Despite Medicare for all being in the state Democratic platform, this state (yes, we can do it here first) legislation has gotten nowhere for decades. If you go to the [masscare.org](http://masscare.org) website you can see whether the candidates you are choosing have pledged to support Medicare for all. Which, by the way, would save the state nearly $30 billion as well as saving 98% of us money, remove for-profit insurance companies from deciding care, and expand care to include dental, hearing, vision, and long-term care. Send people to the legislature who promise to sponsor & vote to support this critically needed legislation. Happy voting!

The current setup spreads the burden through monthly premiums, employer contributions, surprise bills, and constant coverage gaps.

A tax-funded approach would move that cost into one visible line item.

The debate is rarely just about the total dollars — it’s about control, administration, and whether people trust the trade-off.

Either way, the money is leaving our accounts. The only real question is who it goes to and what we actually get in return.

In California, there is a ballot initiative process that literally gets abused by rich people and special interests each and every election cycle. This got me thinking. Why has nobody put together a ballot initiative for Medicare for all in California? I did hear about an outfit that was working on getting California, Oregon and Washington to start some kind of Medicare for all for the left-coast states.

If there was such an initiative would it pass? Then perhaps Oregon and Washington can pass their own initiatives and we all join together?

I have ideas on how to get this to work, but it’s too wonky to post here.

The transition of the United States healthcare sector—which currently consumes 18% of Gross Domestic Product (GDP) under a fragmented, multi-payer system—into a nationalized, single-payer framework represents one of the most significant administrative and economic reorganizations in American history. Currently, private commercial insurance overhead reaches up to 12.4%, compared to just 2.2% for public Medicare. Navigating hundreds of distinct insurance contracts generates $768 billion in annual billing and insurance-related (BIR) overhead and leaves hospitals with $35 billion in uncollected bad debt every year.

To replace this system without causing market instability or gaps in patient care, major federal legislative frameworks—such as the Senate's Medicare for All Act—establish a structured four-year transition timeline. This four-year blueprint systematically expands public coverage by lowering the eligibility age year-by-year, consolidating federal and state health programs, launching an ACA public option, harmonizing provider reimbursements, and enacting "just transition" protections for private-sector workers.

Phase 1 (Year 1): Administrative Consolidation, Stop-Gap Options, and Initial Eligibility Expansion

The primary goal of Year 1 is establishing the federal administrative infrastructure while immediately expanding care to the most vulnerable demographics.

• Lowering the Medicare Eligibility Age to 55: On Day 1 of Year 1, the eligibility age for traditional Medicare is lowered to 55 years old. Individuals aged 55 to 64—a demographic that frequently struggles with high-deductible commercial plans and elevated out-of-pocket costs—gain immediate access to Medicare benefits.
• Universal Newborn & Child Enrollment: All newborns and children up to age 18 are automatically enrolled in the upgraded public system, establishing a baseline of universal coverage for the rising generation.
• Federal ACA Public Option Launch: To cover the non-elderly adult population during the interim, the Department of Health and Human Services (HHS) launches a nationwide public option on the ACA health insurance exchanges. This public plan is made available in all counties—particularly "bare" or monopoly rural markets—with enhanced, income-adjusted premium tax credits and zero deductibles for primary care.
• Medicare Part A & B Benefit Enhancement: Existing Medicare coverage is upgraded immediately. Deductibles and copayments for Parts A and B are eliminated, and benefits are expanded to include vision, dental, hearing, and prescription drug coverage.
• Administrative Registry Setup: Centers for Medicare & Medicaid Services (CMS) modernizes its national data infrastructure to build a unified electronic claims and billing registry, preparing system-wide interoperability standards for all clinical providers.

Phase 2 (Year 2): Middle-Age Phasing, Medicaid Integration, and All-Payer Rate Harmonization

Year 2 focuses on absorbing younger adult age brackets, integrating state-level public programs, and restructuring provider payment systems.

• Lowering the Medicare Eligibility Age to 45: Eligibility for the expanding Medicare program drops to include all individuals aged 45 and older.
• Consolidation of Medicaid and CHIP: Acute care Medicaid and the Children’s Health Insurance Program (CHIP) are formally integrated into the federal Medicare for All trust. This eliminates state-level eligibility cliffs and "coverage gaps" in non-expansion states, establishing uniform national benefits regardless of geographic residence.
• Hospital Global Budgets & Site-Neutral Pricing: Regional HHS directors begin negotiating annual institutional global budgets with hospitals and medical centers. This replaces volume-driven fee-for-service hospital billing with predictable capital and operational funding, while implementing site-neutral payment rules to end facility-fee markups.
• Eradication of Utilization Management: To reduce clinical administrative strain, prior authorization requirements and private utilization management protocols are abolished across all public coverage. This single move frees up an estimated 5% of physician working hours—roughly 4 hours per week—allowing clinicians to redirect administrative time back to direct patient care.

