Medicare for All and Its Rivals: New Offshoots of Old Health Policy Roots

American College of Physicians


As improved Medicare for All gains momentum, single-payer opponents will undermine our efforts by proposing watered-down reforms that preserve a role for private insurance, such as the public option.

But as we?ve recently written, this tactic has a long history among both Democrats and Republicans. All of today?s current proposals — from Medicare for All to the public option to ?repeal and replace? — have been circulating in various forms since the 1940s.

In an article published today in the Annals of Internal Medicine, “Medicare for All and its rivals: new offshoots of old health policy roots,” we reveal the historical foundations of today?s health care debate.

For example, the Medicare for All Act of 2019 (H.R. 1384), recently filed by Reps. Pramila Jayapal and Debbie Dingell, traces its roots back to the 1948 Wagner-Murray-Dingell national health insurance bill and the 1971 single-payer plan proposed by Sen. Ted Kennedy and Rep. Martha Griffiths. Today?s ?public option? plans that would offer individuals the option to buy-in to Medicare or Medicaid were first proposed by two Republicans, Sen. Jacob Javits and Rep. John Lindsay in the early 1960s. Even President Trump?s recent budget proposal — which seeks to shrink the government?s role in health care by cutting trillions in Medicare and Medicaid funding, further privatizing Medicare and the VA, stripping the basic protections of the ACA, and saddling patients with higher deductibles ? echoes policies favored by President Richard Nixon and others in 1971.

When Sen. Kennedy introduced a comprehensive single-payer bill in 1971, Republicans countered with a public option alternative that was friendlier to private insurers, and some conservative Democrats proposed settling for coverage with sky-high deductibles. Sound familiar? Sen. Kennedy held his ground, and complained that the alternative to his single-payer plan …calms down the flame, but it really doesn’t meet the need,? an observation that still holds true today.

We hope that PNHP members will find this article useful, and will share it with others. It’s important to press our political leaders not to repeat the mistakes of earlier generations that tinkered around the edges of the U.S. health system while ignoring its fundamental flaws.


Steffie Woolhandler, M.D., M.P.H.
David U. Himmelstein, M.D.
PNHP co-founders



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