As policy-wise and popular as Improved Medicare for All is, the nation may appear to be as far away from enacting Improved Medicare for All as possible. During his first term, Trump did what he could to accelerate the privatization of Medicare. Unfortunately, his thumb on the scale in favor of privatized Medicare is not only back, but is on steroids.

Adding to the sense that the nation may be as far away from Improved Medicare for All as possible, the Republicans enacted legislation that is projected to cause 15 million people to lose their health insurance. Adding to the sense that we are nowhere near enacting Improved Medicare for All, the two prior presidential elections, in 2016 and 2020, saw Senator Bernie Sanders (I-Vt.) and Senator Elizabeth Warren (D-Mass.), two leading champions of Medicare for All, lose in the primary to the more centrist candidate Hillary Clinton, in 2016, and Joe Biden, in 2020. Trump defeated Clinton and won a second term in 2024 against Vice President Kamala Harris. Though Harris did not mention the fact in her presidential campaign, she was an original cosponsor of the Sanders-authored Medicare for All Act.

Trump’s election to a second term, the Republican control of Congress (as these words are written), and a Supreme Court with two-thirds of the justices who are acting as Trump advocates rather than independent jurists appear to suggest that the nation is moving away from national health insurance. But it is crucial to recognize that today is only a snapshot in time. The pessimistic view that we are moving in the wrong direction sees only the waves at the surface. It misses the subterranean tremors underneath. The Republican cuts to health insurance are already putting a strain on rural and inner-city hospitals, as well as nursing homes. The nation is seeing hospitals close as a result of the enactment. Their closure, in turn, strains even those hospitals and nursing homes not directly affected by the cuts.

Improved Medicare for All won’t magically become a reality. It will take all of us who support it to fight for it, in small and large ways.

With the cost of health care rising and, with it, increased insecurity, a majority of the electorate are concluding that the nation is moving in the wrong direction. Perhaps even more significantly, it will become clearer and clearer that the current path is unsustainable.

Importantly, two action-forcing events requiring Congressional legislation are on the horizon. Social Security and Medicare Part A, by law, can only pay benefits if they have sufficient dedicated revenue to cover their costs. To avoid an automatic across-the-board reduction of around 20 percent of the monthly Social Security benefits received by more than 70 million beneficiaries, and to avoid hospitals no longer being reimbursed, Congress must act. However the precise dates shift over the next few years, Congress unquestionably will have to act in the next half decade or so, before the revenue is insufficient to continue to pay full benefits.

Those action-forcing events provide an opportunity. Because those action-forcing events will result in must-pass legislation, provisions that expand Medicare, as well as Social Security, could be included. To make that a reality, though, it is essential that those who support Improved Medicare for All are fully prepared.

Improved Medicare for All won’t magically become a reality. It will take all of us who support it to fight for it, in small and large ways. The wonderful news is that determined activists are currently working hard to make Improved Medicare for All the law of the land. Building a winning coalition and other steps are already underway.

It is imperative that a winning coalition is built strong enough to defeat those who will fight against Improved Medicare for All. Physicians have been extremely active politically since the United States first started to seriously debate universal health insurance at the start of the twentieth century. Initially, the American Medical Association, whose members in 1910 comprised more than half the doctors in the nation, endorsed the legislation under consideration. Individual doctors, however, strenuously objected and made those objections known through their state medical societies. As a result, in 1920, the AMA’s House of Delegates formally voted to reverse its support, and instead opposed the initiatives.

While the AMA has been a staunch opponent ever since, that may be changing. Though the AMA has opposed national health insurance for over a century, doctors have much to gain from it. The image of the self-employed family doctor who makes house calls is virtually an anachronistic image. Today, around four out of five physicians – 77.6 percent – work for corporations. Historically, doctors have expressed concern over government oversight and interference. More and more, though, physicians’ reality is that they now live under commercial insurance oversight and interference. Unlike elected officials for whom Americans vote and whose salaries are set and paid transparently from public funds, doctors have no say over who runs private insurance companies and how they are operated.

A survey of doctors conducted by the Chicago Medical Society found that 66.8 percent had favorable views of a single-payer system.

The doctors most active in support of Improved Medicare for All are the leaders and 25,000 members of Physicians for a National Health Program (PNHP). They have provided a clear and steady voice on the issue since their founding in 1987. In part because of PNHP’s sustained effort, doctors seem to be moving toward support for Improved Medicare for All. A survey of doctors conducted by the Chicago Medical Society found that 66.8 percent had favorable views of a single-payer system. In fact, when asked to choose between Medicare for All and an improved Affordable Care Act (colloquially known as Obamacare), the doctors chose Medicare for All by two to one!

The increasing support among doctors for Improved Medicare for All is likely in large part a response to how vexing and inadequate the current system is for all participants, including doctors. The increasing support for Improved Medicare for All may also reflect a more diversified pool of physicians. When Medicare was enacted in 1965, doctors were overwhelmingly white men, who tended to identify as Republicans. Accordingly, the AMA gave the majority of its campaign contributions to Republican candidates. Ninety-four percent of the medical students at that time were men. Only 2.5 percent of practicing physicians were African-American, generally having been trained in segregated settings. An even tinier 0.2 percent of medical students were Hispanic or indigenous at that time.

In contrast, women comprised 55.1 percent of the entering classes in accredited medical schools across the country for academic year 2024-25. That was the sixth year in a row that women made up the majority of medical school students. They comprised 54.9 percent of total enrollment. African-Americans comprised 10.3 percent of total enrollment, and Hispanics, 12.3 percent. In 2021, more than one out of four surgeons and other physicians – 26.5 percent – were foreign-born.

Led by PNHP, advocates of Improved Medicare for All must have a focused strategy geared toward physicians to solidify the support of doctors, with the goal of converting the AMA from a force in opposition to a force in support. With a focus on improving the quality of medical practice while compensating its providers adequately, along with improving Medicare and extending it to everyone, the goal for supporters of Improved Medicare for All should be to convince doctors to become a force for its enactment.

Physicians have been perhaps the hardest opponent to overcome in the past, because of the extremely close relationship they have had historically with their patients, who rely on their doctors when their lives are literally on the line. When doctors give patients advice, those words carry enormous weight, even if the advice is about whether universal health insurance would lead to better or worse health care. If physicians tell their patients the proposed legislation will harm their practice and therefore their patients’ health care, that is influential.

While attaining the support of the AMA can likely be achieved with concerted effort particularly and primarily by physicians themselves and would be extremely valuable, that support is not essential. After all, Medicare was enacted despite the AMA’s strong opposition. Moreover, while doctors historically have been extremely influential with their patients about health policy, and they remain so, the need to change doctors because they are no longer in-network and the increasing reliance on teams of healthcare providers, including nurses, nurse practitioners, and physicians’ assistants, have increased the influence of nonphysician providers.

Nurses are another key group, and fortunately they have been leading the fight for Improved Medicare for All. Unlike the AMA, National Nurses United (NNU), the largest professional association of registered nurses, with 225,000 members nationwide, has been advocating for Improved Medicare for All for decades, with determination and effectiveness.

Following the lead of the AMA, the American Hospital Association (AHA), which represents nearly 5,000 hospitals, has opposed the last century of efforts to enact national health insurance. Improved Medicare for All, with its guaranteed payments to providers, its ability to incentivize healthcare providers to practice where the need is highest, and its ability to use tax dollars to subsidize the most at-risk hospitals, is a solution. Though the AHA does not yet support Improved Medicare for All, advocates may be able to persuade individual hospital administrators and, over time, the AHA itself to recognize the advantages of Improved Medicare........

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