Phase 3 (Year 3): Broad Demographic Integration, Drug Price Negotiation, and "Just Transition" Execution

Year 3 expands coverage to the majority of the working-age population while deploying federal support programs for displaced industry workers.

• Lowering the Medicare Eligibility Age to 35: The enrollment window opens to all citizens and lawful residents aged 35 and older.
• National Pharmaceutical Price Negotiation: HHS exercises monopsony bargaining power to establish a national drug formulary, negotiating maximum price ceilings for specialty and brand-name prescription drugs directly with pharmaceutical manufacturers.
• Execution of "Just Transition" Programs: As private insurance administrative needs shrink, federal "Just Transition" funds are activated. Because an estimated 540,000 private insurance and billing workers face job displacement as private underwriting is phased out, the program provides wage replacement, retraining grants, and direct placement into expanding sectors of care delivery—such as primary care coordination and Long-Term Services and Supports (LTSS).
• Primary Care Fee Adjustments: Physician payment schedules are rebalanced, increasing primary care reimbursement rates by 20% relative to specialized procedures to rebuild the national primary care workforce.

Phase 4 (Year 4): Universal Auto-Enrollment, Single-Payer Finalization, and Premium Conversion

Year 4 completes the four-year arc, achieving comprehensive, universal healthcare coverage for every resident of the United States.

• Universal Population Auto-Enrollment: All remaining residents under age 35 are automatically enrolled into Medicare for All. Point-of-care enrollment mechanisms are activated at hospitals and clinics so that any uninsured individual seeking care is registered instantly.
• Transition of Employer-Sponsored Insurance: The legal requirement for employers to provide private health insurance is retired. Employer health plans convert into an employer payroll tax contribution, shifting corporate health expenditures into the public financing trust.
• Elimination of Point-of-Care Costs: All deductibles, copayments, and out-of-pocket cost-sharing are permanently set to zero for all essential health services.
• Re-Casting Private Insurance to Supplemental Only: Duplicate private health insurance that covers services guaranteed by Medicare for All is prohibited by law. Private insurers are restricted strictly to offering supplemental or complementary coverage for non-essential or elective care (mirroring single-payer systems in Canada and Denmark).

Macroeconomic Realignment & Financial Outcomes

+-----------------------------------------------------------------------------------+
|                            FOUR-YEAR TRANSITION TIMELINE                          |
+------------------------------------+----------------------------------------------+
| Phase 1 (Year 1)                   | • Lower Medicare eligibility age to 55       |
|                                    | • Auto-enroll newborns & children            |
|                                    | • Launch ACA nationwide public option        |
|                                    | • Eliminate Part A/B copays & add dental/vis |
+------------------------------------+----------------------------------------------+
| Phase 2 (Year 2)                   | • Lower Medicare eligibility age to 45       |
|                                    | • Integrate Medicaid & CHIP into federal trust|
|                                    | • Implement hospital global budgeting        |
|                                    | • Abolish private prior-authorizations       |
+------------------------------------+----------------------------------------------+
| Phase 3 (Year 3)                   | • Lower Medicare eligibility age to 35       |
|                                    | • Enact mandatory national drug negotiations |
|                                    | • Deploy "Just Transition" worker grants     |
|                                    | • Boost primary care reimbursements by 20%   |
+------------------------------------+----------------------------------------------+
| Phase 4 (Year 4)                   | • Auto-enroll all remaining residents        |
|                                    | • Complete employer premium-to-tax shift     |
|                                    | • Zero cost-sharing at point of care         |
|                                    | • Restrict private insurance to supplemental |
+------------------------------------+----------------------------------------------+

1. Funding the Public Trust

Transitioning to Medicare for All shifts national health spending from private premiums to progressive tax revenues:

• Corporate Tax Reform: Raising the corporate statutory rate to 30%, closing depreciation loopholes, and enforcing a 15% Corporate Alternative Minimum Tax (CAMT).
• High-Earner & Wealth Contributions: Implementing a 25% Minimum Income Tax on households worth over $100 million and lifting the income cap on Social Security and Medicare payroll taxes.
• Employer & Household Payroll Taxes: Replacing private health insurance premiums with a predictable public payroll tax (e.g., a 4% household premium tax with lower-income exemptions and an employer payroll contribution).

2. Wage Substitution Dynamics

Because businesses no longer purchase private insurance plans, the corporate funds previously spent on skyrocketing employee premiums are redirected back to workers in the form of higher taxable cash wages, reversing a multi-decade trend where healthcare costs eroded wage growth.

