In Phoenix, Arizona, Don Ameden lost his job as a driver for a tourist bus service in July 2018 after he spent a month in a hospital following an emergency surgery during a route in California. 

“I had to get a bus ride back to Phoenix with an open wound from surgery. When I got here, I found out the company let me go,” Ameden shared. 

Unable to work, jobless, and in need of post-surgical care, Ameden found himself evicted from the room he was renting at the time. Since then, he’s stayed in homeless shelters in the Phoenix area while working for an airline catering company.

Ameden currently purchases health insurance coverage through his employer, LSG Sky Chefs, but can’t afford the copays he’s charged to receive care for Type 2 diabetes and heart issues as often as he requires it. 

“I avoid going to the doctor because it costs so much,” he added.

Health care is one of the most important issues for voters across the United States because of growing issues with the American health care system.

Six-in-ten Iowans, who participated in the Iowa Caucuses, said they supported the elimination of private health insurance.

But much of the debate within the Democratic presidential primary has focused on criticizing and dismissing “Medicare For All,” which would create a national health insurance program where the government became the single-payer for health care.

Millions of Americans cannot afford the costs of health care in the United States, even with health insurance coverage. Over 80 million Americans have inadequate or no medical insurance coverage at all.

Every year, more than 500,000 Americans, who file bankruptcy, cite medical debt as a contributing factor. Each year, more than 250,000 Americans rely on GoFundMe campaigns to help cover medical expenses.

Polls repeatedly show millions of Americans avoid or delay medical care due to the costs, and most Americans report struggling at least once with financial hardship due to medical care. 

Despite the fact that the U.S. spends by far the most money on health care than any industrialized nation, the  country lags behind other industrialized nations in health outcomes and remains the only industrialized nation in the world without universal health care.

Health care spending is expected to increase substantially. Meanwhile, corporations in the U.S. health care industry continue to report record profits. 

“When you have a system where profit is the goal, the only way to make that profit is to deny care. That’s what we’ve seen over the years” said Jean Ross, a co-president of National Nurses United (NNU) who has been a nurse for 45 years.

NNU is the largest nurses union in the U.S., and it has led a grassroots Medicare For All campaign over the past several years.

Ross contended, “What we have right now is unsustainable. It’s imploding. We already have one of the most unequal societies on Earth and health care is a huge part of it. It’s beyond tweaking. You don’t tweak a bad system. You replace it.“

This would provide universal health care coverage and eliminate bureaucratic costs in the health insurance industry, including the copays, deductibles, and premiums currently paid by those with private health insurance.

The plan was a hallmark of Senator Bernie Sanders’ 2016 presidential campaign, which helped galvanize national support for the proposal.

“Call me simplistic, but I think when you put forward a plan, you ought to put forward how to pay for it, too,” South Bend Mayor Pete Buttigieg told reporters about Sanders’ Medicare For All plan.

Former Vice President Joe Biden repeated similar criticisms while campaigning in Iowa: “Well, that’s not a likely way to pass something through the Senate, saying, ‘I don’t know how much it’s going to cost.’”

Indeed, Sanders noted the exact costs of Medicare For All are unknown, but critics omit the context of the response. His remark was a response to CBS anchor Norah O’Donnell during a January interview.

“You don’t know. Nobody knows. This is impossible to predict.” Sanders added in a follow-up question on whether he would provide the costs of the plan. “Do you know exactly what health care costs will be, one minute, in the next ten years if we do nothing? It will be a lot more expensive than a Medicare For All single-payer system.”

As former Harvard Medical School faculty member Dr. Donald Berwick stated in an op-ed for USA Today, “The cost would depend on many implementation decisions that Vermont Senator Bernie Sanders’ bill, for example, leaves open for thoughtful exploration, careful choice, and adjustments over time: payment rates to hospitals and doctors, content of the benefit package, details of price negotiations with drug companies, design of simplified administration, and more.” 

Along with Biden and Buttigieg, Medicare For All has been consistently criticized as “too expensive” and “unrealistic” by billionaire Koch-funded researchers, former Wisconsin Republican Governor Scott Walker, the Republican National Committee, and anti-Medicare For All group, Partnership for America’s Healthcare Future, an alliance of health insurance and pharmaceutical industry lobbyists. 

