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Medicare for All – A Conversation with National Nurses United · We Can Do Better

• Fran Quigley: Welcome to We Can Do Better, a podcast about ending poverty in our time. My name is Fran Quigley. I'm a law professor. I go with my students each week to eviction court. And there we represent some of the millions of people in this country who are facing the loss of their homes. They are also people who skip filling prescriptions. They are also people who are even going hungry, despite living in the richest nation in the world. We can do better. Now, it comes to healthcare, our US system's emphasis on profiteering has created a remarkable and tragic combination. Somehow we managed to pay historic level world-leading sums of money on healthcare, six trillion dollars a year, while enduring some of the world's worst coverage and health outcomes. And for our sake, or our experience, we see clients all the time who live in pain and whose health conditions worsen because they can't afford prescriptions, they can't afford care. Because of our broken system, they and tens of millions of others are suffering, and the evidence shows that some of them will die because of it. Our guest this week is Jasmine Ruddy of the National Nurses United. Jasmine is here to explain to us why our healthcare system is broken and why NNU, which is the largest union of registered nurses in United States history, supports a single-payer Medicare for All solution. And really importantly, Jasmine is also going to share with us. Why Medicare for All is politically achievable in the near future, a victory that would make US history and that would improve millions of American lives. So Jasmine, thank you for joining us on We Can Do Better. Jasmine Ruddy: Thanks so much for having me. Great to be here. Fran Quigley: Well, I I I'm gonna make an assumption that most of our listeners have heard of Medicare for All and most of our lets listeners have actually heard of something called singer single payer healthcare systems. But but if we could just put it in real concrete context, if we took a person here in the United States, whether it's one of our clients or one of our listeners who has healthcare needs, so whether they be just preventative care or if they have major treatment needs, need prescriptions to be filled, etc. How would the world look different for them under Medicare for all than it does under our current system? Jasmine Ruddy: Yeah, thank you. It's a a great question because I think putting this, you know, the crisis we face and the the the solution that Medicare for All could provide into those kind of visual terms is a great way to to understand how it could impact people. it's it you know, it's a great question. That if there was a person who had those kinds of healthcare needs, you know, and and that person were living instead under Medicare for all system in the United States. I mean, I can just think of an endless number of differences that they would face in their daily lives, right? First of all, that person would no longer have to pay copay, a deductible, a premium, an out-of-pocket cost for their the healthcare that they need. ever again, the idea of you know establishing a single-payer universal healthcare system is that it's free at the point of service. and so that means that that person is, you know, not putting off care due to costs, which we see every single day today in this country. That person is not choosing between, you know, that copay they need to make and the groceries that they need to get for their family this week. I think those are some of the most immediate impacts. and alongside of that, that person is no longer in fear of experiencing medical debt as a result of those. costs, right? you know, we talk about medical debt a lot in this country. And it's a concept that is completely foreign to folks who live in in other countries around the world that have single payer systems. It's, you know, it doesn't make sense to them that that people experience something that that we have a term for called medical debt. So that person would, you know, would never pay an out of pocket bill again in the for for the rest of their life. But it's not just those, you know, those costs. it's also other crucial things that patient would never have to deal with in network or out of network systems again. in a single payer system, there's only one network. It's every hospital, every doctor's office, every clinic in the country is part of one system. No longer navigating this kind of patchwork system of making sure that. You go to the right you know, doctor or see, go to the right hospital that your insurance company takes. and also, you know, not dealing with the other insane complexities that are again unique to this country and unique to the massive private for-profit health insurance industry that we have. things like prior authorizations, right? that person would not have to, you know, wait for an insurance company bureaucrat to decide that they can get the treatment that they need after they and their doctors and nurses have already decided that they need it. there would be no such thing. So I think it's ultimately about you know, removing those kind of bureaucratic hurdles, those costs that people have to face. And of course we know that, you know, through that means that that person will receive the care that they need more timely. and and and better therapeutic care, that person will