3. Systemic Cost Savings & Lives Saved

Macroeconomic modeling by the Congressional Budget Office (CBO), Yale University, and independent economic studies confirm that a full single-payer transition yields a net reduction of 13% in national health expenditures—saving over $450 billion to $650 billion annually. These administrative and prescription drug savings fully fund universal coverage, eliminating financial barriers to care and preventing over 68,000 avoidable deaths every year.

https://americanideas.start.page

In 2024, Katie Hobbs made tackling Arizona medical debt a priority. Her administration just hit a major milestone- clearing over $1 billion for over 670K Arizonans. It didn’t cost Arizonans a penny 💪🏾

This was a no application process. People just received notification in the mail.

She worked w/ the Undue Medical Debt organization. They purchased medical debts belonging to burdened patients in bundled portfolios for a fraction of their face value.

Every Democrat should be running on clearing medical debt. This is a major GOTV, swing the swing voters issue

https://michaelfeuerstein.medium.com/democratic-socialism-isnt-going-anywhere-it-is-the-unfinished-argument-of-the-new-deal-44d486a3a264

Years after I first argued that democratic socialism would become a lasting force in American politics, the country is again confronting the same questions Franklin Roosevelt left unresolved: Who should benefit from economic growth, how much power should wealth buy, and what does freedom actually mean when millions of people lack economic security? where robotics/AI/Data Centers and automation are on the horizon, who will think of the working class?

When I originally wrote *Democratic Socialism Isn’t Going Anywhere*, I was trying to describe something larger than Bernie Sanders, Alexandria Ocasio-Cortez, or a presidential election. I was arguing that American politics was entering a period in which the old political center would have increasing difficulty answering the economic and technological problems confronting ordinary people. I wrote then that Americans wanted “something deeper, something bolder,” because the familiar promise of gradual change increasingly felt like “the same old, same old.”

Years later, that argument has not disappeared. If anything, it has become easier to see.

In the summer of 2026, democratic-socialist and strongly progressive candidates have continued winning consequential Democratic primaries. Democratic socialist Angie Nixon won Florida’s Democratic Senate primary despite being heavily outspent, while Reuters reported additional progressive victories that immediately revived the argument inside the Democratic Party over whether its future lies with establishment moderation or a more economically populist left. Republicans see those victories as an opportunity to portray Democrats as radical; some Democrats instead argue that the party cannot simply exile voters who are profoundly dissatisfied with the status quo.

That argument should sound familiar because it is the argument I was making years ago. “Both sides of the political American experience are pulling the center,” I wrote, predicting that the definition of the political center itself would change as the parties moved farther apart. What I underestimated was how many additional forces would accelerate that process: a pandemic, another inflationary cycle, an extraordinary housing crisis, accelerating climate disruption, renewed geopolitical conflict, the rapid deployment of artificial intelligence, the extraordinary growth of data centers, and an increasing concentration of technological and financial power.

The central question is therefore no longer whether democratic socialism will vanish when one charismatic politician leaves the stage. The better question is why the conditions producing it keep returning.

The New Deal Made a Promise America Never Finished

Franklin Roosevelt was not a democratic socialist in the modern partisan sense. He was a New Deal liberal who sought to reform capitalism rather than abolish it. That distinction matters historically, and my original article was too loose when it treated FDR almost as though he belonged to the contemporary movement. But correcting the label actually strengthens the larger argument.

Modern American democratic socialism did not materialize from nowhere. It inherited a political problem that New Deal liberalism identified but never completely solved.

By the 1930s, the United States had already learned what happens when economic power becomes concentrated while workers possess too little bargaining power and millions of families have almost no protection against unemployment, illness, old age or financial catastrophe. The New Deal responded by creating institutions that Americans now frequently take for granted. Social Security, unemployment insurance, labor protections, banking regulation and public works were not communist revolutions. They were democratic interventions intended to prevent economic insecurity from destroying political and social stability.

Then Roosevelt went further.

In 1944, he articulated what became known as the Second Bill of Rights, arguing that political rights were insufficient if citizens lacked basic economic security. The philosophical leap was enormous: freedom was not merely protection from government. Meaningful freedom also required enough material security for people to actually exercise their liberty.

That is the bridge between the New Deal and modern democratic socialism.

I wrote in the original article about “a secure healthcare system that does not profit or bankrupt those most desperate,” “a secure future where 40+ hours a week equals a living wage,” greater accountability for government and corporations, a stronger tax code, expanded Medicare and Social Security, access to higher education, environmental responsibility, housing security and democracy within economic life. Those are not accidental similarities to Roosevelt’s economic-rights vision. They represent a political lineage.

The problem is that the Second Bill of Rights never became a second constitutional Bill of Rights.

Americans received pieces of it. Social Security expanded. Medicare and Medicaid arrived. Public education expanded. Veterans received an extraordinary demonstration of what publicly supported opportunity could accomplish through the GI Bill. The National Archives notes that roughly eight million veterans received educational benefits under the 1944 law and that university degree attainment expanded dramatically in the decades that followed.