Industry-backed critiques steer discussion away from the rising costs of the current and inherently cruel system, where millions of Americans are denied or face financial burdens to afford life-saving medical treatment.

As Sanders previously stated, the answer to the persistent question of “how are you going to pay for it?” is “we already are.”

Deborah Burger, president of the California Nurses Association and co-president of NNU, declared, “We are already spending the money. It’s just the fact we’re giving a huge chunk of our health care dollars, anywhere from 20 to 30 percent of our health care dollars, to a middle man that doesn’t provide any real health care service other than trying to make sure patients don’t receive treatment their own doctors recommend.”

According to NNU, grassroots organizers focus on personal experiences with the U.S. health care system in mobilizing and rallying support for Medicare For All. The union’s campaign often relies on nurses from Canada, the United Kingdom, and other countries with universal health care to explain to Americans through town halls what a Medicare For All system could look like. 

“It makes those corporate interests defend the existing system by helping people see they’re not alone in the problems they’re having with health care,” argued Jo Beardsmore, an adviser from the U.K. to the NNU’s Medicare For All campaign. “We know from history the only way you achieve positive change is by concerted organized action from the grassroots.”

Filiberto Lares Cordova, another airline catering worker in Phoenix, Arizona, recently had to travel to Mexico with his daughter to have gallbladder surgery because he couldn’t afford to pay for it in the United States, even after paying $500 monthly premiums to cover his family. 

“Here in the US, for a hospital stay of one day, I paid $7,000 with health insurance. I’m still paying monthly payments to cover that,” Cordova said. “There I spent $5,000 for a complete surgery, medicine, and over a week in the hospital. It’s a lot cheaper.”

In Los Angeles, California, Margarita Hernandez went years without any health insurance coverage because she couldn’t afford it, but she recently was forced to purchase coverage through her employer after she developed severe liver problems. 

“I didn’t have health care because I couldn’t afford it. I wasn’t able to receive preventive screenings or exams. I don’t make enough money, but I have no other choice but to buy my employer’s health insurance because I’m facing all these health issues, ” Hernandez shared.

Hernandez pays a little over $50 every week in premiums, and she still pays 20 percent of her bill as copays. She is required to meet a $1000 copay to receive out-of-network treatment.

Under “Medicare For All,” private health insurance would be eliminated, and in doing so, excessive costs associated with maintaining the for-profit industry would disappear. 

“Those who claim that Medicare for All is too expensive are simply not being honest about what we are currently spending and what we will spend to maintain the most expensive health care system in the world that, sadly, does not produce the healthiest residents,” said Lindsey Sabadosa, a state representative in Massachusetts who is co-author of a state bill to create a single-payer, Medicare For All system for Massachusetts. 

State Representative Paul Mark, the other co-author of the Massachusetts single-payer bill, emphasized Medicare For All would have benefits for local economies. 

“When someone is paying out of their paycheck every week for a deductible or paying out of pocket for an office visit or to fill a prescription, that’s money that is effectively being removed from the local economy,” Mark said. “When we talk about the costs it is essential that the total costs are examined as they are now and how they would be under an improved system, and that means public money now being spent on health care but also private economic activity that would be unleashed by reducing the non-tax related health care burden families are facing today.”

A study from a Koch Brothers-funded think tank estimated costs of reform would total $32.6 trillion over 10 years, less than what the U.S. spends annually on health care (Note: Costs were $3.5 trillion in 2017. So, over ten years, that would be $35 trillion, without taking into account significant and constant increases in health care costs under the current system). 

The same study showed “Medicare For All” would save $5.1 trillion over a ten-year period, a conservative savings estimate based solely on eliminating excessive administrative costs within the private health insurance industry. In fact, in 2017, health insurance providers spent $800 billion, or nearly $2,500 per person, on administrative costs.

“When critics talk about [how] we’re going to spend trillions of dollars in health care for ‘Medicare For All,’ we’re already paying for that. What will happen is when we transition to ‘Medicare For All’ [spending] will go to providing real access to health care, not health care insurance,” Burger concluded.