Healthcare — The Common Good Party Policy Document

Section 01

Executive Summary

The United States spends more on healthcare than any nation on Earth — approximately 17% of GDP, nearly twice the average of peer countries — while ranking dead last among eleven high-income nations on health outcomes, equity, and administrative efficiency.

The Common Good Party position is clear: healthcare is infrastructure, not a product. The policy is Medicare for All — a single-payer financing system with private delivery of care, phased in over five to eight years. Every American covered from birth. No premiums. Co-pays scaled to income. A national fee schedule. Federal negotiation of all drug prices. Full dental, vision, mental health, and long-term care coverage.

Americans spend over $1,000 per person annually on healthcare administration alone — five times the average of comparable countries — funding billing departments, prior authorization battles, and insurance denial processing rather than actual medical care.

This is not radical. Every developed nation on Earth provides universal healthcare coverage. The question is not whether it can be done — it is whether the United States has the political will to join the rest of the world.

Section 02

The Problem

The U.S. ranks last among eleven high-income countries in the Commonwealth Fund's 2024 Mirror Mirror assessment on every major metric: health outcomes, equity, access, administrative efficiency, and care process. The core failures are structural.

Administrative Waste

The U.S. spends over $1,000 per person on healthcare administration — five times peer nations. Private insurers spend 12% on overhead. Taiwan's single-payer system operates at approximately 1% administrative overhead.

Price Inflation

Americans pay dramatically more per encounter. An MRI costs $450 in France and $1,500 in the U.S. An appendectomy costs $3,000 in Germany and $15,000 in the U.S. Prices are unregulated and set by monopolistic hospital systems.

Insurance Barriers

Prior authorization requirements, narrow networks, surprise billing, and coverage denials create a system where access to insurance does not guarantee access to care. An estimated 100 million Americans carry medical debt.

Employer Dependency

The link between employment and health insurance — a relic of post-WWII wage controls — traps workers in jobs they would otherwise leave, suppresses entrepreneurship, and creates coverage gaps during unemployment.

Drug Pricing

The same drugs cost 2–10× more in the U.S. than in peer nations. Patent evergreening and pay-for-delay agreements extend monopoly pricing indefinitely. The federal government was until recently prohibited from negotiating prices.

The result: the wealthiest country in human history has a healthcare system that bankrupts its citizens, shortens their lives, and costs more than every alternative. Japan achieves comparable or better outcomes at $4,150 per capita. The status quo is indefensible.

Section 03

How We Got Here

The American healthcare system was not designed. It accumulated through a series of political compromises, wartime accidents, and industry lobbying that produced a chaotic hybrid unlike any system in the developed world.

1940s

The Employer Accident

During WWII, wage freezes led the IRS to rule that employer-provided health insurance was not taxable income. This wartime workaround became the foundation of American healthcare — an accident of history that no economist would design from scratch.

1965

Medicare & Medicaid

President Johnson signed Medicare (for seniors) and Medicaid (for the poor) into law. These programs acknowledged that the private market could not serve the most vulnerable — but left the working-age population dependent on employer coverage.

1970s–1990s

The HMO Era

Managed care promised to control costs through gatekeeping and network restrictions. It succeeded temporarily but generated widespread public backlash against coverage denials. Costs resumed their upward trajectory.

2010

The Affordable Care Act

The ACA expanded coverage to approximately 20 million previously uninsured Americans through Medicaid expansion and marketplace subsidies. But it preserved the multi-payer structure and the insurance industry's central role — leaving fundamental cost and complexity problems intact.

2020s

The Breaking Point

Employer-sponsored family health insurance now exceeds $25,000 per year. Medical debt affects 100 million Americans. Rural hospitals are closing. Insurance company profits reach record highs while coverage denials increase. The system is approaching structural failure.

Section 04

What Other Countries Do

Every developed nation provides universal healthcare coverage. The United States is the sole exception. Four basic models exist, and the most successful systems share common features the U.S. lacks.

Country	Model	Cost (% GDP)	Key Feature
Taiwan	Single-payer (NHI)	6%	1% admin overhead · universal digital records · no wait times
Japan	Multi-payer, national fee schedule	~8%	$4,150/capita vs. U.S. $14,885 — comparable outcomes
Germany	Bismarck (nonprofit sickness funds)	~11%	140+ years universal · free choice of doctor · no wait times
UK (NHS)	Beveridge (government-owned)	~10%	No bills ever · cheapest universal system in the developed world
Netherlands	Regulated private	~10%	Ranked #2 globally · must-accept, nonprofit model
Canada	Single-payer (provincial)	~12%	Universal · wait times caused by underfunding, not structure
United States	Chaotic hybrid	~17%	Last among peers on outcomes, equity, and efficiency

On wait times: Canada and the UK have wait time problems. Taiwan, Japan, Germany, and the Netherlands do not — all universal systems. Wait times are caused by underfunding and provider shortages, not by the structure of universal coverage. This is the strongest argument against single-payer, and it is empirically refuted by multiple functioning systems.

