Isn’t Necessary — But Single Pricing Is – Great explanation, stats & chart in FORBES

    Medicare-for-All Isn’t the Solution for Universal Health Care – This article on The Nation explores single-payer options of other nations

    Trump betraying all his health care promises is the biggest Trump scandal of all – According to Vox News, It’s out in the open. And it’s a huge deal.

    Excellent side-by-side comparison of Obamacare and the GOP’s replacement plan (LA Times)

    Democratic Ideas On ACA Improvements – If Republicans reach out for help recovering from their Manufactured Crisis, the Dems have plans ready. This article includes More From CBO On BCRA Medicaid Cuts.

    Unpacking The Sanders Medicare-For-All Bill (Health Affairs Blog) This is a thorough early analysis of Bernie Sanders’ Universal Medicare Program (UMP) bill. While problem areas still exist, it seems to provide an excellent ACA repeal-and-replace framework that, unlike prior Republican attempts, could actually provide universal coverage with better health care and lower overall costs, even with increased taxes.

    President Carter: Lack of Universal Healthcare Should Be a ‘National Scandal’ (TIME) “In a country as rich as the United States, blessed with talented medical professionals, world-class hospitals and research institutes, and an almost unparalleled capacity for technological innovation, the lack of universal health coverage should be a national scandal.”

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