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By Chuck Pennacchio
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America’s healthcare crisis is no longer a mystery, and it is certainly not a problem of insufficient wealth.
We are spending enough to cover everyone, yet Americans still go bankrupt, postpone treatment, remain reluctant to leave jobs because doing so could mean losing health insurance, and die because care is priced beyond their reach.
The real scandal is that we know how to build a better system, and yet we continue choosing not to.
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A Yale-led preprint modeled a national public insurance program similar to Medicare for All and estimated that it could reduce annual national health expenditures by $1.04 trillion, or nearly 20 percent of 2024 spending. The model projected that universal coverage itself could avert about 62,900 deaths annually.
Its central projection is eye-catching: the researchers estimate that America could provide universal coverage while spending less overall than it does today.
According to Centers for Medicare & Medicaid Services (CMS) data, national health expenditure reached $5.3 trillion in 2024, 0r 18 percent of GDP. The American Hospital Association estimates that administrative staff and technology account for 25 percent to 35 percent of all healthcare spending.
Critics argue that this fragmented system can prioritize corporate interests over patient care, leaving many working-age adults underinsured and leading many to delay or forgo needed medical care due to high out-of-pocket costs, which can contribute to preventable deaths every year.
That should infuriate every American, regardless of party or ideology.
And healthcare is only one part of the larger emergency. You cannot create a healthy society while people lack nutritious food, stable housing, quality education, worker rights, or the economic security necessary to live with dignity.
Even the finest healthcare system will be forced to treat the consequences of a society that keeps making people sick.
Growing Frustration
This is why I have grown increasingly frustrated with the way our movements operate.
Organizations fighting for healthcare, housing, food security, education, labor rights, and democratic reform too often work in separate silos, competing for scarce resources while the profit-first medical industries continue to expand their stranglehold on our healthcare system.
Meanwhile, corporate and billionaire money exerts extraordinary influence over both major political parties, narrowing the boundaries of what elected officials are willing to fight for.
Bold reforms are routinely dismissed as unrealistic, not because they cannot work, but because they threaten entrenched power. If we accept that arrangement, the future is not difficult to predict.
Healthcare costs will continue consuming household budgets. Small businesses will continue to face challenges from the cost of providing health benefits, while businesses in countries with different healthcare financing systems face different cost structures.
Workers will stay chained to jobs because changing careers risks losing coverage. Tragically, more Americans will carry insurance cards while discovering, at the moment they need care, that coverage is not the same thing as access, especially as some communities lose hospitals, services and healthcare providers.
But there is another path.
The Alternative
Imagine an America where necessary medical care is available when you need it, without deductibles standing between illness and treatment.
Imagine entrepreneurs free to start businesses without gambling with their families’ health coverage. Imagine employers able to compete without acting as insurance brokers.
Imagine our political and social movements joining forces around a simple proposition: in a wealthy democracy, basic human needs should not be luxuries.
This is not fantasy. America has built transformative institutions before. The New Deal, Social Security, Medicare, and Medicaid did not emerge because powerful interests suddenly became generous.
They happened because people developed a vision, organized around it, built political power, and demanded change.
We must do the same now.
That means both remembering our past successes and thinking beyond the next election cycle.
What We Need
We need a long-term vision for the country we intend to build, then the discipline to work backward from that destination.
We need focused strategic leadership, decentralized grassroots power, and state-by-state organizing capable of adapting to local realities while advancing shared national goals.
Stop waiting for politicians to rescue us. They will not act boldly until we make the cost of inaction greater than the cost of confronting their donors.
Healthcare advocates cannot fight alone, and neither can housing organizers, labor unions, food security advocates, educators, or defenders of democracy.
We must stop competing in separate silos and build a movement around what connects us: the belief that in the richest country in the world, people should not have to earn the right to live with dignity.
The work begins where people have the greatest ability to build power: in the states.
Organize locally. Build alliances across movements. Develop leaders. Elect candidates who answer to people, not corporate money. And use state-by-state victories to force national change.
We can continue accepting a country where illness destroys families and wealth buys political power. Or we can organize to build one where healthcare and the basic conditions for a healthy life are guaranteed.
Chuck Pennacchio co-founded Healthcare for All Pennsylvania, leads the One Payer States network as president, and is the organizer and strategist for the Arc of Justice Alliance.
The views expressed in this article are the writer's own.
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