Section 05

Our Policy — Seven Pillars

The Common Good Party's healthcare policy is built on seven pillars, each grounded in international evidence and designed to address a specific structural failure of the current system.

P1

Medicare for All — You Keep Your Doctor

You keep your doctor. You keep your hospital. You keep your provider. The only thing that changes is who pays the bill — the government, the way Medicare already does for seniors. Private hospitals, clinics, and physicians deliver care exactly as they do today. Every American covered from birth. No premiums. Co-pays scaled to income. No doctor loses their practice. No patient loses their provider. Employer-based insurance phased out entirely, freeing labor mobility.

P2

National Fee Schedule

A federally mandated fee schedule for every medical procedure, set by an independent health pricing board. No hospital, doctor, or facility may charge above the schedule. Prices benchmarked to the median cost in peer nations — proven by Japan at less than one-third the U.S. per-capita cost.

P3

Federal Drug Price Negotiation

Expand Medicare drug negotiation to all high-cost drugs. International reference pricing: no drug may be priced above 120% of the six-nation peer average (Canada, UK, France, Germany, Japan, Australia). Limit patent evergreening. Expand the $35 insulin cap to all Americans and all essential medications.

P4

Comprehensive Coverage

The universal package includes full dental, vision, mental health, and long-term care coverage. Mental health parity is structural — covered identically to physical health in every respect. Long-term care is integrated rather than forcing families into Medicaid spend-down poverty.

P5

Provider Supply & Wait Time Prevention

Explicit provider supply targets written into the statute. Federal funding for medical school expansion. Loan forgiveness for primary care physicians in underserved areas. Community health center expansion in rural areas. Wait times are a funding and supply problem — the statute prevents them by design.

P6

Universal Digital Health Infrastructure

A universal digital health record system, interoperable across all providers, modeled on Taiwan's universal health ID. Any doctor can access any patient's full medical history instantly. No more faxed records. No more redundant imaging. Strong privacy protections enforced by law.

P7

Antitrust Enforcement

Aggressive antitrust enforcement against hospital mergers, insurance consolidation, and pharmacy benefit manager (PBM) vertical integration. PBM reform: de-link compensation from list prices, mandate rebate transparency, require divestiture of vertically integrated pharmacy-insurer-PBM conglomerates.

P8

Medical Liability Reform — National Liability Trust Fund

The medical malpractice system is broken for everyone. Doctors pay crushing liability insurance premiums — $50,000 to $300,000+ per year depending on specialty — that drive up healthcare costs, push physicians out of high-risk specialties, and incentivize defensive medicine adding an estimated $55–200 billion per year in unnecessary procedures.

The CGP plan replaces this with a National Medical Liability Trust Fund:

Mandatory physician contribution — every licensed physician pays into the Trust Fund based on specialty risk tier, replacing private malpractice insurance. Premiums drop 60–80% because the fund operates at cost — no insurer profit, no marketing overhead.
No-fault patient compensation — patients who suffer avoidable medical harm receive compensation through an administrative process. Faster, fairer, and without expensive litigation. Modeled on New Zealand’s Accident Compensation Corporation.
Accountability with proportionality — physicians found negligent face escalating consequences: mandatory retraining, supervised practice, practice restrictions, or license revocation for serious/repeated failures. Criminal negligence remains prosecutable.
Defensive medicine ends — when liability is handled through a trust fund, the incentive to order unnecessary tests purely for lawsuit protection disappears. This alone saves tens of billions annually.
Specialty protection — the current system drives doctors away from obstetrics, emergency medicine, and surgery because of insurance costs. The Trust Fund’s risk-pooled model makes every specialty financially viable.

Section 06

How We Pay For It

The most common objection to universal healthcare is cost. The answer is straightforward: the United States already spends more than enough to fund universal coverage. The problem is not insufficient spending — it is wasteful spending.

Administrative Savings $400–600B/year

Eliminating the multi-payer insurance bureaucracy. Taiwan demonstrated that covering the uninsured costs less than the administrative savings from switching to single-payer.

