Party memo to Jeffries notes ‘diversity of views’ on universal coverage

The Guardian reported that 1,500 unionized nurses gathered at the Marriott Marquis in San Francisco last week to cheer for Medicare for All, a cause they have championed for years. Michigan Democratic Senate nominee Abdul El-Sayed took the lectern and asked, “Medicare for who?” The crowd answered, “ALL!”

El-Sayed went on to describe why he wrote a book about Medicare for All: to answer questions about “the very simple idea that in the richest, most powerful country in the world you should not have to suffer for your healthcare.”

The rally highlighted a continuing internal tension in the Democratic Party. As progressive candidates like El-Sayed prevail in primaries and Democratic leaders stress unity ahead of November’s midterm challenge to Republicans, Medicare for All remains a pressure point — embraced by the party’s left and viewed as a political liability by centrist groups.

“There’s too many unnecessary illnesses and unnecessary costs,” said Michelle Gutierrez Vo, president of the California Nurses Association, the National Nurses Organizing Committee, and vice-president of National Nurses United — unions that represent nurses at the San Francisco conference. “What are we doing?”

These unions have advocated for Medicare for All for years and watched interest swell as candidates like El-Sayed picked up steam. By contrast, centrist Democratic groups such as Third Way consider the policy an unattainable albatross.

“Medicare for All has a lot of political and substantive issues,” said Gabe Horwitz, senior vice-president for the economic program at Third Way.

The party is unanimous in opposing the $1 trillion in healthcare cuts made by President Donald Trump’s One Big Beautiful Bill Act, which Democrats have taken to calling the “big, ugly bill.” That legislation is expected to result in an additional 16 million people becoming uninsured by 2034, according to analyses cited by The Guardian.

“We want to get everyone insured, we want to lower costs and want to make care easier to use,” Horwitz said. “I don’t know if there’s one Democrat in the party who wouldn’t agree with that. There is unanimity in the goals — the ends — there’s just not necessarily unanimity in the means to get there.”

The divide was most recently evident in an 84-page memo sent to House Minority Leader Hakeem Jeffries from the party’s cost-of-living healthcare working group.

“Members of the Democratic Caucus hold a diversity of views on how to achieve universal coverage,” the memo read, “including Medicare for All” and a wide range of other, more incremental policies.

Centrist Democrats have sought to address what to do about rising healthcare costs and insurance company practices by proposing incremental reform — a strategy that builds off the Affordable Care Act passed by the Obama administration. Their proposals include a healthcare bill of rights, more government subsidies to health insurance companies to offset costs to consumers, and some version of a “public option,” a government-sponsored health insurance plan that people could buy into.

For years, the party’s left has offered a proposition at once seen as radical by US standards and typical by many of the world’s industrialized democracies: a single-payer health system sponsored by the government.

“All Democrats from 1948 on have been in favor of universal healthcare — that’s been in every Democratic platform since literally Harry Truman,” said Elaine Kamarck, a senior fellow at the Brookings Institution, whose recent analysis of primary victories across the political spectrum found mainstream candidates continue to win. “That’s not the issue — the issue is how do you do it.”

Kamarck added that the issue is one likely to simmer long past the primaries. US health reform is, in her view, a virtual nonstarter while Republicans hold the Oval Office. But if Democrats won a “trifecta” in 2028, “then this is going to be a really big issue.”

The US health system is a patchwork of different insurers, or “payers,” all of which are subsidized by US taxpayers. Four large programs dominate: employer-sponsored health insurance covers almost half of Americans (48% of the population), Medicare covers people older than 65 (14.8%), Medicaid covers low-income and disabled people (20.4%), and Obamacare allows people to buy private insurance as individuals (6.6%), according to the Kaiser Family Foundation.

About 27 million people (8.2%) lack insurance entirely. Roughly one in four Americans are “underinsured,” meaning they have high health costs relative to their income.

Across these programs, the US government plans to spend $33.6 trillion through 2034 — equal to 7.4% of gross domestic product, including subsidies for employer-sponsored insurance. The United Kingdom, by comparison, spends about 11.9% of GDP to insure everyone in the country, according to the Commonwealth Fund. Total US health spending is 18% of GDP, far more than comparable countries.

Although the slogan “Medicare for All” has a somewhat loose definition, a bill repeatedly introduced in Congress provides for a Medicare-style single-payer system with universal health coverage. Private insurers would be barred from duplicating services. Because healthcare as an industry represents 18% of US GDP, and a transition would inevitably disrupt thousands of jobs, the bill also provides for temporary worker compensation.

For advocates like Gutierrez Vo, anything less is “a patch-up — it’s not a fix.”

“Just like nurses take care of the whole patient — that’s like taking care of a leg and letting the rest be ill,” she said. “That’s silly.”