Health care costs blow big holes in Upper Valley school budgets and taxpayers’ wallets; federal subsidies for Affordable Care Act premiums lapse, making them unaffordable for millions; some rural hospitals and clinics shutter vital services because they are in such dire financial straits; federal cuts to Medicaid threaten to leave thousands in the Twin States without coverage; consultants warn that Vermont’s health care system is at risk of collapse; patients face months-long waits for elective surgery; a severe and continuing shortage of primary care physicians leaves many Upper Valley residents without access to basic care.
Valley News readers will be familiar, perhaps painfully so, with many such stories that have made headlines in recent months. They speak to a health care system that is broken, and perhaps going broke. What is surprising is the near disappearance from public discourse of an idea that gained traction not so long ago: universal health care coverage
Let’s stipulate at the outset that the current political climate is hostile to government-provided health care in general, as demonstrated by the recent cuts to the ACA and Medicaid, under which an estimated 15 million people could lose coverage. A comprehensive system that guarantees coverage and access to everyone on an equal basis is a non-starter at the moment.
But we do think that as many millions of people across the country experience a health care system that is increasingly expensive, inaccessible and unaccountable, the logic of universal health care may come to seem like common sense, not a communist plot.
U.S. Sen. Bernie Sanders of Vermont, of course, remains the foremost advocate for universal health care, in the form of his Medicare for All legislation, which he reintroduced in Congress last spring.
He is also a source for assessing the state of the current health care system, which he notes is the most expensive in the world and which numerous studies show to be one of the worst among wealthy nations, producing life expectancy that is four years lower than in comparable countries.
In a Boston Globe commentary last fall, Sanders wrote, “In America today, despite per-person spending of over $14,500 on health care annually, more than 85 million are uninsured or underinsured. The nation faces a massive shortage of doctors, nurses, dentists, and mental health professionals. Tens of millions of Americans cannot see a primary care doctor when they need one — even those who have good insurance. The country has an aging population, but nursing homes throughout the country are under-staffed and many are shutting down. The home health care situation is a disaster.”
For all that, the American health care system is also capable of providing extraordinary and compassionate care. The point of universal coverage is to make that high quality care available to all segments of society, no matter what their economic station in life. That approach is encapsulated in the phrase, “health care is a human right, not a privilege.”
It’s also a fact that there’s no guarantee that those who enjoy good health care now will continue to do so if the system becomes increasingly dysfunctional.
Medicare for All is an appealing point of departure for universal coverage, because the existing Medicare program, like Social Security, is pretty efficient and highly regarded by recipients. A solid foundation exists for expansion, even if it is done gradually over time.
Expensive, yes. But the nonpartisan Congressional Budget Office estimates that in some iterations, Medicare for All would save Americans $650 billion a year. How? By, in Sanders words, eliminating an enormous amount of bureaucracy, profiteering and administrative costs and reorienting the current system’s misplaced priorities. From this it can easily be inferred that big insurers and drug companies that now enjoy unconscionable profits will not be enlisting with Sanders in this fight, nor will Republican members of Congress.
But as the 2026 midterm congressional election campaigns unfold, smaller and more attainable goals are in play. We think that there is broad support for reinstating the Affordable Care Act subsidies, the elimination of which doubled premiums for 20 million Americans.
The cuts made to the Medicaid program as part of the Trump administration’s massive tax break legislation for the wealthy ought to be a high priority for repeal. Medicaid is not only a lifeline for struggling working families but also for health systems that rely on the flow of reimbursements to help provide care for all patients.
The American economy generates fabulous wealth for the few. If you doubt it, take a ride around the hills of the Upper Valley and note the mansions and estates that sit unoccupied except for a few weeks a year when their out-of-state owners choose to visit, perhaps in connection with lavishing millions of dollars in donations on the elite institutions from which they and their children have graduated.
The wealth is there to create universal health care coverage if the American people can generate the political will to do so.