Real Medicare for All!
Revisiting the original vision of Pediacare and Medicare for All
Early this morning 5/21/25 I put a rushed version of this up up as a stub for a policy brief I plan to write this summer. At a more godly hour this morning at 7:30am, I have revised this stub. My goal is to fulfill a project which began as an implementation of an article I published in Summer 2023: Dover, M. A. (2023b). Bringing Human Needs Back into Policy Practice. Journal of Policy Practice and Research, 4(3, September), 188 – 194. https://doi.org/10.1007/s42972-023-00088-3.
As someone who worked as a social worker in several multi-employer health funds in union-based memberhip assistance programs at the UAW-District 65, AFSCME District 37, SEIU Local 32 BJ, and the National Maritime Union, I have long been skeptial of Bernie’s Medicare for All Bill. I favor what I call Real Medicare for All.
Similar tensions existed in the 1930s formualtion of the original Social Security, between progressive advocates of a social insurance plan and advocates of a seemingly more progressive proposal for richer coverage, via a plan funded not by social insurance but by steep progressive taxation, as is the case with Bernie’s Medicare for All Bill. I will discuss this, and its lessons, in the historical section of the policy brief.
The tension between the goals of universal coverage and single payer, which Bernie’s bill seeks to reconcile, remain. I favor prioritizing universal coverage over single payer. I want universal social insurance coverage per the original vision of Medicare.
See this great piece by John Tropman on the origional vision. See this piece by Dean Baker on how to move forward with medicare for all. Notice he does not mention Bernie’s bill. Overall, I like Dean’s message about a re-focus on medicare for all. He claims: “By contrast, the administrative costs of Medicare are just over 1.0 percent of what it pays out to providers.”
That is true, but it is also true that as I understand it, the profit margin for the firms which that same federal employee-run Medicare pays to process the Medicare claims in nine regions to nine contractors—who do the job quite effectively—are also quite low. This will be one of the aspect os of my research for my policy brief.
Late last night I quickly presented some of my initial thinking for my vast readership. But at this point I' have edited this down to a stump: to be developed. In the meantime, see the two pieces to which I linked above, and feel free to contact me with your ideas.
Roughly speaking, my proposal is what was earlier known as a “public option” on steroids. Everyone now paying into FICA for Social Security, Medicare and Social Security Disability and Unemployment Insurance would pay an equal amount into Medicare, with an employer match, and this would be supplemented as needed, by funds drawn from raising the current maximium income subject to FICA taxes. Everyone is at risk and everyone contributes. The social insurance principle, would prevail.
I’m going to write a 2500-word policy brief about this very soon. We need progressive pragmatic proposals for real change. I’m hopeful Bernie will be willing to consider revisions to his visionary but flawed proposal, but I fear that dogmatism on the some parts of the left—on which I have been since 1967 and will remain until my dying days— will find it difficult to be openminded about such a possibility.
In the meantime I have shared privately some of the details of my proposal with a few hundred friends on the democratic left from whom I hope to receive feedback. As the plan develops, I’ll further develop this stub further, as in my other “beats” in dated addendums.