Employer Contribution Redirect $16,000+/employee

Employers redirect current premium spending to a payroll-based health tax. Most employers pay less, not more, under the new structure.

Progressive Health Tax Scaled to income

A graduated payroll tax replacing current premiums. Low- and middle-income households pay less than they currently spend on premiums, deductibles, and out-of-pocket costs combined.

Drug Price Negotiation Tens of billions

Bringing U.S. drug prices to 120% of international averages eliminates the pharmaceutical premium Americans pay to subsidize corporate profits.

National Fee Schedule Price normalization

Benchmarked to peer-nation costs, eliminating price gouging by monopolistic hospital systems that currently charge 5–10× what the same procedure costs abroad.

Multiple independent analyses — including from the Congressional Budget Office, the Political Economy Research Institute, and Yale epidemiologists — have concluded that total national health expenditure decreases under single-payer. The United States does not need to spend more on healthcare. It needs to spend what it already spends more efficiently.

Section 07

Implementation Timeline

The transition to universal coverage is phased over five to eight years to ensure stability, build capacity, and allow adjustment. No one loses coverage during transition.

Phase 1 Years 1–2

Lower Medicare eligibility to 55
Expand drug negotiation to top 100 drugs
Begin digital health record infrastructure
Establish federal pricing board
Medical school expansion funding

Phase 2 Years 2–4

Lower Medicare eligibility to 45
Implement national fee schedule for hospitals
Expand drug negotiation to all high-cost drugs
PBM reform enacted
Community health center expansion

Phase 3 Years 4–6

Universal enrollment — all Americans covered
Employer-based insurance transition complete
Universal digital health records operational
Full dental, vision, mental health coverage active

Phase 4 Years 6–8

System optimization and benchmarking
Long-term care integration complete
Provider supply targets met nationwide
Full antitrust enforcement program active

Section 08

Addressing Counterarguments

The strongest objections to universal healthcare deserve honest engagement. Each is addressed below with evidence.

"Single-payer means long wait times."

Canada and the UK have wait time problems. Taiwan, Japan, Germany, and the Netherlands do not — all universal systems. Wait times are caused by underfunding and provider shortages, not by the structure of universal coverage. Our policy includes explicit provider supply targets specifically to prevent this failure mode. Taiwan implemented single-payer with zero increase in wait times.

"We can't afford it."

The United States already spends $4.5 trillion annually on healthcare — more than any country on Earth. Multiple independent analyses confirm that total national health expenditure decreases under single-payer because administrative savings and price controls more than offset the cost of covering the uninsured. The question is not whether we can afford universal healthcare — it is whether we can afford the current system.

"Government-run healthcare means worse quality."

The government would not run healthcare delivery. Doctors and hospitals remain private. The government's role is as payer — the same role it already plays for 65 million Medicare beneficiaries and 85 million Medicaid recipients. Medicare has higher patient satisfaction ratings than private insurance.

"It will destroy pharmaceutical innovation."

NIH-funded public research accounts for the foundational science behind most breakthrough drugs. The private sector excels at development and commercialization, and will continue to do so — every country with price controls still has a functioning pharmaceutical industry. The argument that Americans must overpay to fund innovation is a subsidy paid by patients to corporate shareholders.

"People will lose their employer-provided insurance."

Yes — and gain something better. Employer-based insurance ties coverage to employment, creates job lock, disappears during unemployment, and varies wildly in quality. Replacing it with universal, portable, comprehensive coverage that follows the individual regardless of employment status is an upgrade, not a loss.

Section 09

Cross-References

Healthcare policy intersects with multiple other platform positions. The following cross-references identify dependencies and complementary policies.

#2	Taxation	Progressive tax structure funds the transition. Employer health tax replaces current premium spending.
#13	Labor & Minimum Wage	Eliminating employer-based insurance frees labor mobility. Workers can change jobs, start businesses, or take time off without losing coverage.
#15	Social Safety Net	Medicaid is integrated into the universal system. The separate, stigmatized program is replaced with equal coverage for all.
#20	Corporate Power & Antitrust	PBM reform, hospital antitrust enforcement, and insurance industry regulation are core components of both healthcare and corporate power policy.
#26	Food & Agriculture	Nutrition and preventive health are inseparable. Agricultural policy directly affects long-term healthcare costs.

"The United States spends more than any country on Earth on healthcare and gets worse results than all of them. Every country that outperforms us has made the same basic choice: healthcare is a right, not a product. The debate is over. The evidence is in. The only question is whether we have the political will to join the rest of the developed world."

— The Common Good Party