Rethinking Healthcare: Can We Afford Not to Talk About Single Payer?
By Chuck Webb
I’ve spent decades advocating for a better healthcare system, beginning with my membership in Physicians for a National Health Program (PNHP) back in the late 1980s. Over the years, one lesson has become abundantly clear: we cannot fix what we refuse to talk about. And yet, the topic of a national single-payer healthcare system remains conspicuously absent from many of the conversations that matter most—especially within the senior living sector, where the consequences of our current system are felt so acutely.
Many of us remember when General Motors declared that it spent more on healthcare than on steel. That was over twenty years ago. Since then, the cost of care has only grown, while outcomes have not kept pace. We continue to witness massive taxpayer subsidies flow into private companies—estimates suggest that between
$88 billion and $144 billion annually is funneled into Medicare Advantage programs alone. This isn’t just a budgetary issue—it’s a structural one, with direct impacts on affordability, access, and equity.
A recent newsletter from
National Single Payer (NSP) reported on grassroots actions demanding a system that
places health over profits. What stood out to me was not just the breadth of participation—from rural advocacy groups to urban justice movements—but the absence of major faith organizations, large labor unions
(with a few exceptions), and senior advocacy groups. It made me wonder: why are we so often missing from this conversation?
Perhaps one reason is that many older Americans—including those of us in traditional Medicare or Medicare Advantage plans within large communities—feel relatively well served by the current system. By global standards, seniors in the U.S. actually fare better than their peers abroad: we live longer and tend to receive more coordinated care. But this silver lining masks a darker truth. It’s younger adults who suffer the most under our fragmented, profit-driven model. Americans between ages 19 and 49 are
2.5 times more likely to die than their counterparts in other industrialized countries. According to
The Atlantic, Americans under age 65 with serious illness are
twice as likely to die here as they would in countries with universal coverage.
This discrepancy is a moral and practical red flag. As traditional Medicare is gradually phased out—a process CMS has projected will conclude by 2030—today’s seniors may soon find themselves caught in the same downward spiral. The protections we enjoy now could erode, leaving us vulnerable to the same systemic failures that younger Americans already face.
Meanwhile, frustration is building. The U.S. spends
$13,432 per person on healthcare—nearly double what most comparable nations spend. Yet we have fewer physician visits, shorter hospital stays, and higher death rates in adults aged 25 to 44. A 2023 survey found that
45% of Americans worry about affording healthcare, and
28% delay or forgo care due to the cost. An estimated
41% carry medical debt, totaling over
$220 billion.
The outlook is sobering. The Congressional Budget Office projects that the Republican budget bill would slash
$500 billion from Medicare through automatic cuts under the Pay-As-You-Go Act.
Amid this, health policy experts like Dr. Stephen Kemble have outlined what a cost-effective system might look like. His recommendations, recently summarized in
CounterPunch, include:
- Public financing of essential services, with the government retaining risk.
- Focus on reducing administrative costs rather than restricting care.
- Prohibiting for-profit corporate ownership of medical practices and hospitals.
- Eliminating “value-based payment” schemes that introduce perverse incentives.
- Simplified fee-for-service models tied to professional time and training.
- Global budgets for hospitals and salaries for employed doctors.
- Government-regulated pharmaceutical pricing.
- Non-risk-based contracts for administrative and quality assurance functions.
If implemented, this approach could reduce per-capita healthcare spending by
30% to 40%, bringing U.S. costs in line with countries like Canada.
Those of us living in Continuing Care Retirement Communities (CCRCs) have an up-close view of how fragmented, inefficient, and financially burdensome our healthcare system can be. It is not uncommon to hear stories of care delayed, denied, or dictated by opaque insurer algorithms—rather than patient need or clinical judgment.
This is not a rallying cry—at least not yet. It’s an invitation. Can we begin to talk, seriously and respectfully, about what a nonprofit, publicly financed healthcare system might look like for our communities?
NaCCRA members may not all agree on the specifics. But surely we can agree on the need for an honest, inclusive dialogue. The old Peace Corps volunteer in me still believes that such conversations can lead us forward—toward justice, toward sustainability, and perhaps even toward healing.