maybe survive in a you know, as opposed Fran Quigley: Yeah. Jasmine Ruddy: to a system today where where they may not. So I think those are some of the Fran Quigley: Yeah. Jasmine Ruddy: the the core differences. Fran Quigley: No, I mean and and and and frankly, you know, how can anyone ever argue against that, right? Except for people do. And and I do think you described this an amazing system that none of us who've grown up in the United States have ever seen before. So I guess there's a couple of questions that people would have about whether this is even possible. First of all, you know, everyone getting entitled to healthcare assistance, point of service, not having to pay copies, etc. you know, how is that something that we could afford? How is that something that that is possible for, you know, the country to to actually pay for? Jasmine Ruddy: Yeah, yeah. Yeah, absolutely. It's a question that we get a lot. So it's important to be armed with the answer. And oftentimes I think a lot of what we start with is how can we how can we not afford it? Right. you mentioned in the beginning how we spend six trillion dollars per year for healthcare in the United States. So we pay twice as much per person than any other major country in the world right now for this broken healthcare system. so when folks, you know, first of all, it's important to get to the sort of like very nuts and bolts about how we do afford it, because we we absolutely do, but I think it's it's first helpful to put back on to folks who resist this kind of major reform, how we continue to afford what we have today, which cause the answer is that we that we don't, right? Our healthcare costs are are a a a growing crisis year after year. And if we don't get things under control, which we argue can only be done through a Medicare for All system. I mean how how can we how can we not afford to to to to change? but to to your question, I mean I think that there there's a couple of important things to to point out. So when we talk about Medicare for all saving this country, you know, trillions in savings, or you know hundreds of billions annually, trillions over over a period of 10 years is a what is a what a lot of studies have looked at. And these are studies across the, you know, across the political and ideological spectrum, time after time after time that have shown. In fact, there was a like a meta-analysis done a couple years back of all the various studies that concluded that like all of them show that that Medicare for all would save hundreds of billions potentially annually. And the reason it it would be able to do those things is a couple of key things. I mean, the first and foremost is that a Medicare for all system, which is you know a universal single single-payer healthcare system, essentially eliminates the for-profit insurance private insurance industry in this country as we know it today. removes it, removes, you know, that middleman in the system. Today you go to the doctor, you receive you know the care that you need, your the hospital that you go to or the clinic you go to navigates a like very complex system of billing, probably has an entire billing department dedicated to figuring out where your hospital bill goes. Does it go to Medicare? Does it go to Medicaid? Does it go to one of seven private insurers? do you not have insurance, right? there's an immense amount of administrative complexity that comes with the Just the kind of like spider web of complexity that we've created in the system today through having a network of variety of insurers. So with with a Medicare for all system, that administrative that that that kind of a huge administrative cost nearly completely goes away, right? Instead you have every hospital, every clinic, every doctor's office billing. The federal government as the single payer for our healthcare. That's that's how we get the term single payer. The government becomes a single payer. It doesn't become the owner or the employer of of of hospitals. they remain, you know, privately owned, but becomes the single payer of the bills. Fran Quigley: Right. Jasmine Ruddy: that's the the major way. You know, we could go into a number of other ways, but you know, a variety of other crucial things that Medicare for All does that other Healthcare reforms do not do are what help at lower costs, right? the introduction of global budgets for hospitals helps us to curtail costs. The ability for the federal government to become the only sole negotiator for the price of prescription drugs, for example, dramatically lowers the cost. Because if the federal government suddenly is the only payer. And says, hey, we're gonna pay you X amount of dollars for this Fran Quigley: But Jasmine Ruddy: prescription drug rather than hundreds. those pharma companies have no choice because the federal government's the only purchaser, the only payer. that's how we see huge differences in prescription Fran Quigley: Right. Jasmine Ruddy: drug prices in countries like Canada, for example. and a variety of other reasons we could go into. Also, just you know, the the you know. Longer term effects we would see through things like less expensive care in emergency departments. as more people are able to access preventative care for the first time through having a Medicare for all system that dramatically lowers costs. But it's really about the administrative bloat in our system today. That's what's unique, and that's what saves us money by switching to a Medicare