Home | About | Donate

'Everybody In, Nobody Out': What We Know So Far About the Medicare for All Act of 2019


'Everybody In, Nobody Out': What We Know So Far About the Medicare for All Act of 2019

Benjamin Day, Mark Dudzic

As the 2019 legislative session in Congress kicks off, the Democratic majority in the House will, in very short order, have to address a national surge of support for Medicare for All (otherwise known as single-payer healthcare). At the close of the last Congress, almost two-thirds of Democratic Representatives had signed onto HR 676, the Expanded & Improved Medicare for All Act. They will be joined by the long list of freshman Democrats who ran and won on this issue.


I like what I’m hearing. But seeing is believing.


Hope this actually does go somewhere but I don’t have my hopes up considering the current Dem leadership


If the bill Jayapal is writing arrives with everything this article describes I would be more than happy to apologize for my past comments on this subject and admit I was wrong. But I also want to see the written bill before that happens.
I did notice a curious phrase in the text, it could be nothing and just the way the authors wrote it, or something big.
“…every resident of the United States would be eligible for coverage under the new health plan.”
It seems like an odd way to word it, like the way an insurance co. would word the sentence. Instead of just saying everyone would be covered. Again, could just be skepticism on my part.


OK and of course everything worthwhile takes time. However, aren’t the calls to rally behind the undisclosed bill a little premature? Of course we are hoping it will be at least as strong as HR 676 but let’s wait to read the fine print and put pressure on Jayapal to make it at least as good as HR 676.



No, we are not just nervous nellies with an emotional attachment to the number 676, but thanks for the random insult. We have serious concerns that have not been addressed.


For a nation that spends the majority of its bounty on death-dealing, one might say this is a karmic moment. The scale of what the warmongering empire has generated … in some sense by default, but ultimately by choice.

Continuing the parallel, I am reminded of the debacle caused to life and land of Viet Nam and us as perpetrators. In the 70s Francis Fitzgerald wrote “Fire in the Lake”- a history and analysis of the conflict. that mirrors the failure we suffer through in health care.

"Fire in the Lake – the image of revolution in the I Ching, the Chinese Book of Changes – is both a journalistic and a scholarly account of the US involvement in Vietnam. It is a study of rare insight into the conflict, recounting not only facts but searching also for explanation into ‘states of minds’. US political blunders were magnified by misperceptions, lack of understanding of Vietnamese realities, and an unwillingness to confront the plain social, cultural, and national facts of life in Vietnam. "

I am reminded that those conducting the war were entirely blindsided by their own testosterone poisoned premises and there was a sea change when it became obvious that “the will of heaven” did not include the US presence. (As an aside, this is what I see returning with Pompeo and mustache)

Something similar is clearly happening with health care as a right. The sheer unethical premise of profiting from poor health causes distortions that are equally unethical to allow to persist.


These guys are terrific!!! Thanks for the link!


PAY CLOSE ATTENTION - we are about to lose Medicare all together and get an insurance scheme.

Expand medicare means EXPAND what is currently here.

These people want to remove medicare and start a new one,that pays insurance companies and not providers. meaning we will be in an insurance scheme that offers us less every year for our tax dollars when we should keep insurance out of it all together and pay providers like the current system does. DON’T LET ANYONE END MEDICARE UNDER THE LIE OF EXPANDING IT.

Expand the CURRENT medicare to everyone.

Don’t listen to Bernie - he’s about ending the current medicare and creating a new one FOR the insurance companies. Run from that old man talking out both sides of his mouth and ultimately acting like a sociopath. RUN.

Keep only the current medicare and EXPAND that.


I completely agree! From what I know so far, we need to call Rep. Jayapal to pressure her to make sure the new bill she is writing totally bans for-profit health facilities and Managed Health Organizations with their “capitation” funding, and includes a planned buyout of investors, and the inclusion of every U.S. resident, regardless of immigration status.