But the larger promise remained incomplete.

Healthcare never became an enforceable universal right. Housing never became one. Higher education never became one. Employment security never became one. Workers did not receive a constitutionalized right to economic democracy. Roosevelt placed the carrot in front of American politics, but generations later we are still arguing about whether people deserve to reach it.

That helps explain why democratic socialism keeps returning. It is not simply a revolt against the New Deal. In important respects, it is a revolt against the incompleteness of the New Deal.

The Carrot-on-the-Stick Politics of Economic Security

The frustration I was trying to describe in the original essay was not simply ideological. It was frustration with promises continually postponed.

I wrote what I called a “maybe moment”: maybe people were moving left because of long wars, corporate bailouts, failures on civil rights, the crime bill, college debt, unaffordable rent, inadequate healthcare, and a political establishment that seemed repeatedly able to explain why meaningful change had to wait.

Some of those arguments were too generalized. “Centrists” are not a single historical actor, and each policy deserves individual examination. But the underlying political phenomenon remains real: people lose confidence in institutions when those institutions repeatedly acknowledge problems without solving them.

That dynamic is visible again in 2026. A Reuters/Ipsos poll released this week found Democrats holding a significant advantage over Republicans on the cost of living, but it also found 37 percent of respondents either undecided or unconvinced by either party’s approach. That is an important warning to both parties. Economic dissatisfaction does not automatically belong to the left. It belongs to whoever can convincingly demonstrate that government can materially improve everyday life.

That is why Zohran Mamdani’s experience in New York is politically interesting beyond New York. His administration has deliberately emphasized visible municipal competence — fixing potholes, streetlights and other everyday infrastructure — echoing the old “sewer socialist” tradition in which left-wing governments tried to prove their case not through ideological lectures but by making public institutions work.

That may turn out to be one of the most important lessons for democratic socialism. If it wants to endure, it cannot merely promise a morally preferable future. It must demonstrate administrative competence in the present.

## “If Democracy Is Good Enough for the System, It Should Be Good Enough for the Workforce”

That line from my original article remains, to me, one of its most important arguments.

American political culture treats democracy as almost sacred inside government while often treating concentrated economic hierarchy as natural outside it. We debate representation in Congress, voting rights and judicial power while frequently accepting that institutions controlling enormous portions of people’s waking lives should operate according to radically different principles.

Yet employment determines far more than a paycheck. It can determine healthcare, retirement, where a family lives, whether parents see their children, whether someone can afford to leave an abusive workplace, whether a worker can challenge unsafe conditions, and whether technological productivity enriches employees or only shareholders.

The United States recognized this contradiction long ago. The National Labor Relations Act established legal protections for organizing and collective bargaining precisely because the government understood that workers and employers did not always possess equal bargaining power.

Modern democratic socialism extends that old labor question into a new technological economy.

If democracy is justified because concentrated political power requires accountability, why should concentrated economic power automatically escape the same philosophical scrutiny?

That does not require abolishing private businesses. It requires asking who participates in decisions, who receives the gains from productivity, who bears the risks, and whether workers possess meaningful rights inside the institutions upon which their livelihoods depend.

In my original article, I cited political theorist Robert Dahl’s argument that, if democracy is justified in governing states, serious questions follow about democracy within economic enterprises. That question is more relevant in 2026 than it was when I wrote it.

Because now the factory has become an algorithm.

I Wrote About Automation. Then AI Arrived Faster Than Politics Did.

One section of my original article has aged in an unexpectedly revealing way.

I argued that automation would become inseparable from inequality and predicted disruption across white-collar work, manufacturing, transportation and other sectors. I wrote that technology would appeal strongly to those holding economic power because machines “don’t sleep, eat, get sick, take holidays off,” and because whoever possessed enough capital to own those technologies would capture disproportionate economic advantage.

My exact employment predictions were too confident. I cited contemporary estimates suggesting that 25 to 40 percent of workers could be replaced and later wrote that 40 percent of the workforce might disappear. We now know that “jobs replaced” is an inadequate way to measure AI. Technologies automate tasks, reorganize occupations, create new forms of work, eliminate others, and shift bargaining power in ways that cannot responsibly be reduced to a single percentage.

But the more fundamental question survived intact:

**Who owns the machines, and who receives the productivity?**

Artificial intelligence has transformed that from a hypothetical question into public policy. The Government Accountability Office now maintains an AI Accountability Framework built around governance, data, performance and monitoring, because advanced AI systems create problems of reliability, transparency, oversight and responsibility that cannot simply be left to technological enthusiasm. GAO’s 2026 work also treats AI competitiveness as a national policy issue involving deliberate choices about how the technology is developed and governed.

