Editor's Note: The following is the second excerpt from Nancy J. Altman's latest book, The Road to Medicare for All: A Call to Action (Routledge, 2026), now available for purchase wherever quality books are sold. Read the first excerpt published by Common Dreams here. As the United States continues to spend substantially more on health care than other wealthy nations but with poorer health outcomes, Altman's book analyzes the dysfunction of the current system and sets forth the solution. "Medicare for All won’t happen without a fight," she argues, "but it is a fight we can win."

Imagine having more money in your pocket. Imagine being able to see any doctor you want without checking whether the provider is in your network and covered by your insurance. Imagine having more time with your doctor and, at the end of the appointment, simply walking out the door without having to take out your wallet or even ask what you owe for the visit. Imagine being free of filing insurance claims. Imagine being able to simply get any medicine your doctor prescribes without discovering it is exorbitantly expensive and asking your doctor what, if anything, they can prescribe that is covered by your insurance. Imagine no such thing as medical debt. Imagine simply getting the care, procedures, hospital stays, therapies, and medications your doctor prescribes with your only focus and thought being on how to restore and optimize your health. That is what you will experience.

Where is that destination? It is tantalizingly close. In fact, those who, on average, have the greatest medical needs—seniors and people with disabilities—are already almost there. Medicare, having recently celebrated its 61st anniversary, is well known to Americans. Most people are either covered by Medicare or know someone who is. It already covers Americans from age 65 to the grave. To reach the destination that health care is a right, not a privilege, with all those imaginations a reality, it has to be extended back to the cradle and improved, so that its coverage is completely comprehensive and available without premiums, co-payments, co-insurance, or deductibles. (To be clear, the destination is the expansion of traditional Medicare, not privatized Medicare—the deceptively named Medicare Advantage—whose serious shortcomings are discussed throughout this book.)

Medicare, which currently covers only seniors and people with disabilities—those who, on average, have the highest healthcare costs—does so more efficiently, comprehensively, and fairly than commercial insurance does, or indeed can. Medicare is the most important birthday gift those turning age 65 get. Too many Americans in their late fifties and early sixties lack adequate health insurance and desperately seek to hang on until they reach that special birthday that brings Medicare. As important as Medicare is, though, it should be improved. As Chapter 3 explains, soon after Medicare was enacted and expanded to people with disabilities, the most powerful forces organized against it. They succeeded in stopping further expansion of its coverage and the services and treatment it provides. They also stood in the way of reducing the costs of those it covers.

As important as Medicare is... it should be improved.

On the road to Improved Medicare for All, traditional Medicare should be expanded to cover all essential services. As the nation is driving toward Improved Medicare for All, traditional Medicare should be expanded to cover all safe and effective prescription drugs, also. Under the current system, without Medicare simply covering all safe and effective prescription drugs automatically at no cost, beneficiaries must repeatedly answer the following impossible, ludicrous questions: What illnesses will you contract next year? What medications will your doctor prescribe to treat those yet-to-be-contracted illnesses? Only if you know the answers to those unanswerable questions, can you intelligently decide, in today’s dysfunctional system, which insurance plan has the right drug formulary or list of covered drugs at a price you can afford.

Expanding traditional Medicare to cover all prescription drugs will mean that people can fill all of their prescriptions without worry about their cost. In addition, Medicare should be expanded to cover long-term care—both care at home and in nursing homes.

If Medicare were expanded to cover in-home services and supports as well as nursing home care for those who had no other alternatives, people who were able could age at home, as most want, with the security to know that they would not be a financial burden to those they love. An expanded Medicare for All would meet Americans’ needs today and their unforeseeable needs in the future. As it does today for seniors who have traditional Medicare, it would pool risk among everyone so that everyone is protected; people with costly and complex medical conditions would not be saddled with huge costs.

Under today’s patchwork system, out-of-pocket costs in the form of deductibles, co-pays and co-insurance force people into the arms of commercial insurance, whether they like it or not. Those with traditional Medicare must buy, if they can afford it, private supplemental insurance, colloquially known as Medigap, since traditional Medicare lacks an overall cap on out-of-pocket expenses. Those who can’t afford Medigap may be forced to purchase an inadequate Medicare Advantage plan which includes an overall cap, one more thumb on the scale placed by those who are hostile to single-payer health insurance.

With comprehensive coverage, without co-pays, co-insurance, deductibles, or premiums, there will be no need for supplemental, so-called Medigap, private insurance. We do not pay out of pocket for public libraries, schools, fire protection, or the military. Rather, those services are paid from taxes. We should not be required to pay out of pocket for health........

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