Randy on Long-Term Healthcare Goals

Why We Need Single-Payer Healthcare
(The Long-Term Goal)

The United States already pays more for healthcare than any other nation, yet millions remain uninsured or underinsured. A single-payer system would replace premiums, deductibles, and surprise bills with a simpler, fairer system where everyone is covered and costs are tied to ability to pay. At the end of this paper, I give a brief summary of other countries’ plans. I think we can learn from them, and make the best possible plan for the U.S.

1. The Current System Is Too Expensive and Too Inefficient

• The U.S. spent $4.9 trillion on healthcare in 2023—about $14,570 per person, nearly twice
  what other wealthy countries spend, while achieving worse outcomes.
  • Policy solution: Replace fragmented private insurance with a single public system that lowers costs through bargaining power and simplicity.
• Administrative waste accounts for up to 30% of U.S. healthcare spending, driven by hundreds of insurers, plans, and billing systems.
  • Policy solution: Streamline administration under one payer, freeing resources for patient care instead of paperwork.

2. Families Are Crushed by Medical Debt and Unequal Access

• • Medical debt contributes to over 550,000 bankruptcies per year, and 3 million Americans
    owe more than $10,000 in medical bills.
    • Policy solution: Eliminate out-of-pocket costs for essential care and ban medical debt
      entirely.
  • Coverage gaps leave many without dental, vision, or mental healthcare, especially low-income
    and rural families.
    • Policy solution: Guarantee comprehensive coverage—including mental health, dental, and vision—as a basic right.

3. Corporate Control Drives Higher Prices and Worse Care

• • Insurance and healthcare monopolies increasingly control hospitals, clinics, pharmacies, and
    drug manufacturers, limiting choice and inflating prices.
    • Policy solution: End for-profit control of essential healthcare services and enforce antitrust laws.
  • Despite record spending, the U.S. ranks last among 10 high-income countries on access,
    equity, and outcomes.
    • Policy solution: Shift the system’s focus from shareholder profit to patient outcomes.

4. Addressing Common Concerns About Single Payer

• • Wait times may increase as more people gain access.
    • Policy solution: Expand medical education, raise provider pay, and incentivize rural practice during a multi-year transition.
  • Transition costs are real but temporary.
    • Policy solution: Use phased implementation and transition financing (including bonds), while replacing insurance premiums with payroll contributions that are lower for most families and small businesses. Most lower- and middle-income households would save money overall.
  • Insurance job losses must be addressed responsibly.
    • Policy solution: Guarantee retraining, wage protections, and union rights, while expanding jobs in direct care, rural health, mental health, and administration.

5. A Responsible Path Forward

• • Phase in coverage, starting with a strong public option and voluntary buy-in.
  • Protect healthcare workers, ensuring fair pay, union protections, and clinical independence.
  • Build secure, modern systems that protect patient privacy and support efficient care delivery.
  • Engage the public honestly, countering misinformation and building trust through education.

Bottom Line

We already pay for universal healthcare—we just do it in the most expensive and inefficient
way possible. Single payer is about replacing waste and inequality with a system that delivers
better care, lower costs, and dignity for every family.

Other countries have figured it out

Other countries do healthcare differently, but they all get one thing right: everyone is covered and costs are kept under control. Whether it’s single payer or a mixed system, they spend less than we do and get better results—because they put healthcare before corporate profits.

Canada: Classic single payer—government pays for doctors and hospitals, which are mostly nonprofit. Care is free at the point of service, though dental, vision, and drugs aren’t always fully covered.

United Kingdom (NHS): Fully public system where the government funds and runs care. Care is free, but non-urgent wait times can be longer; private insurance is optional for faster access.

France: Government insurance covers most costs, with nonprofit supplemental plans filling the gaps. Patients have broad choice and short wait times.

Germany: Universal coverage through tightly regulated nonprofit insurers. Prices are set nationally, keeping costs low despite a more complex system.

Japan: Universal coverage with strict national price controls. Mostly private providers, very low costs, and short wait times.

Australia: Public coverage for essential care, with optional private insurance for extras or faster service.

What They All Share: Everyone is covered, prices are controlled, and they spend far less than the U.S. while getting better health outcomes.

Bottom Line: There’s no single model—but every successful system treats healthcare as a public good, not a profit center.