That creates an entirely new frontier for the political argument I was making.

A democratic-socialist politics of the AI age should not be anti-AI. Trying to stop technological development would be both unrealistic and counterproductive. The question is whether society allows extraordinary productive power to become extraordinary private political power without corresponding accountability.

Who owns the models?

Who owns the data used to train them?

Who benefits when a thousand workers can be replaced or augmented by software?

Does higher productivity shorten the workweek, increase wages and improve life, or does it primarily increase returns to capital?

Who is responsible when an automated system denies employment, insurance, credit or opportunity?

Who decides which jobs disappear?

Those are no longer science-fiction questions.

They are labor questions.

They are democracy questions.

And therefore they are increasingly socialist questions in exactly the sense I meant years ago.

The Data Center Is the 21st-Century Factory

The AI debate has also exposed something that is often hidden behind the apparent weightlessness of software.

AI occupies physical space.

It requires enormous data centers, power infrastructure, transmission lines, cooling systems, water, land, semiconductors and increasingly large capital investments.

That means communities are again confronting a question that industrial towns understood more than a century ago: when a giant productive institution arrives, who receives the benefits and who absorbs the external costs?

My current position is not literally “no data centers.” That slogan is too broad. America needs computing infrastructure. AI, scientific computing, cloud services, healthcare, communications and countless other systems depend upon it.

The defensible principle is no unaccountable data-center expansion.

Communities should have the right to ask what happens to their electricity rates, water supplies, property taxes, transmission infrastructure, land use and environment. They should know what public subsidies are being granted, how many permanent jobs will actually result, what happens when the infrastructure becomes obsolete, and whether residents are subsidizing private profits.

This is the same economic-democracy question in a new costume.

The smokestack became the server rack.

The industrialist became the platform company.

The assembly line became the neural network.

The underlying question remains: Who possesses power, and who gets a voice?

America Is Still Arguing About Individualism and Collectivism

The deepest philosophical argument in my original essay was never really about Bernie Sanders.

I wrote that “the idea of America and other modern democratic societies” has involved balancing two forces: individualism and collectivism. Later I argued that pure individualism and pure collectivism each contain their own dangers and that “there must be balance.”

That remains my position.

A society obsessed exclusively with the collective can destroy conscience, autonomy, dissent and personal liberty. History provides abundant evidence of governments committing atrocities in the name of the people.

But a society obsessed exclusively with individualism can produce another kind of domination: concentrated private power capable of controlling employment, housing, healthcare, information, technology and political access while insisting that every outcome simply represents individual choice.

Real liberty requires protection against both.

The original Bill of Rights primarily restrains government power and protects individual liberties. The National Archives correctly describes the amendments as central safeguards against governmental abuse.

Roosevelt’s Second Bill of Rights asked a different question: what happens when someone is formally free but economically incapable of exercising that freedom?

A person with freedom of speech but no healthcare is still free to speak.

A person with voting rights but facing eviction still has a vote.

A worker legally permitted to quit a dangerous job but unable to survive without the paycheck technically possesses choice.

The democratic-socialist criticism is that formal liberty and practical liberty are not always the same thing.

That is not an argument against the First Bill of Rights.

It is an argument for taking liberty seriously enough to ask what material conditions make it meaningful.

The Supreme Court and the Myth That Institutions Cannot Change

The same conflict between democracy and concentrated institutional power appears in another part of American government: the judiciary.

The Supreme Court has nine justices today, but nine is not specified by the Constitution. Congress has repeatedly altered the size of the Court throughout American history. The first Court had six justices; at different times the number fell as low as five authorized seats and rose as high as ten. For part of the nineteenth century, the number of justices tracked the number of judicial circuits because Supreme Court justices literally rode circuit. Congress fixed the Court at nine in 1869. Today there are 13 federal judicial circuits while the Supreme Court remains at nine.

That does not mean there must be 13 justices, but in my opinion thier should be. There is no constitutional requirement that the numbers match.

But neither is nine some divinely ordained constitutional constant.

FDR discovered the political danger of altering the Court when his 1937 expansion proposal encountered enormous opposition, including legitimate concerns about judicial independence. Congress rejected it.

The lesson is not that reform is forbidden. The lesson is that institutional reform must be judged by whether it increases democratic legitimacy and accountability rather than merely allowing one faction to capture power.

That principle should apply equally to Congress, the presidency, the judiciary, corporations and political parties.

No institution should be above accountability merely because it is old. Its time for the number of Supreme Court justices to match the number of circuit courts.

The Democratic Party Is Still Fighting the Battle I Wrote About

My original article described a Democratic Party struggling between its establishment center and an emerging progressive left. I wrote that some Democrats viewed the moment as “a passing of the torch” while others saw it as a return to “something similar to FDR progressives.”

