Last week, 1,500 unionized nurses gathered in a large conference room at the Marriott Marquis in San Francisco to cheer for a cause they\u2019ve championed for years: Medicare for All.<\/p>\n
Considered a radical and even fringe idea for decades, interest in sweeping healthcare reform has surged as progressive Democrats have won a series of primary victories before November\u2019s crucial midterm elections. Most prominent among its advocates is Abdul El-Sayed<\/a>, the Democratic US Senate nominee from Michigan, who took the lectern before the nurses.<\/p>\n \u201cMedicare for who?\u201d asked El-Sayed.<\/p>\n \u201cAll!\u201d the crowd shouted back.<\/p>\n El-Sayed went on to describe why he wrote a book about Medicare for All: to answer questions about \u201cthe very simple idea that in the richest, most powerful country in the world you should not have to suffer for your healthcare\u201d.<\/p>\n As progressive candidates like El-Sayed prevail in primaries, and the Democratic party stresses unity in the face of its midterm challenge to Republicans<\/a>, Medicare for All remains a pressure point \u2013 embraced by the party\u2019s left but often considered a liability by centrists.<\/p>\n \u201cThere\u2019s too many unnecessary illnesses and unnecessary costs,\u201d said Michelle Gutierrez Vo, president of the California Nurses Association, the National Nurses Organizing Committee and vice-president of National Nurses United \u2013 all unions that represent nurses attending the San Francisco conference. \u201cWhat are we doing?\u201d<\/p>\n These unions have advocated for Medicare for All for years, and watched interest swell as candidates like El-Sayed picked up steam. By contrast, centrist Democrat groups, such as Third Way, consider Medicare for All an unattainable albatross<\/a>.<\/p>\n \u201cMedicare for All has a lot of political and substantive issues,\u201d said Gabe Horwitz, senior vice-president for the economic program at Third Way. The party is unanimous in opposition to the $1tn in healthcare cuts made by Donald Trump\u2019s One Big Beautiful Bill Act, which Democrats have taken to calling the \u201cbig, ugly bill\u201d. The legislation is expected to result in an additional 16 million people becoming uninsured by 2034<\/a>.<\/p>\n \u201cWe want to get everyone insured, we want to lower costs and want to make care easier to use,\u201d said Horwitz, who also said the party acknowledges that it needs to make reforms for people struggling to afford employer-sponsored health insurance. \u201cI don\u2019t know if there\u2019s one Democrat in the party who wouldn\u2019t agree with that.<\/p>\n \u201cThere is unanimity in the goals \u2013 the ends \u2013 there\u2019s just not necessarily unanimity in the means to get there,\u201d said Horwitz.<\/p>\n This divide was most recently evident in an 84-page memo sent to Hakeem Jeffries<\/a>, the House minority leader, from the cost-of-living healthcare working group.<\/p>\n \u201cMembers of the Democratic Caucus hold a diversity of views on how to achieve universal coverage,\u201d the memo read<\/a>, \u201cincluding Medicare for All\u201d and a wide range of other more incremental policies.<\/p>\n Centrist Democrats<\/a> have sought to answer the gnawing question of what to do about soaring healthcare costs and reviled insurance company practices by proposing incremental reform \u2013 a strategy that builds off the Affordable Care Act (ACA) passed by the Obama administration.<\/p>\n A healthcare bill of rights<\/a>, more government subsidies to health insurance companies to offset costs to consumers, and some version of a \u201cpublic option\u201d, or a government-sponsored health insurance plan that people could buy into.<\/p>\n For years, the party\u2019s left has offered a proposition at once seen as radical by US standards and typical by many of the world\u2019s industrialized democracies: a single-payer health system sponsored by the government.<\/p>\n \u201cAll Democrats from 1948 on have been in favor of universal healthcare \u2013 that\u2019s been in every democratic platform since literally Harry Truman,\u201d said Elaine Kamarck, a senior fellow at the Brookings Institution, whose recent analysis<\/a> of primary victories across the political spectrum found mainstream candidates continue to win. \u201cThat\u2019s not the issue \u2013 the issue is how do you do it.\u201d<\/p>\n What\u2019s more, said Kamarck, the issue is one likely to simmer long past the primaries. US health reform is a virtual nonstarter while Republicans hold the Oval Office. But if Democrats won a \u201ctrifecta\u201d in 2028, \u201cthen this is going to be a really big issue\u201d.<\/p>\n At present, the US health system is a patchwork of different insurers, or \u201cpayers\u201d, all of which are subsidized by US taxpayers. Four large programs dominate the mix: employer-sponsored health insurance covers almost half of Americans (48% of the population), Medicare covers people older than 65 (14.8%), Medicaid covers low-income and disabled people (20.4%) and Obamacare allows people to buy private insurance as individuals (6.6%), all according to Kaiser Family Foundation<\/a>.<\/p>\n About 27 million people (8.2%) lack insurance entirely. About one in four Americans are \u201cunderinsured\u201d, or have high health costs relative to their incomes.<\/p>\n Across these various programs, the US government plans to spend $33.6tn<\/a> through 2034. This includes subsidies for the private insurance Americans get through their jobs, for which employers receive a tax break. That is equal to 7.4% of gross domestic product. As a point of reference, the United Kingdom spends about 11.9% of GDP to insure everyone in the country, according to the Commonwealth Fund<\/a>. Total US health spending is 18% of GDP \u2013 far more than comparable countries.<\/p>\n