{"id":811,"date":"2026-07-24T10:37:58","date_gmt":"2026-07-24T10:37:58","guid":{"rendered":"https:\/\/americanlivingreport.com\/?p=811"},"modified":"2026-07-24T10:37:58","modified_gmt":"2026-07-24T10:37:58","slug":"the-big-healthcare-fight-democrats-keep-dodging","status":"publish","type":"post","link":"https:\/\/americanlivingreport.com\/?p=811","title":{"rendered":"The big healthcare fight Democrats keep dodging"},"content":{"rendered":"
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Abdul El-Sayed is among America\u2019s most prominent proponents of Medicare-for-all.<\/p>\n<\/div>\n

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The frontrunner in Michigan\u2019s Democratic Senate primary literally wrote the book on that policy (or at least, a<\/em> book on it). In El-Sayed\u2019s view, Medicare should cover \u201call necessary healthcare\u201d for every American \u2014 without co-pays, premiums, or deductibles \u2014 and be \u201caccepted everywhere.\u201d<\/p>\n

Read more How Israel lost the Dems<\/a><\/p>\n<\/div>\n

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Alas, despite his many years of advocacy, El-Sayed has seemingly failed to persuade his wife of that last point: According to a recent report from the Washington Free Beacon, El-Sayed\u2019s partner, the psychiatrist Sarah Jukaku, does not accept Medicare as a form of payment at her private practice.<\/p>\n<\/div>\n

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This bit of gossip is of little importance, in and of itself. The Free Beacon\u2019s story does nothing to refute the case for El-Sayed\u2019s candidacy or his healthcare plan (his wife\u2019s business is, well, her business). As hit pieces go, it\u2019s weak tea.<\/p>\n<\/div>\n

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Nevertheless, the tension between El-Sayed\u2019s healthcare proposals and his wife\u2019s business practices is real. And it is illustrative of a major challenge facing anyone <\/em>who wishes to reform our nation\u2019s misbegotten healthcare system: To meet the medical needs of all Americans, reformers will need to defy the interests of most doctors \u2014 and in many cases reduce their compensation.<\/p>\n<\/div>\n

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And that won\u2019t be easy. Few people feel a deep fondness for insurance companies. But El-Sayed is far from the only American who loves a physician.<\/p>\n<\/div>\n

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The biggest obstacle to Medicare-for-all<\/strong><\/h2>\n<\/div>\n<\/div>\n
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To understand why Medicare-for-all would be bad news for many doctors \u2014 and how the Free Beacon\u2019s story illustrates that point \u2014 we must first dwell on one fundamental fact about America\u2019s healthcare system: It\u2019s a rip-off.<\/p>\n<\/div>\n

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The US spends about twice as much per person on medical goods and services as other wealthy countries. And yet, all that money does not actually buy us much more care. Compared to our peers abroad, Americans are less likely to see a doctor, secure a long hospital stay, or access a timely appointment for medical treatment. On the other hand, we do have the privilege of paying radically<\/em> higher healthcare prices.<\/p>\n<\/div>\n

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To take just one telling example: In the United States, a coronary bypass surgery will typically cost more than $89,000; in Australia, it costs just $17,741.<\/p>\n<\/div>\n

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Such exorbitant prices are the chief obstacle to any <\/em>version of universal healthcare. Even with one-third of working-age Americans uninsured or underinsured \u2014 and thus, consuming too little medical care \u2014 the bill for America\u2019s health sector ran to $5.7 trillion in 2025.<\/p>\n<\/div>\n

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In El-Sayed\u2019s vision, Americans would consume vastly more medical services than they do today: The uninsured would suddenly have access to every doctor in the country, while everyone else would see their co-pays and deductibles drop to zero, encouraging them to schedule far more doctors\u2019 visits.<\/p>\n<\/div>\n

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This would be a costly proposition in any country. At America\u2019s current healthcare prices, it would be prohibitively expensive. There is simply no way to realize anything approaching the left\u2019s healthcare ambitions without slashing the amount of money that Americans pay per medical service.<\/p>\n<\/div>\n

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Doctors will pay a price for universal healthcare<\/strong><\/h2>\n<\/div>\n<\/div>\n
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Medicare-for-all advocates are aware of this fact. And they\u2019re typically eager to talk about one<\/em> source of America\u2019s high healthcare prices: The inefficiencies of our private health insurance model.<\/p>\n<\/div>\n