That argument remains unresolved.

The names have changed, but the structural conflict has not.

One faction emphasizes institutional stability, incremental reform, private-sector growth and broad electoral coalitions. Another argues that those methods have become incapable of confronting concentrated wealth, housing costs, healthcare, labor decline, climate change and corporate power quickly enough.

Neither camp can simply declare itself correct.

Progressives must demonstrate that ambitious government can actually govern.

Moderates must demonstrate that moderation can actually solve the problems voters are angry about.

And voters are increasingly unwilling to accept rhetorical victories in place of material ones.

Recent primary results suggest that progressive politics possesses real momentum in parts of the country, but not uniform national dominance. Democratic socialism has won impressive races while remaining electorally difficult in many conservative or swing constituencies. That matters. A movement claiming to represent ordinary working people cannot indefinitely remain concentrated only in ideological strongholds.

The test is not whether democratic socialism can trend.

The test is whether it can govern.

“When the Value of Things Outweighs the Value of People, You Lose the Value of Everything”

That sentence from my original article may capture the entire argument better than the political labels do.

The purpose of an economy is not merely to create things.

It is to sustain human beings.

Markets are extraordinary mechanisms for coordinating information, incentives, production and innovation. Government bureaucracies can fail spectacularly. Central planning can become inefficient, coercive and authoritarian. Democratic socialists should acknowledge those historical realities plainly.

But markets are tools, not gods.

GDP can rise while people become more economically insecure.

A corporation can become more efficient while a town becomes poorer.

AI can increase productivity while workers lose bargaining power.

A data center can generate billions in corporate value while local residents subsidize the electricity infrastructure.

A hospital system can generate profit while patients accumulate crushing debt. An economy can succeed according to one metric while failing according to another. That is why the argument over democratic socialism cannot be reduced to “free stuff.”Healthcare is not free. Education is not free. Infrastructure is not free. Social Security is not free.

Neither are corporate tax deductions, military contracts, financial rescues, intellectual-property protections, highways, courts, policing, bank insurance, agricultural subsidies or the enormous publicly financed infrastructure on which private markets depend.

The serious question is not whether society pays.

It is what society chooses to pay for, who contributes, who benefits, and who gets to decide.

The Argument Was Never Cuba Versus Capitalism

Critics frequently respond to democratic socialism by pointing to Cuba, Venezuela or North Korea.

Those cases deserve serious historical examination. Authoritarian governments, command economies, political repression and catastrophic economic policymaking should never be excused because they occurred under a socialist banner.

But pointing to North Korea does not answer whether Americans should have universal healthcare. It does not answer whether workers should bargain collectively. It does not answer whether Social Security should exist. It does not answer whether corporations should be allowed to externalize environmental costs. It does not answer whether monopolies should control essential technologies. It does not answer whether AI requires democratic accountability. And it certainly does not establish that every increase in public provision inevitably ends with dictatorship. The United States has lived for generations with a mixed economy containing private property, markets, public schools, Social Security, Medicare, public infrastructure, labor regulation, publicly funded scientific research, and private enterprise simultaneously.

The actual argument is about where the balance should sit.

That is what I meant when I concluded my original article by writing that history continually returns to “the individual vs the collective,” but that “there might be a third choice, one of balance.” I wrote that “life is not black and white, life is gray,” and argued that compromise, tolerance, empathy, and logic must remain part of the political project.

I would keep those words today.

I would simplie take them further.

Eighty Years Later, We Are Still Looking at Roosevelt’s Carrot

Roosevelt proposed his Second Bill of Rights in 1944.

More than eight decades later, Americans are still debating whether healthcare should be guaranteed, whether working full time should provide economic security, whether higher education should bury young adults in debt, whether housing should be treated primarily as shelter or an investment vehicle, whether workers deserve stronger bargaining rights, and whether extraordinary concentrations of wealth can coexist indefinitely with political equality.

Now we have added new questions Roosevelt could not have imagined.

Who owns artificial intelligence?

Who owns the data?

Who owns the robots?

Who captures the productivity gains?

Who builds the data centers?

Who pays for the electricity?

Who decides what gets automated?

Who protects workers when human labor becomes less economically necessary?

Technology changed.

The argument did not.

That is why democratic socialism is not going anywhere.

It does not survive because Americans secretly want authoritarian communism. It survives because the economic-rights argument articulated during the New Deal was never fully resolved. It survives because every generation discovers that political democracy becomes fragile when economic power becomes too concentrated. It survives because Americans continue to experience an uncomfortable distance between the liberty promised by their political system and the insecurity imposed by their economic lives.

In my original article, I wrote that I did not want to look future generations in the eye and admit that we had failed them because we “supported a system that valued things more than life.”

I still do not.

But today I would frame the challenge differently.

