Medicare for All — A Moral Imperative

by Margaret Villani

The term, universal healthcare coverage, means all residents in a country have access to quality healthcare free from the burden of debt. The United States falls short of that goal. Our National Healthcare Expenditure (2020) was $4.1 trillion, $12,530 per person. We do not cover everyone. 9.8 % remain uninsured.  Our peer countries provide at least 95% of their population, at an average cost of about $4000, without anyone going bankrupt over medical bills.

Debt And Harm 

Despite paying thousands of dollars in health insurance premiums, Americans remain vulnerable to medically related debt which can negatively affect people’s physical, mental and financial health .

Recently the Kaiser Family Foundation (KFF) conducted a poll to learn the impacts of debt on a personal level. The KFF survey found that 41% of adult respondents reported medical debt. At the time they incurred debt, 32% were insured. To cope with their debt, 63% cut back on necessities, 48% depleted much or all their savings, 41% charged more non-medical expenses to their credit card and 15% reported being denied care due to their indebtedness. Medical debt affects people’s ability to get credit or find housing. The most common debt falling into collections is medical debt.

Deductibles, copays, and coinsurance (known as cost sharing) are out-of-pocket costs that discourage people from seeking care. KFF polling indicates that half of Americans postponed care and that 10.6% of North Carolinians did not see a doctor in the past twelve months due to cost. Delaying care can be dangerous and costly. NPR recently noted an uptick in the number of late-stage cervical cancer diagnoses. Late-stage cervical cancer’s five-year survival rate is only 17%. Annual routine tests can catch precancerous growth that when surgically removed prevent cancer.  Rationing insulin leaves diabetics vulnerable to serious avoidable medical conditions (e.g., heart and kidney diseases.) 

Uninsured people have even harder time accessing care and have quite different health outcomes than insured people and are more likely to die prematurely. For example, uninsured breast cancer and colon cancer patients are 50% more likely to die than insured patients.  The percent of uninsured people, under the age of 65 is 12.4% in North Carolina, 12.2% in Chatham County and 28.9% in Siler City. 


Strategies for reining in our ever-growing NHE and improving healthcare include:

• streamlining the administration process. 

• negotiating fair prices with providers of health services, equipment, and drugs.

• avoiding preventable complications that arise from treatment delays due to cost. 

• increasing the availability of community-based care such as home health care. 

• encouraging people to receive preventive services. 

Medicare for All legislation is the only proposed policy that accomplishes all these strategies.

National in scope, Medicare for all covers all residents in one national insurance pool spreading the financial risk of healthcare as thin as possible. 

One plan. with one set of procedures. and one set of prices is much simpler and cheaper to administer than a myriad of plans. In 2017, administrative expense comprised about 34.2% of our national spending while Canada’s was only 17%.

Medicare for all would have one nationwide provider network. People would have a greater choice of providers and could see a provider anywhere in the country without out encountering out-of-network charges. 

Medicare for All would make the government the sole payer of healthcare bills giving it the leverage needed to negotiate fair and transparent healthcare care prices.

Medicare for all would provide comprehensive care, including community-based care, free at the point of service. There would be no cost sharing to deter people from seeking preventive or necessary care. Preventive care, acute care and consistent management of chronic conditions reduces avoidable complications, disability, and expense. 

You can help move the legislation forward by asking your town and county to pass resolutions in favor of Medicare for All. Resolutions passed by local governments have moved legislatures to support Medicare for All. For more details visit:

Margaret Villani is a resident of Greensboro who is active on health care issues and women’s access to needed care.