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In America\u2019s byzantine system, each insurer needs its own teams of auditors, claims reviewers, and myriad other specialists, while every major healthcare provider needs a horde of administrators to navigate the idiosyncratic rules of all these different insurance companies. Americans pay dearly for this bureaucratic bloat. By one estimate, our system\u2019s administrative costs are $500 billion higher than they would be if the insurance industry was consolidated into a single public insurer.<\/p>\n<\/div>\n

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And yet, as large as that figure may seem, it still represents a fraction of America\u2019s excess healthcare costs. The primary cause of our nation\u2019s exorbitant medical prices is simpler than administrative redundancies: our healthcare providers charge exceptionally high rates.<\/p>\n<\/div>\n

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Hospitals are the biggest culprits on this front. But physicians are also part of the problem.<\/p>\n<\/div>\n

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According to a from economists at the University of Chicago, Stanford, and the US Census Bureau, American physicians earn about twice as much as Canadian ones \u2014 and four times as much as Swedish doctors.<\/p>\n<\/div>\n

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Critically, this does not merely reflect America\u2019s greater wealth or wage inequality. It is true that educated professionals of all kinds \u2014 financial analysts, lawyers, software engineers, etc. \u2014 earn more in the US than they do in other rich countries. But American doctors don\u2019t just earn unusually high absolute incomes \u2014 they also occupy an atypically rarified place within their own country\u2019s class hierarchy. About 42 percent of American specialty physicians are in the top 1 percent of their nation\u2019s income earners. Among Canadian specialists, that figure is just 27 percent; for Swedish ones, it is 7 percent.<\/p>\n<\/div>\n

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The main driver of these disparities is straightforward: America imposes fewer price controls on its healthcare sector than other nations do.<\/p>\n<\/div>\n

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And this is where Jukaku\u2019s practice reenters the picture.<\/p>\n<\/div>\n

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The public parts of America\u2019s insurance system \u2014 Medicare and Medicaid \u2014 pay rates that are only modestly above international norms. It is when American doctors bill private insurers \u2014 or the rich consumers of boutique medicine \u2014 that they really make bank.<\/p>\n

Read more Did Trump just kill his own nuclear deal?<\/a><\/p>\n<\/div>\n

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As a result, top clinicians like Jukaku often decline to take Medicare. If you\u2019ve got affluent patients beating down your door, accepting Uncle Sam\u2019s rates just doesn\u2019t pay.<\/p>\n<\/div>\n

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Unless the government forces doctors and hospitals to swallow steep pay cuts, however, Medicare-for-all won\u2019t pencil out. According to a widely cited 2018 analysis by the economist Charles Blahous, if a single-payer system kept provider payments constant, national health spending would rise by $3.25 trillion over a decade, even with administrative savings taken into account. By contrast, if all providers were forced to accept Medicare\u2019s rates, health spending would actually fall<\/em> by $2.05 trillion over the same period.<\/p>\n<\/div>\n

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Soaking physicians is tough politics<\/strong><\/h2>\n<\/div>\n<\/div>\n
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Thus, there is a clear conflict between progressives\u2019 healthcare ambitions and medical providers\u2019 material interests.<\/p>\n<\/div>\n

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Yet the left is often reluctant to acknowledge this reality. El-Sayed tends to portray insurers as the sole economic beneficiaries \u2014 and political defenders \u2014 of America\u2019s inequitable healthcare system. The fact that hospitals and doctors also profit off the status quo\u2019s dysfunctions does not feature prominently in his rhetoric. To the contrary, El-Sayed suggested in 2020 that doctors like his wife are actually underpaid<\/em>, even though American psychiatrists earn far higher salaries than their counterparts abroad.<\/p>\n<\/div>\n

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To be fair, progressives aren\u2019t alone in eliding providers\u2019 culpability. Virtually all Democratic politicians do the same. And not without reason. Politically speaking, it is one thing to denounce the greed of private insurers \u2014 the faceless bureaucracies standing between Americans and their desired treatments. It\u2019s quite another to call for reducing the wages of doctors, men and women who perform laudatory work and enjoy widespread admiration.<\/p>\n<\/div>\n

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Precisely for this reason, however, reformers must grapple with healthcare providers\u2019 investment in the current system. The American Medical Association (AMA), the lobby representing our nation\u2019s physicians, was instrumental in killing past attempts to move toward single-payer. And at least some segments of the medical profession would surely mobilize against any contemporary Medicare-for-all bill that imposed substantial cost controls on the healthcare sector. What\u2019s more, in doing so, they would be able to draw on a resource the private insurance industry lacks \u2014 the public\u2019s trust.<\/p>\n<\/div>\n