for All system. so it saves us money overall. Now, you know, I think lastly, some folks may wonder, you know, still what that looks like. And and, you know, for for regular working class people like you and I, like what does that look like? How do we how do we pay for it? We can certainly go into that, but essentially the proposal here is you know, systems of progressive taxation instead of the out of pocket costs that we pay today. So instead of you and I paying Fran Quigley: But Jasmine Ruddy: a copay deductible premium today. Instead we shift that that to public taxation, a progressive system of taxation that involves, frankly, taxing the rich at their fair share, and and taxing, you know, the lowest income Americans the least. Fran Quigley: Yeah, that's great. That's great. And and we'll put in the show notes as as you reference, Jasmine, those those study after study after study. So not only can we afford it, but but our you really can't afford not to because it saves so much money in terms of efficiency. And and also you look at I think the last number I saw was in twenty twenty four that the seven biggest for profit health insurers made seventy-one point three billion dollars in profits. Those are that's seventy one point three billion dollars in savings right there, right? Jasmine Ruddy: That's right. Fran Quigley: so there's the money that that we that as you say we're paying so much more than other nations. And and as you say, the the proof that this is possible is the fact that we're the only ones who don't do this and we're well or at least don't do some form of this and that other nations have much better health coverage and outcomes at a much lower cost. So we'll we'll put some evidence and again I want to commend to folks and we'll put it definitely put a link into the National Nurses United Medicare for All page, which I Jasmine's had a big hand in, with lots and lots of responses and answers to folks who may have questions about how feasible this is and and why, of course, that it's needed. so we've talked from the perspective of of people like me, people like our clients who are patients who who are consumers, I don't like that term that much, but but consumers of a healthcare system. but you represent National Nurses United. So Why is Medicare for all something that's important to nurses and other healthcare providers? Jasmine Ruddy: Yeah, absolutely. Absolutely. well, yeah, like you said, I mean, I'm I'm really grateful to get to work every single day representing nurses in in our union. as you mentioned, National Nurses United is the largest nurses union in the country. And we've been on the forefront of the fight for single payer healthcare in this country for for decades. back in and some of the fights in California as as early as the the early nineties. And and it you know, there continues to be like one really there are several major reasons, but a core reason that that is like one of the top political priorities of our members. And it's because nurses are on the front lines and see every single day that they go to work how this broken system is operating, perhaps more than anybody else. I have heard our members tell stories of being in the room with patients. As they're the ones helping them through that conversation of like whether they should get this treatment they need or pay their rent this month. You know, acting like social workers alongside their work as nurses in many cases. I have heard our some of our leaders talk about patients on the operating operating room table, ready for the procedure that all of the healthcare providers in the room have deemed necessary, and they're waiting on the insurance company's. prior authorization to come back, putting this patient's life at risk, right? So nurses and and and doctors and other healthcare workers are navigating this broken system and and and how it's it's letting people fall through the cracks every single day. And there's a term that we use in our work called moral injury that I think is is is really core to this. That when nurse our our members, and we see this, you know, again with doctors and healthcare workers alike, are not able to fulfill the oath that they took to get into medicine, to take to get into taking care of patients. When they are unable to like fulfill that duty, it it takes a toll on you. And it it, you know, it causes something that we call moral injury, the sort of like ethical toll that it takes to be in a position of of not being able to provide your patients with the care that you can see plainly with your professional expertise that they so desperately need. because we have you know an insurance system that's that's getting in the way. and that takes that takes a toll, I think, year after year after year, with healthcare providers at the bedside. they, you know, get into this work because they want to use their judgment. To take care of patients and they ought to be able to do that. And there's no other proposal than a Medicare for all system that removes that kind of like prior authorization and the other kind of like bureaucratic hurdles. And and that that actually puts healthcare providers back in the decision making position that they should be able to be in. that's I think really the the core reason. I'll also just mention that you know. when we talk about Medicare for all, a huge part of the proposal that's part included in the legislation today in the House and the Senate versions, is another large priority