The Indicator from Planet Money - Medicare for All is not Medicare for All

Episode Date: August 25, 2026

As midterms near, Medicare for All is back in the spotlight and Michigan U.S. Senate candidate Abdul El-Sayed has become the newest face for it. Today, we dig into what Medicare for All would actually do and hear directly from El-Sayed on why he thinks it’s critical to figure out. Tomorrow, billionaire Mark Cuban joins the show as we continue our discussion on Medicare for All.Fact checking by Sierra Juarez.Your Next Listen — I’m just here for the health benefitsConnect with The Indicator — Sign up for The Indicator’s weekly newsletter! — Buy the Planet Money book — Find our socials, YouTube and more! — For sponsor-free episodes, subscribe to NPR+ Support public media with NPR+ and enjoy perks for over 25 podcasts like this one. This show’s perks include sponsor-free listening. Learn more at plus.npr.org. See pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences.NPR Privacy Policy

NPR. Medicare for all is a politically divisive topic. Progressive Democrats think it's a great idea. It's an improved version of Medicare. Republican lawmakers, including the president, think it's terrible. It will be the worst thing that's ever happened to you and your family. It's either the worst thing or the best thing ever, Adrian. This is the indicator from Planet Money.

I'm Adrian Ma. I'm Ricky Mulvey. And you may remember Medicare for All from some years ago. Well, it is hot in the streets again, a key issue in the Democratic primaries and a top priority for the progressive wing of the party. But what is Medicare for All? Is it what people think it is? And what would it do to our economy? Today on the show, one of the loudest voices on Medicare for All.

I dropped Abdul Al-Said Democratic candidate for U.S. Senate in Michigan. We'll see you and Abdul El-Said after the break. So what is Medicare, the current version? Fundamentally, Medicare is health insurance that the first. federal government helps pay for. It's available to Americans and some lawful residents age 65 and older. You may get it earlier if you have a disability, but it's not free. Medicare Part A is generally the free bit, but it only covers part of your inpatient hospital treatment. You still have copays. So on top of that, Medicare enrollees will have to pay for doctors insurance, dental and hearing,

preventative care annual checkups, and of course, all of the co-pays and deductibles that entails. And that's why there's even an entire industry built around extra Medicare insurance. I don't think that the people who say they want Medicare for all actually want traditional Medicare for everybody. Because traditional Medicare without any supplemental insurance or anything like that actually doesn't provide great financial protection for people. Craig Garthwaite is a professor of strategy at Northwestern's Kellogg School of Management. He wrote a paper called The Economics of Medicare for All. Craig laid out this example.

Imagine a patient who has cancer, a really expensive illness to treat. That Medicare-insured patient is still on the hook to pay for a portion of expensive drugs. So when you go to get a physician's service of which chemotherapy drug is, you pay 20% of the cost of that drug with no end. Right. And so that can add up when you're talking about drugs that are $70,000, $100,000 a year. So when you hear Medicare for All, you're hearing a proposal to upend the entire health care system in America, a proposal that would provide government-paid health care from cradle to grave. That isn't Medicare at all.

So I think really what people mean when they say Medicare for All is they want national insurance of the quality of health care they get today for free. Still, the promise of a nationalized health system with no more health insurance premiums, that's a key part of Abdul El-Said's campaign. He just won Michigan's Democratic Senate primary, and he's also an epidemiologist who co-authored a book called Medicare for All, a citizen's guide. We caught up with Abdul for a few minutes on the phone toward the end of a long day of campaigning. He sees Medicare for All not just as Medicare, but Medicare with more options.

I actually think on net Medicare for All would be substantially better for hospitals across this country. I shared with him some of the fears I have with our current system, anxiety about going to a doctor's office when the costs are unknown, those random bills that show up a few weeks after your visit. Right, you didn't know about the facility fee that's actually separate from your doctor's bill? Yeah, sorry, sorry we didn't tell you about that. It's not good.

