El-Sayed’s Medicare for All plan is sold as coverage with no premiums, copays, or deductibles. What it does is put the federal government in charge of the coverage and the payments.
The government would be both the insurer and the payer. It would provide the coverage and pay doctors, hospitals, and other providers for covered care with public funds. The plan does not begin by seizing hospitals or putting doctors on the federal payroll. The Sanders bill El-Sayed has said he would support replaces duplicative private insurance with that government role and has Washington pay the providers.
His campaign site calls this guaranteed government coverage. The bills go further. They would have Washington set and annually update a national fee schedule for covered services and pay hospitals through global budgets. In practice, the government decides what providers get paid.
Once the government covers everyone and pays the bills, private insurance for the same care becomes unnecessary. In the Sanders-style bills he has backed, duplicative private coverage is generally barred. Supplemental plans can cover only what the public program does not. Hospital care, doctor visits, dental, vision, and drugs would sit with one civilian insurer and one civilian payer.
El-Sayed has told union audiences that employer or union plans “can still be there.” The legislation he has said he would co-sponsor would make those plans redundant for the care the public program already covers. Providers who want to stay in business take the federal price. Patients who want care use the federal card. That is not a competing insurance market. It is take the government rate, limit what you offer, or leave.
Defenders say this only changes who pays, because hospitals stay private and doctors do not become federal employees. Ownership is not the point. If the government provides the coverage, pays with public funds, sets the rates, and makes competing coverage for the same care illegal, it controls the terms. The building can stay in private hands. The money still comes from Washington.Ending premiums, copays, and deductibles does not end the cost of care. It moves the bill onto taxpayers.
El-Sayed has described that swap himself: instead of paying a premium to an insurer, people would pay more in taxes. The care is not free.
That price list would be written by a Congress that has never had to run an insurance plan, balance a hospital budget, or make payroll when the money was not there. Congress has not enacted all of its regular spending bills on time since 1996. This year it pushed about $1.8 trillion in discretionary funding past Election Day with a stopgap through December 11. Fiscal 2026 opened with a 42-day government-wide shutdown, the longest on record, then more funding gaps. Washington spends about $7 trillion a year, takes in far less, and is adding about $2 trillion to the deficit. Gross federal debt is already over $40 trillion.
That same government already runs Medicare. The Part A hospital trust fund is projected to exhaust its reserves in 2033. When it does, incoming money would cover only about 89% of those hospital bills unless Congress changes the law. Medicare already spends more than $1 trillion a year. Now they want that office writing the prices for the whole country.
No to mention, Democrats opem the border every time they take power with promises of free healthcare for all. Taxpayers would pay for care for people who entered the country illegally. Americans would literally have to wait in line behind people in the USA illegally. People who should not be here. Tens of millions of them with many more millions on the way as long as Democrats are in charge.
I cannot believe anyone would vote to give the government even more control the healthcare system. Their interference in the healthcare system today, is where most if its problems come from.
Whoever writes the checks and sets the prices controls the terms. Under Medicare for All, that is the government. If that is the system you want, vote Democratic.