of our members, which is the establishment of nurse-to-patient ratios through the legislation. the lack of nurse-to-patient ratios across this country is a a crisis. for our members, it's probably the number one issue that union and non-union nurses alike you know, talk about. as the the center of of the crisis in their hospital. we're lucky to have nurse to patient ratios established in the state of California, but California is still the only state in the country that has ratios set for the number of of patients that a nurse can take care of in in various settings. Those ratios are written into law federally because they're a large part of you know how we would ensure high quality patient care through a Medicare for all system. And I would say that that's another another really motivating factor for for nurses. Fran Quigley: Well, that's it it's so admirable. Like you say, I know it's important for nurses' own mental health, physical health, workplace safety and responsibility. But but it's also so admirable that nurses are are using their time, their energy, their cre credibility, their union dues to to try to improve the system for their patients, which of course those of us who know nurses are not surprised by because know folks get into that profession to to help and it's not surprising that they're doing that collectively the same way they do it individually. So please please thank the the folks all the NNU members for for for doing this. And and and as you say, lots and lots of work over over the years to educate the public about Medicare for All and to push it. And and that's been successful because polling shows And duh, we've listened to you describe it. People want Medicare for all. They want a single payer system. They wanna, they wanna change radically what our broken system looks like now. but as of 2026, we don't have Medicare for all. We still do have this broken system. So what's the what's the what's the path to change this? What you know, you mentioned House and Senate bills and legislation is proposed. You know, how how do we how do we get there? How do we, as the title of the podcast goes, you know, how do we do better? Jasmine Ruddy: Yeah, absolutely. I mean, just to underscore first what you said about the the public support, it just absolutely is worth repeating that, you know, there's there's new polling that Congresswoman Jayapul's PAC just put out last week that shows that Medicare for All has support among like 94% of Democrats, and still large majorities of independent voters and even a slim majority of Republican voters. voters. So like just and that's, you know, that's that's like levels of polling that we've seen repeated by a variety of pollsters over the last couple of years, only increasing, I will just say too. So that's just like, first of all, is like the you know, Congress, Democrats in Congress like not taking action on this now is like wildly out of step with their base. and it is frankly supported at this point across the political spectrum because It doesn't have to be a left versus right issue to understand that this healthcare system's not working, and that we could that we could do better. and people are, I think are hungry for bold reforms and are hungry for politicians willing to to step up for those bold reforms that actually deliver for working class people, regardless of party, regardless of of who they are. so the support is like clearly there. And you know, in in the House and the Senate bills that we have in Congress, we've been reintroducing these bills. So Congresswoman Pramilla Jayapal, along with Congresswoman Debbie Dingle are the two lead sponsors of the House version of Medicare for All. And Senator Bernie Sanders is the Senate co-sponsor or the Senate sponsor of the Senate version of the bill. We have together ourselves, like the National Medicare for All Coalition, which is a number of unions and national organizations that we're proud to help be leading along with those congressional offices. Together, we've been reintroducing these bills every session since 2019. and the support for them has like steadily grown. we have over Like over half of the Democrats in Congress right now in the House side are co-sponsors of the bill. And now we're at 17 co-sponsors, I believe it's 17, right? In the Senate, which is like record support. we had, you know, with that's a number of of of of new supporters. And we've seen, even over the last year, like nearly 10 new co-sponsors across the House and the Senate. So support is increasing all of the time for for these bills. and I should say, by the way, they're not just like, you know, resolutions that are like a couple pages long. These are like hundreds of pages long legislation that I would encourage folks to take a look at that are like ready to implement a Medicare for all system tomorrow, should they be enacted and passed by Congress. years and years of of hard policy work done to really envision what the multi-year transition would look like and you know, what the benefit system would look like and what the governance would look like, just like all of this thought that's that's been been put in and is ready to implement. so the the support is is growing among co-sponsors. but it's nearly not not nearly enough, right? Medicare for all is legislation that at best would only need to be supported by the Democratic caucus. And potentially may even need a small amount of bipartisan support. It depends on you know, how we if