The objective should not be to destroy individualism in favor of collectivism, nor to destroy markets in favor of government. It should be to build institutions in which each limits the pathologies of the other: markets capable of innovation without oligarchy, government capable of collective action without tyranny, technology capable of extraordinary progress without turning human beings into disposable inputs, and democracy strong enough to exist not merely every few years inside a voting booth but wherever concentrated power determines the conditions of human life.

Perhaps that is what the unfinished New Deal was ultimately pointing toward.

Perhaps the Second Bill of Rights was not merely an abandoned political program from 1944.

Perhaps it was the first draft of an argument America is only now being forced to finish.This is not an argument that every policy labeled democratic socialist is automatically better, because political ideology cannot be scientifically proved “better” in the abstract, but there is substantial evidence supporting many of the economic and social policies associated with the New Deal, democratic socialism, and modern social democracy: workers have a federally recognized right to organize and bargain collectively, and the National Labor Relations Act was explicitly designed to encourage collective bargaining and reduce harmful labor conflict; universal healthcare systems are built around the principle that people should have access to necessary healthcare regardless of their ability to pay; progressive taxation and social protection can reduce poverty and inequality; public investment in education, infrastructure, healthcare, housing, research, clean energy, and other public goods can expand opportunity and productive capacity; concentrated economic power can translate into concentrated political power, which is why antitrust enforcement, campaign-finance reform, stronger unions, consumer protection, and democratic participation matter; Social Security, unemployment insurance, disability programs, food assistance, childcare support, and other safety nets exist because losing a job, becoming disabled, growing old, or being born poor should not mean economic destitution; climate policy and a Green New Deal approach seek to combine decarbonization with infrastructure, employment, energy security, and environmental protection; AI should absolutely have accountability because the nonpartisan U.S. Government Accountability Office has concluded that AI creates significant governance, privacy, reliability, bias, security, environmental, and societal risks and has developed an accountability framework based on governance, reliable data, measurable performance, continuous monitoring, independent assessment, and human oversight, while the OECD likewise warns that AI can increase inequality, discrimination, market concentration, and security risks if its development is not accompanied by appropriate public policy; and the same principle should apply to the physical infrastructure behind AI, because opposing uncontrolled data-center expansion does not mean opposing technology — it means demanding that new facilities demonstrate that their enormous electricity, water, land, grid, subsidy, and community impacts are justified, with U.S. Department of Energy material projecting U.S. data-center electricity demand rising from roughly 280 TWh in 2024 to roughly 530 TWh in 2028; the evidence therefore does not prove that “Democratic Socialism is scientifically better,” but it does provide a serious factual foundation for arguing that universal access to essential services, worker bargaining power, social insurance, progressive public investment, restraints on concentrated corporate power, democratic participation, environmental protection, AI accountability, and responsible infrastructure development can produce important public benefits, and that is the argument worth having instead of pretending our only political choice is Democrat versus Republican when the deeper disagreement is often over who should possess economic and political power and whether government should primarily protect concentrated wealth or give ordinary people enough economic security and democratic power to meaningfully govern their own lives. We are not angry enough about the current status of affairs for the poor, the environment, the downtrodden, and soon-to-be automated away; no job is safe. Those without health insurance or food stamps in the coming year are going to suffer and die thanks to Republican choices. It's time for a New Deal 2.0 Democracy where a living wage matches inflation and is protected along with labor, where Medicare for All is established; where LGBTQ rights are codified into law along with equal marriage, where Big Tech, Big Pharma, Big Oil, etc. are finally held accountable. Where a womans right to choose/health is respected. Where tuition-free college or trade school is covered by taxes already paid for the sake of national security, it's time for a 2nd Bill of Rights.

How do we, as a nation, transition from private insurance to Medicare for All? How do we convince all the doctors to keep being doctors and accept a salary? Do we, as Hillary Clinton proposed during Bill’s presidency did, make private healthcare payments illegal? For the record, I am perfectly fine paying a percentage of my income, as opposed to what I am paying out of pocket now, for healthcare.

on tirzepatide for a few months now through a telehealth provider. it's been changing for me - lost 30lbs, my blood sugar is normal, inflammation is way down. but the cost is just ridiculous.

im paying out of pocket because my insurance won't cover it. even though i was prediabetic and had high blood pressure. they'd rather pay for my eventual heart attack than pay for prevention apparently.

the brand name stuff is like 1000+ a month. i went with a compounded option through oztrim which is way cheaper but still adds up. and it makes me think - this shouldn't be this hard. people shouldn't have to choose between their health and their bank account.

it's wild to me that we have these medications that work and they're locked behind insane prices. meanwhile the drug companies are making billions. this is exactly why we need medicare for all.

anyone else dealing with this?