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How to make healthcare less expensive right now<\/strong><\/h2>\n<\/div>\n<\/div>\n
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There is no easy answer to the problems all this presents. But part of the solution is to chip away at providers\u2019 payment rates where progressives already have the power to do so. This would not only help drive down costs for existing healthcare in the short term, an urgent priority all its own, but also would smooth the path to universal coverage in the long run.<\/p>\n<\/div>\n

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That project can take many forms. One would be state-level payment regulations. In Maryland, hospitals receive the same rates, no matter whether their patients pay with Medicare, private insurance, or cash. And their budgets are also fixed, so that they aren\u2019t able to milk fees out of unnecessary care. Rhode Island, meanwhile, caps the growth of its hospital reimbursement rates at the pace of overall inflation. Other states could follow their lead.<\/p>\n<\/div>\n

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But policymakers should also address the supply constraints that undergird American doctors\u2019 high salaries. US physicians\u2019 ability to command high pay doesn\u2019t just reflect America\u2019s weak cost controls but also a persistent shortage of working doctors. The US has roughly 2.7 physicians for every 1,000 of its residents; the average among comparable countries is 3.9, according to a Kaiser Family Foundation analysis.<\/p>\n<\/div>\n

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In this context, forcing down doctors\u2019 pay might seem perilous. After all, doing so would reduce young people\u2019s incentive to pursue a medical career, potentially deepening the shortage.<\/p>\n<\/div>\n

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In reality, however, there is no dearth of qualified people who want to practice medicine in the US. We just don\u2019t let many of them do so.<\/p>\n<\/div>\n

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This is partly because American policymakers consciously sought to restrict<\/em> the number of doctors in the country, beginning in the 1980s. As Robert Orr of the Niskanen Center explains, the US government issued a report in 1981 warning of an imminent \u201cphysician surplus\u201d and recommending \u201cimmediate action to curtail both the domestic training of physicians as well as the admittance of those trained outside of the country.\u201d<\/p>\n<\/div>\n

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The report\u2019s argument rested on false premises; it failed to anticipate that Americans\u2019 demand for healthcare would rise sharply as they grew wealthier. Nonetheless, its recommendations were largely implemented: Federal support for medical-school scholarships was pared back while funding for residencies has been capped since 1997.<\/p>\n<\/div>\n

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At the same time, policymakers maintained high barriers to the immigration of fully-trained foreign doctors: Even physicians with years of experience, and credentials in nations with high medical standards, are typically required to complete a multi-year residency before being able to practice in the US.<\/p>\n<\/div>\n

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Ending the federal freeze on residency funding will require congressional action. But states can immediately make it easier for foreign doctors to practice within their borders. In fact, Tennessee established a pathway for such physicians to ply their trade in the state, without having to repeat a residency, in 2023. And many states.<\/p>\n<\/div>\n

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Removing the bottlenecks on America\u2019s doctor supply won\u2019t eliminate the political hurdles to Medicare-for-all. But it would put downward pressure on doctors\u2019 salaries, reduce the risks of capping physician pay, and make the left\u2019s vision of healthcare abundance more feasible. After all, you can\u2019t actually eliminate the care rationing that so many Americans resent by extending insurance coverage or enacting price controls alone. No matter how we pay for our medical services, we can only deliver as much care as our health sector\u2019s resources allow.<\/p>\n<\/div>\n

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Don\u2019t hate the doctor, love the sick<\/strong><\/h2>\n<\/div>\n<\/div>\n
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In saying all this, I don\u2019t mean to convey disdain for the medical profession. Like El-Sayed, some of my best friends are doctors! In fact, my mother, father, brother, and sister-in-law are all physicians. And they all have contributed far more to American society than I ever will. My brother spends his workdays providing lifesaving treatments to cancer patients; I often spend mine sitting at a desk in my pajamas, arguing about politics on the internet.<\/p>\n<\/div>\n

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Physicians deserve to be well-paid for their strenuous labor. But if we want healthcare in America to be universally affordable and widely accessible, we will need to pay many of them a bit less.<\/p>\n

Read more So is the lettuce bad or not?<\/a><\/p>\n<\/div>\n

See More:<\/span><\/p>\n
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  • Health Care<\/li>\n
  • Policy<\/li>\n
  • Politics<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

    Abdul El-Sayed supports Medicare-for-all. Yet his wife\u2019s medical practice doesn\u2019t take Medicare. 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