we want to get into the the filibuster and reconciliation Fran Quigley: Mm-hmm. Jasmine Ruddy: and all that. But let's just say at best requires at least the support of like the entire Democratic caucus. That means we're not nearly all the way there, right? We need to do Fran Quigley: Okay. Jasmine Ruddy: a major amount of work still to convince every single Democratic member. And of course, of course, here what what we're assuming is that the Democratic Party is like the party more likely to support Medicare for All than the Republican Party. So let's say we're assuming that we have to get, you know, the entire Democratic caucus behind this unanimously as the the push. Now the good news is that we see a really clear path for that. So should Democrats take back power and take back a trifecta in 2029, which I think is the the hope of many, right? That repa that Democrats will manage Fran Quigley: Right. Jasmine Ruddy: to win the White House and maintain control of the Senate and the House. If they should do that, they've made really clear that they see healthcare reform, that they see major healthcare reform as the top of their agenda. we've been in a lot of conversations this summer, a lot of processes in the Democratic caucus, as they are kind of searching for. What their healthcare reform kind of demands should be and where they should start at. And we're trying to be really active in those conversations and ensure that Medicare for All is the demand. We're about a generation removed from the passage of the Affordable Care Act. We still sit here today with millions of people that are uninsured and underinsured. So the good news is that Fran Quigley: Mm-hmm. Jasmine Ruddy: the Democratic Caucus seems to recognize that. Their base is asking for them to do something bold that takes on industry and that meaningfully addresses the crisis that we face. it's our job to make sure that they view Medicare for all as the only solution to that crisis, which it is. and so that's really the kind of path that we see ourselves on right now at the moment, is working over the next two and a half years to make sure that. Medicare for All is the demand. because we're we think that we're only gonna have like one bite at the apple on healthcare reform. We're not gonna come back two years later and do something else, right? and so what that means is a number of things in in that time period. It means, frankly, starting right now, this fall, with ensuring really strong outcomes in the 2026 midterms, demonstrating that candidates Fran Quigley: Mm-hmm. Jasmine Ruddy: Who are running in swing races on platforms like Medicare for All can win. it means taking advantage of next year if Democrats at least flip the House. it means reintroducing Medicare for All and using the Democrats' power in the House, at least, which we anticipate knock on wood, to call for hearings. Congresswoman Jaya Paul's publicly stated she wants to call for a full markup of the bill. we wanna gain more co-sponsors, you know, hold public events, do lots of rallies, making sure we're taking advantage of that time period next year to to to build to build and rally support will be crucial. And then of course goes without saying, but our work now to organize around the 2028 presidential primary is a key part of of this work. ensuring that as many candidates in that primary as possible support Medicare for all. That's how we make sure we start twenty twenty nine with hopefully a presidential candidate who supports or is open to in a Congress, Democratic Health Congress that that is ready to push for it. Fran Quigley: that's great. So that's again, as you say, we've got midterms. This is just I think I saw something the other day. We're like 40 days away from midterm elections right now, which will, you know, hopefully bring a Democratic majority to to to the House and to we lead those folks to be committed before and after they're elected to Medicare for All because there will be a a moment where it's gonna be real and they're gonna have an opportunity to make this historic change. So what we if the if as as listeners and folks who are not members of National Nurses United, but but believe that Medicare for All is the solution and we do need to have a single payer healthcare system, you know, what can we do as constituents, as voters, as as activists here in across the country to to make this a reality? Because it's exciting when you think about it. I mean, twenty twenty nine, January twenty twenty nine is is is what just a little over two years away and that could change the trajectory of this country for generations. as you say, it's this is historic opportunity. So the question is what can what can we do to to help? What can we do to to help make this happen? Jasmine Ruddy: Yeah, absolutely. Absolutely. Well, thank you. I think I would encourage everyone listening to, you know, to do what you can to to get involved. I think that this is gonna be the biggest fight of our lives. if we can if we can do this right. And I think that will require every one of us involved actively, no matter where we live in in pushing for this demand among our elected leaders. I've been reflecting a lot this summer. on the kind of original passage of Medicare in nineteen sixty-five. we celebrated the anniversary of the passage of Medicare this past July and there's just been a lot of conversation and reflection among the movement about sort of like what that what that fight took and and and what was