And a dread I feel paying my health insurance premium. My wife and I spend over $900 bucks a month on just okay marketplace insurance. We're in our 30s and relatively healthy. Under Medicare for all, you'd be guaranteed public health insurance without a premium, so that goes away, without a copay or deductible, so that goes away. So you wouldn't dread being able to see a doctor if you needed one. Abdul's vision for Medicare has no more bills when you need to see a doctor for necessary medical care. You could see whatever doctor you wanted,

because rather than having to choose between the doctors, your private health insurance company negotiated with, for a sweetheart deal and a reimbursement package that benefits them both, you could go take your portable health insurance wherever you went. Yeah, you know, this is sounding like universal health care, not Medicare. Either way, Medicare for All as it's being called, means that your health insurance is no longer tied to your employer. So one economic effect would be that more Americans may be able to take a risk in their careers,

leave their job, try opening a new business. We just reported on a growing number of Americans who don't want to leave their job because they need the health insurance. Their job locked into it. We'll leave a link to that in the show notes. But a Medicare for All program would require trillions of dollars in additional federal government spending. Creating an estimate for how much this would cost is difficult. For example, a 2020 estimate from the Congressional Budget Office said that federal subsidies could be between $1.5 and $3 trillion. For context, that range is close to the total amount of money that the United States spent on Social Security in 2025. Yeah, so there's a trade-off.

Yes, taxes in some way would go up, but so could wages, since your employer wouldn't directly pay individual health insurance companies. We asked Abdul how his version of Medicare for All, one without co-pays that covers just about everything, could be funded. Abdul says the money will come from avoiding wars and closing tax loopholes. And I would rather make sure that rather than paying a health insurance company off the top of my paycheck, right, that I pay the government a little bit more for health care that is more efficient, that's not gate kept, and that's durable to me losing that job. He believes the tradeoff is worth it and says that we're paying for health care one way or another. And we can start subsidizing it in more progressive ways by asking, asking, billionaires to pay their fair share and a little bit more off the top, so everybody pays less than health care.

Still, Medicare for All is a disruptive idea. Close to 20% of America's gross domestic product is spent on health care, and that doesn't count people in the health system who spend money in the economy. And implementing nationalized health insurance would disrupt hundreds of thousands of jobs in the health care industry. But Abdul says that health insurance companies are already using AI to try to destroy many of these administrative jobs. The corporations themselves are trying to automate out these jobs.

And so, you know, I'm not under the impression that, you know, we can get Medicare for all switched over tomorrow. It's going to take a lot of political work and technical questions. He's also concerned about how health insurers will use artificial intelligence. I would much rather be in a situation where rather than a corporation using an AI to tell me what health care I can have, that we have a agency where, where it's not motivated by their bottom line with humans making sure I can have the health care I actually need to have. Did we just get a pivot? Is AI always the villain we could rely on?

Like, dang, he's good, Adrian. To his credit, though, a majority of physicians are concerned that health plans are using AI to deny more care. Craig Garthwaite, the health care economist, pointed out a negative economic effect. Drug innovation. Hospitals and drug companies generally make a higher profit margin from privately-injured. patients than those on Medicare or Medicaid. Some of this profit goes into research for new drugs. So we will just get fewer drugs.

And again, I want to be clear, that is a choice we can make. Craig thinks this is a key part of the conversation about Medicare for all. What I get frustrated about by people who support either prescription drug negotiations for Medicare or Medicare for all is this belief that is put out there that we can lower the spending and not see innovation go down. And that just is not the way that this works. For his part, Abdul Al-Said thinks that we can't just apply the rules of Medicare to Medicare for All. For example, this new program would have to change how it pays medical providers. That's part A of our Medicare for All story. Part B comes tomorrow. Are we ready for Medicare

for All? Do we need a different medicine first? The challenge is the lack of of information. That is Mark Cuban, billionaire entrepreneur, firmer shark, and now a health care executive. He continues the conversation tomorrow. This episode was produced by Cooper Katzum Kim and engineered by Cina LaFredo. It was fact-checked by Vito Emanuel. Kickin Canon is our show's editor and the Indicator's production of NPR.