Beyond Medicare for All: Building Real Healthcare Capacity

Our current healthcare system is projected to cost a mind-boggling $75 trillion over the next decade. $75 trillion.

I keep saying Democrats need to offer a real alternative to MAGA—something rooted in the actual repair of our systems and institutions. That can sound vague, so here’s a concrete example: healthcare. Just one area, but it says everything about where we are—and where we need to go.

Our current healthcare system is projected to cost a mind-boggling $75 trillion over the next decade. $75 trillion. Let that sink in.

How are we gonna pay for that? It's a fair question, especially considering healthcare spending will soon make up 20% of our entire GDP. One out of every five dollars circulating in our economy will go toward healthcare. Yet, despite all this spending, we’re getting less and less quality and value every year.

I remember when AOC went on Jake Tapper's show to discuss her policy agenda. Tapper grilled her about the $40 trillion price tag, demanding, "How in the world would you pay for that?" Yet nobody asks that same question about our current system’s looming $75 trillion bill. "How will you pay for it?" only matters when you're trying to help ordinary people, not when you’re letting corporations bleed them dry.

The answer to how we pay for our current healthcare crisis is simple: pain. Mostly poor and working-class people will bear this pain. They'll go untreated. They'll face medical bankruptcies, lose homes, and watch family members die unnecessarily. They'll suffer amputations from diabetes, strokes from untreated hypertension, and relentless anxiety from medical debt. Medical costs drive two-thirds of bankruptcies in America.

More than 26,000 Americans die each year from a lack of healthcare.

They died because they couldn’t get treatment. Nearly 700 women die annually from pregnancy-related complications, making the U.S. dead last among wealthy nations in maternal mortality, with Black mothers nearly three times more likely to die during childbirth. These aren't just numbers—they're real people, real families. This is how we've chosen to fix healthcare: by extracting health, happiness, and dignity from the most vulnerable among us.

Life Expectancy in the U.S. Dropped for the Second Year in a Row in 2021

Digging deeper, it turns out a lot of the stats we’re celebrating aren’t telling the real story. Take life expectancy. Sure, it looks impressive at first glance—jumping from about 64 years in 1940 up to 77.5 today—but recently it’s been falling again. And the way we measure it, from birth, masks what’s actually happening.

Hidden in those same official tables: if you reached age 50 in 1940, you were already expected to live to about 75 on average. Today, reaching age 50 gives you an average expected age of about 81. That’s an improvement of only about six years for those surviving to middle age – a far cry from the nearly 14-year leap celebrated in the 'at birth' statistics.

Why the dramatic rise from birth, then? Because fewer children die now. In the early 20th century, 30% of deaths in America were children under five. Improved public sanitation, clean drinking water, and vaccinations—not miraculous private healthcare—drove these gains. Our healthcare system loves taking credit, but the truth is, it hasn't significantly extended our healthy years. Most additional years are spent hooked up to machines, pumped full of expensive drugs, extending suffering more than life.

This focus on misleading metrics highlights how the current system fails to deliver genuine health improvements, which is why simply changing the payer with Medicare for All, while crucial, won't fix the underlying problems. As someone who worked with Bernie and AOC, you'd expect me to champion Medicare for All—and I do. But here's the hard truth: Medicare for All, by itself, isn't enough. It’s a necessary step, but insurance reform alone won't address the deeper, systemic flaws in healthcare. Medicare for All changes who pays, but not necessarily how healthcare functions. Our issues aren't just about who covers the bills—they’re about a fundamental lack of capacity and resilience in the system itself.

The US is suffering a healthcare worker shortage. Experts fear it will only get worse.

A single-payer system would dramatically increase demand overnight, and our current healthcare infrastructure isn't built to handle it. Hospitals and providers keep their operations lean because idle capacity cuts into profits. But healthcare isn’t like making iPhones or cars. You can't afford "just-in-time" efficiency. Healthcare must have elasticity, spare beds, extra ventilators, surplus capacity, ready for pandemics or any mass health emergency. Yet, that’s fundamentally against corporate logic.

Consider this: by 2034, we’re facing a shortage of up to 124,000 physicians. The American Medical Association, intentionally or not, helps sustain this shortage by restricting training slots and creating artificial scarcity to maintain profits. Private hospitals merge and consolidate to reduce overhead, further limiting healthcare capacity. REITs even own hospital buildings and lease them back at inflated rates, redirecting money away from care and toward investor profits.

We need something more ambitious than single-payer alone. We need a publicly owned healthcare system—clinics and hospitals built, staffed, and run by the government, designed not for profit but for public health.

When COVID-19 hit, Walter Reed Medical Center developed a vaccine effective against multiple SARS viruses—not just COVID-19—with broader protection than those released by Pfizer or Moderna. Yet because there was no pharmaceutical giant ready to profit billions, this vaccine remains unused. Meanwhile, private pharma companies layer dozens of patents to block competition, allowing them to charge outrageous prices for medicines funded by public research.

We should be expanding the VA and TriCare not gutting them.

It's clear we need a public competitor, an entity with no incentive other than public health. Healthcare, like power generation, education, housing—things essential to human dignity—demands public competition. History proves this approach works. The VA system, Medicare, Medicaid—these are examples of public capacity we've successfully built.

What would public healthcare look like today? Start with rural America, where hospitals are closing and leaving entire counties without emergency care. Build public facilities staffed by doctors and nurses trained in expanded medical schools. Establish a medical corps offering debt-free education in exchange for service, reversing decades of artificial scarcity. Manufacture critical medications publicly, reclaiming patents and creating real competition to bring down prices.

None of this is radical. It's returning to common sense: when markets fail, the public steps in—not just to regulate but to compete, to provide real alternatives, and to build capacity that's resilient to shocks, pandemics, and the demands of a changing population.

In a country as wealthy as ours, no one should lose everything because they got sick. No one should die rationing insulin or foregoing cancer treatments. No one should endure preventable suffering. Yet, every day, thousands do exactly that. That’s not inefficiency—it’s a moral catastrophe.

We don’t just need Medicare for All; we need a publicly built healthcare system—measuring success by lives improved, not profits extracted. Seventy-five trillion dollars over ten years is too high a price for a system designed to prolong suffering rather than deliver health. It’s time to reclaim healthcare—not just as a right, but as a public good we build and protect together.