kind of created. And it was it really does not go without saying that we We fought and and enacted Medicare originally in this country, which was like transformative for its time, even though there were many folks pushing for universal health care at that time and and and even two decades before then, post kind of World War II. But even the passage of Medicare was like was transformative, right? For for seniors when when past. And the only reason that it was accomplished is because we had a historic kind of coalescence of The labor movement, the civil rights movement at the time c really coming together and centering this as like a huge public demand. It took the AFL, CIO, making it its number one legislative priority to pass Medicare, and civil rights leaders championing it as a huge, a huge platform priority as well. and you know, when we think about that, I think it's important to just recognize that it will take. just as large, if not larger, of a huge coalition you know, this time as well. So that's really kind of first of all, one of the things that we remain really focused on. We are really grateful that we have a large and robust Medicare for all national coalition and a table of organizations, unions, and nonprofit organizations. We released an open letter earlier this summer. With 335 organizations signed on, openly calling on Congress to pass Medicare for All and nothing less. So we're continuing to to work on that. But that would be, I think, the first thing is make sure that any organization, any union, any any group that you're part of is is signed on, is endorsing Medicare for all, is is actively part of the campaign. and is and is talking about this as a public demand. but more than that, you know, I think everyday folks across this country can be part of this fight no matter where they live. You can visit our website, first of all. That's the easiest first step to take is to sign up, join our email list, sign up to get updates. Our email, I'm sorry, our website is Medicare for with the number four. All dot org, so Medicareforall.org with the number four. so you can sign up there to make sure you're in the loop and getting updates. And you there's tons of really, really crucial work to do no matter where you live. we talked about you know growing the number of co-sponsors, needing to reach a place where every member at least of the Democratic caucus, if not some Republicans, are supporting this legislation. That means checking to make sure that your member of Congress. Is a co-sponsor, your senators are co-sponsors, they may be, they may not be. so helping to get involved locally to push your members of Congress to become co-sponsors now is really crucial work. and you know, there's a variety of other activities as well. we also talk a lot in this campaign about the influence of the corporate healthcare industry on our democracy, and and frankly, a large part of the reason why we haven't already. Past Medicare for All is the influence of the insurance, pharma, and hospital industries on Congress. we're also always running a campaign we call our patients over profits pledge. Folks anywhere in the country can take that pledge and/or can you know can bring that pledge to anyone from your city council member to your state representative to your members of Congress and ask them to take the pledge to reject. contributions from the corporate healthcare industry. So those are, I think, just some of the ways. There's a variety of more activities that we could get into, but those are just some of them. Fran Quigley: No, that's great, Jasmine. This and and as you mentioned, I the the fact that we would do need to check and see whether our members of Congress or representatives are sponsoring Medicare for all, because I can tell you that almost everybody from both from both parties is saying, we want to fix healthcare. We want to improve healthcare. You see that from folks who are who are are are very, very to the right elected officials because they know that's what people want. But what we have the ability to do is say, yeah, you want to fix healthcare. The way to do it is with Medicare for All. Are you sponsoring that? Are you are you in support of that? And I must say, I'm I'm talking to you from a red state of Indiana. So it's not exactly a a bastion of progressive thought, but we have multiple Medicare for all chapters in our state. And I'm sure that's true then across the country. So if folks are interested, there's almost certainly in your geographical area a Medicare for All chapter that's pushing. for this that's working alongside Jasmine and others at National Nurses United and and all the other, as you say, hundreds of organizations that are pushing for this. And we really do have an opportunity, opportunity coming up to to make a historic change and to frankly save lives and improve lives that will probably include us and our loved ones. So Jasmine, I want to thank you for coming on We Can Do Better. I want to thank you and your colleagues for for all your important work and When we talk about we can do better, improving our healthcare system and making this historic change you're working for is it's got to be right at the top of that list. So so thank you for all you do and and hopefully we can help you push this across the finish line. Jasmine Ruddy: Awesome. Thank you so much. Fran Quigley: Thank you. And thank you all to the listeners. And remember, especially when it comes to healthcare, we can do better.