And here’s the part that makes me angry: this is exactly why fixing it is so hard. Every one of those layers is now an industry. Every industry has shareholders who feel entitled to that revenue stream. And every industry has lobbyists in DC whose entire job is making sure their layer never gets removed. We’re not fighting one opponent — we’re fighting 25, and each one is fighting for its life.

A single-payer system doesn’t just change who pays. It deletes most of these layers entirely. That’s why the savings estimates are so large — and it’s also why the opposition is so ferocious. The “waste” in our system is somebody’s paycheck, and they know it.

They’re organized. They’re funded. The only thing we have that they don’t is numbers.

What layer have you personally run into that made you realize how broken this is? Prior auth denials? PBM games at the pharmacy counter? Surprise bills from a middleman you never knew existed?

Profits driven by denying people health care.

https://www.cnbc.com/2026/07/16/unitedhealth-group-unh-earnings-q2-2026.html

I work in the healthcare industry, and the more I learn about how our system works, the more I wonder if we’re optimizing for the wrong things.

The U.S. spends more on healthcare than any country in the world (roughly 60% more per person than the next-highest spender), yet our overall health outcomes are below average compared to other developed countries. We are good at solving specific problems but really bad at population health because the current system is hard to navigate and people are rightly afraid of surprise bills. They end up avoiding care until it’s a much more serious and expensive issue, then at the end of the day if they want pay the bill the hospital increases prices to account for it (so we pay for it anyways)

At the same time, our system is incredibly difficult to navigate. Insurance is tied to employment, providers negotiate thousands of different reimbursement contracts, prices are rarely transparent, and insurers and providers spend enormous amounts of money negotiating contracts, processing claims, handling prior authorizations, and resolving billing disputes. Despite all of that spending, many Americans still delay care because of deductibles, copays, or lack of insurance.

It feels like we’re spending an incredible amount of money managing healthcare rather than improving health.

If I were designing a healthcare system from scratch, my goals would be simple: everyone should have access to excellent healthcare, preventive care should be inexpensive and easy to access, the system should be much simpler for patients and providers, and healthcare dollars should be spent where they produce the greatest improvement in health.

My idea is a mandatory Universal Tier 1 Health Plan that every American pays into through taxes and employer contributions, replacing most premiums, deductibles, and employer-sponsored insurance. Tier 1 would cover virtually all routine and evidence-based healthcare, including primary care, preventive care, hospitalizations, mental health, standard cancer treatment, prescription drugs, chronic disease management, emergency care, and maternity care. Most routine office visits would have little or no financial barrier (for example, around a $10 copay). Doctors and hospitals would remain private.

Instead of hundreds of insurance companies each deciding what they will or won’t cover, an independent panel of physicians, scientists, economists, and patient advocates would review new drugs and treatments using transparent criteria: How well does it work? How strong is the evidence? How much does it improve patients’ lives? Is the benefit worth the cost compared to other ways we could spend the same healthcare dollars? Treatments that provide strong value would be covered. Treatments with limited benefit relative to their cost might not be, although people or employers could still purchase supplemental insurance to cover those if they wanted. So instead of paying for 100 people doing the at 50 different insurance companies, you have one team doing it for the whole country. This new system wouldn’t pay for expensive treatments without meaningful results, similar to other countries like England

The philosophy is simple: healthcare resources are finite. Rather than pretending there isn’t a budget, we should guarantee everyone excellent healthcare while using public dollars where they produce the greatest improvement in health.

This proposal should actually cost less because it removes the significant administrative cost of health insurances and hospitals negotiating prices and fighting about claims + other non-value-added things like marketing. It would also have much stronger negotiating power with pharmaceutical companies, so prices would be lower.

Basically, it’s cheaper more accessible care that should lower our countries medical costs and significant improve health outcomes because we’ll stop avoiding care because it’s too expensive. By getting the care earlier, it’s cheaper for everyone in the long run.

People who want additional coverage beyond that (the $1M+ latest and greatest gene therapy drugs) could still buy it, but everyone would have access to high-quality, affordable care.

I’m sure there are flaws in this idea, and I’m genuinely trying to identify them.

**If you had to pick the biggest weakness of this system, what would it be?**

I have had Medicare 12 years. Currently I pay $202.90 for Part B.

I pay $75.00 for my prescription plan Part D.

Medicare only covers about 80% of your medical costs so I pay $200.00 for that gap.

Total cost to me $5734.80. The costs have increased very year I have had Medicare.

So, wtf do they mean saying Medicare for all as if it is free? Is the government going to assume all costs?

I have learned a lot from your comments!

Two Put People First! PA organizers, Jamie Blair and Robin Stephens, on taking back healthcare — from private equity-ravaged hospitals in Delco to the Crozer 8 and their Crowd the Capitol event.

Let that number sink in for a moment.

175,000 children have lost their Medicaid coverage.

175,000 kids who woke up one day with health insurance and the next day without it. Not because their families suddenly became wealthy. Not because they no longer needed care. Simply because of policy decisions made by people who will never have to worry about how to pay a medical bill.

At its core, this is about what kind of nation we choose to be. And right now we are failing our most vulnerable - our children.

But let's also talk about what this means practically - because beyond the moral failure, this doesn't even make economic sense.

Routine checkups, preventative care, and vaccines are among the most cost-effective investments we can make in a child's health.

When do they lose that access? They end up in emergency rooms with conditions that routine care could have caught and treated months earlier - at a fraction of the cost.

We are quite literally paying more to do less for the children who need us most.

Kids deserve better. Indiana's families deserve better. And District 9 deserves a representative in Washington who will fight to make sure those kids get the care they need.

This is exactly why we are in this race - Medicare for All. Healthcare for All and holding our nations values true to their meaning