So far… from the little that they have allowed to be known, the new bill does NOT do these things! In addition, from what I can tell, the plan for the system’s administration is using the model of the Centers for Medicare and Medicaid (CMS). This is bad news because all the directors are political appointees. The Secretary is appointed by the Pres. (with approval of Congress) and the Sec. then appoints the General Director, who appoints all Regional Directors.

Any new bill MUST stop the political appointees to the administration of our national healthcare plan. The General and Regional Directors should be elected!

Please call Rep. Jayapal and insist on these things:
Jayapal’s contact info: D.C: 202-225-6197 Seattle: 206-674-0040


Allowing privatized facets of medicare for all dooms health care to capitalist pirates who see sickness as profit.

People want to rewrite the US medical economy, equivalent to about 1/5 of the entire Russian economy. They want to rewrite united states health insurance law in a few hundred pages and be partners with capitalists, too.

Medicare for all means change the age of eligibility for medicare to birth.

Medicare for all is three words.

Get real. Medicare for all is not a baby step.

You want to cure all the current injustices in medicare and leave room for continued capitalist injustice? Get medicare for all first. One simple edit of eligibility age. Now you are aimed. Stand up for human dignity.

Stop killing and maiming foreigners in regime change wars and add dental or whatever you want next to medicare.


This does not sound good.

Here we go: Pandering to the capitalists. The UK had it right when it socialized health insurance and healthcare.

We have tried to regulate corporations before and we will continue on this merry-go-round until we have a NON profit, SINGLE-payer system that covers everyone under ONE plan.

Why so? Where is that risk taking bit? They gambled, made considerable profit over our needs they should take the loss.

Then it is not a single payer system.


Medicare for all can NOT just be a bill! When the bill is accompanied by a work-stoppage of the 70% of Americans who want Medicare for ALL, it will sail through both house’s and inked by the WH like an oligarchs yacht of the Hampton shores.


The authors seem to be very well informed about what is to be in HR 2019.


Any for profit, private institution does a market up over the costs of bringing a good or service to us, we call it profit, Marx called it surplus value. There has been a huge consolidation in the healthcare delivery sector in recent decades, which means increased monopoly power. Boring mainstream economics teaches us that monopolistic power allows companies to raise the prices for their goods and services even more. The obvious fear is that the government would wind up essentially subsidizing private monopolies or oligopolies and their markups. The UK has four NHS systems, and the British NHS has been slowly moving towards more of a single payer system like the one proposed here through progressive privatizations, and the studies show that it is not improving care at all. A recent Rand study showed that the majority of care at VA facilities is better than what veterans get in private facilities, and the VA has thousands of open positions that the government simply refuses to fill. Think about how good it would be if our politicians weren’t worthless parasites.

Need to add that Pelosi is a horrible human being. Sorry, she might be nice to her kids, grand kids, colleagues, or whatever, but she is someone that is in public office and has a responsibility to us all, and she doesn’t care about anything but herself and those getting her rich. I am sick to death of people like her in politics.


It IS time for insurance companies to stop treating patients, instead of our doctors. My mother saw a doctor yesterday and was prescribed 10 days of Vicodin. The insurance company would only give her 7 days worth. What up with that? I guess they got out their crystal ball and made a different determination than the doctors.
All of these little bad dreams turn into a nightmare at some point.


I inadvertently posted a one-liner, so I will just have to ‘reply’ to it myself with this second post. Sorry.

The proposed HR2019 reported in this article addresses many of the pitfalls of the watered-down measures of Obamacare, which treats medical services as a zero sum game that we can afford to play only if we are frugal. The truth is, we cannot afford to parcel services out. If we deny a non-citizen help, he can transmit a serious disease, and even start an epidemic. Everyone, but everyone, must be treated in a timely fashion, lest our collective budget takes a hit, not to mention our humanity. Thus, ‘everyone in’ is an absolute must, and HR 2019 addresses that.