I'm posting to get more info on the question in the title because I don't recall B Sanders addressing this point. To wit, would M4A require that all US residents participate in the same plan?

In an attempt to summarize who would benefit and who would incur detriment from a transition from our current situation to M4A, I prepared an informal bar chart showing the level of medical access and cost incurred by various categories of people under the present regime and under M4A. Sorry, but I don't have a chart I can visually reproduce here.

Union members (such as the UAW):

Currently have above-average access, and likely subsidized cost.

Transtion effects: would likely experience reduced access (due to having to share access to the same number of doctors with a larger population of insured patients). Costs may rise depending upon how M4A gets funded.

Current Medicare participants:

Currently have reasonable access at a range of costs, depending on which variation of Medicare they have.

Transition effects: Medical access would likely decline due to sharing access as described above.

Wealthy patients who direct-pay: Costs will increase. Access *may* decline if M4A follows the approach of prohibiting private contracting of patients with doctors.

Patients who currently uninsured or badly insured: Access will obviously massively improve. Costs will likely be nearly nil if progressive income taxafion is used to fund the system.

The problem as I see it:

Only one of the above categories of patients clearly benefits in both access and cost from the transition to M4A. This poses a major obstacle given that our medical industry is staffed to take care of only about 80% of the population and to take *good* care of fewer than that.

My question is how politicians are going to sell a plan that may clearly benefit only about 25% of the population (i.e. category #4 above).

Look, full Medicare for All isn't happening anytime soon politically, the Overton window is moving but there is still resistance. My idea is Medicare Bookend. Adding all children under 18 to Medicare .

Kids are by far the cheapest demographic to insure, so adding roughly 70 -73 million of them to the pool instantly drops Medicare's average cost per person. Taking kids off private workplace plans would cut premiums for working families right away and eliminate all the messy state by-state Medicaid/CHIP income cliffs.

Since almost everyone agrees on protecting kids and pediatric preventive care pays off big down the line, covering both ends of life is just way easier to pitch to regular voters than trying to blow up the whole private insurance system at once. It would hugely popular to anyone pro Family .

The best part is how this actually pays for senior dental and rx coverage. Employers and families currently pay a fortune for family insurance tiers. If you take kids off those plans, you can take a small slice of what employers were already spending and redirect it straight into Medicare. Combine that new revenue with the money saved by dumping state Medicaid paperwork, and you suddenly have plenty of cash to cover senior dental, vision, and lower drug prices. You basically swap overpriced commercial insurance for a single pool, using the savings to fix the exact areas where healthcare currently fails both kids and seniors.

Other things I'd like to see in this study are: costs to individual person (patient), costs to government if involved, length of time, recovery, etc.

Put a $ amount on, say, a broken leg in the US, Canada, Germany, France, Australia, Japan, etc.

Important and yet tricky: what do those patients pay in taxes in their country.

What I think we should try to get is what it would cost in additional taxes for an American patient to get the same service they are used to, but then also what they'd save in insurance, co-pays, etc.

I'd bet the US system loses profit for private insurance, and overall people in the US save money.

I want M4A or something like it. It just seems like most people think that paying for it will be trivial or just a matter of increasing taxes on someone else. Some costs will go down, but we would also be bringing millions of currently uninsured people into the system. It is socially the right thing to do, but do we really understand how much it is going to cost?

UPDATE: Still looking for something more than a "hand waving" response. Taking all insurance company profits and using them to cover the currently uninsured would only cover maybe 20% of the bill. Shifting company paid premiums into the system doesn't add coverage for anyone, just shifts where the money comes from.

The first reason is that healthcare is an inelastic good. This means demand does not change much when prices change.

This makes this good completely different than other goods such as food or electronics or anything like that.

The other reason is that this good is by definition, anti-competitive. For most insurance companies you are often given maybe a few places that will accept your insurance within 50 miles. Meaning you have very little competition you are able to choose from. Not only that but if you live in a very rural area you might only have one location in general that you can go to within 50 miles to get a procedure done.

Which makes the American healthcare system one of the worst for prices. Because you have an inelastic good that has a very low amount of competition.

I say all of this because this puts the American consumer at a point that works actively against them. You immediately have insurance companies that have an insane level of power who purely just care about making a profit. Insurance companies purely work as a middleman to drive up prices.

The thing all about this is that it leads to the U.s as the highest healthcare costs per capita out of all the developing countries per capita. They also rank last in terms of quality of care.

There is no argument to be made as well that it is cheaper to do the U.S current system than other countries system Long term.

The thing is the republican base has said before that this is a broken system but they do not have a plan to directly fix said system. As in the famous debate moment with Trump and Kamala talking about things related to healthcare and trump said he had concepts for a plan.

This is a losing issue that democrats should focus on because republicans know they have to acknowledge an issue is there and yet they cannot propose a plan.