But, you ask, how can we contain cost? We do it by (1) spreading the actuarial risk, by covering everyone; young and old, everyone in. We thus become vested in helping the old and infirm, cynically if you will, because we cannot afford not to. (2) Providing a financial incentive for every tax payer to support measures that prevent disease, and cost. That includes protecting our environment, clean water, toxic waste prohibition. We become vested in sanctioning polluters. (3) Using purchasing clout to beat drug costs down. Hell, threaten to bill big pharm for basic research done in our universities, if you must play hard (but fair) ball. (4) Remove the financial incentive to make more money if more medical service is spuriously created, like a lawyer padding his billable hours.

(4) brings me to the main defect in the authors’ analysis in this article. Paying fee-for-service as we do now should be thinned out over time. In the mean time, for goodness sake, watch like a hawk the one who orders the service, and happens to also own the facility providing the service. We are not all saints.

(1) and (2) takes time for savings to kick in; (3) and (4) however, create immediate savings. It pans out.

Good luck to you, HR2019.


“And the nonprofit section of the industry itself has gone through extensive consolidation and often embraces a business model that is virtually indistinguishable from that of investor-owned facilities.”
The above quote implies, or states, that nonprofits are indistinguishable from investor-owned facilities. (??) Isn’t that a completely asinine, contradictory assertion? Since when does a nonprofit skim the cream-of-the-crop dollars off the top of revenues and pay them out to investors? Since when does using health care, and thereby the rate of ill health, as a source for profit taking, make any more sense than allowing profit taking off the use of sidewalks, roads or law enforcement? While making a profit is not in itself a bad thing, just as money itself is not bad, “the love of money is the root of all kinds of evil,” and the profit motive is also “the root of all kinds of evil.” Health care as a human right, just as access to sidewalks and streets and air and water are equally the birthright of every person, could and should become the sea change of civilization toward the prosperity that a fair sharing of Earth’s abundance can provide for everyone alive and yet to be born. This is not pie in the sky utopianism. It is actually hard core capitalism tempered by justice, equality and freedom as demonstrated in detail by Henry George in Progress and Poverty. Search the free audiobook abridgment by Bob Drake at the Henry George Institute, Chicago


That is consistent with the opinion of the authors that:

Converting IHS and VA facilities into general providers for anyone in the population could significantly diminish their ability to offer targeted, effective service for Native Americans and veterans. The new Medicare for All Act will keep the IHS and VA systems fully funded and intact, even while their target populations will gain access to broader range of providers and services.

In general, I thought this story was a pretty good read - I got a lot more information out of it than I have 90% of the M4A stories on CD. It gave me a much better feel for the “investor owned facilities” issue. It doesn’t look like many here are going to be happy with the bill when it is released. I haven’t seen polls of people in the movement, but if the authors are right that:

But there is considerable disagreement in our movement about whether buying out the for-profits is the best way to deal with the distortions of profit taking.

Then I’m not convinced we are in trouble there. I was leaning towards the HR 676 view, but I can see it is a non-trivial choice to make and if we can get a single payer system in place with real teeth (I appreciated the comment on teeth for drug pricing too), I will be a lot happier than with some alternatives that I’ve heard. Perhaps we will find we want to phase out investor owned facilities, or perhaps we find that the teeth will work well enough, but it seems like a decision we can push down the road unlike the decision to get rid of the private insurance industry which it sounds like this bill will make clear it is going to do.

In general, I’m against the excuses that you can’t write a bill in public due to legal issues - I’m sure this can be done with careful tags on paragraphs as to whether a particular portion has been legally vetted or not or is sill in the planning stages, but I’m way way on the extreme when it comes to open development of everything - software and legislation. I doubt I’ll ever get what I want there.

I’d also prefer a simpler bill to one that is unnecessarily complicated, but I will try to plow through the 200+ pages in this bill when it is released.


I would put the probability that we could get a system that would treat anyone who walked in the doors of a facility identically and not require identification as zero. Canada doesn’t do that nor does any other country I’m aware of. That doesn’t mean that there can’t be rational policy to handle non-citizen/non-permanant-resident/non-work-visa cases in ways that aren’t cruel or stupid from a cost or public health point of view. But to assume everyone could walk in with no questions asked just isn’t going to happen.